The role of immunohistochemical and molecular genetic markers in organ-sparing treatment of early-stage cancer and atypical endometrial hyperplasia
Dvoynishnikova A.O., Alekhin A.A., Shebzukhova Z.R., Pronin S.M., Ovodenko D.L., Ashrafyan L.A.
Endometrial cancer ranks second in terms of gynecological cancer incidence in Russia and worldwide. The steady upward trend in morbidity is associated with both increased life expectancy and rising prevalence of obesity, metabolic syndrome and endocrine disorders. Most cases of the disease are diagnosed in postmenopausal women; however, from 7 to 10% of patients are reproductive-aged and still wish to have children. Atypical endometrial hyperplasia (AEH) is regarded as a precancerous condition with a high risk of progression to endometrial cancer. According to international guidelines, organ-sparing treatment is acceptable in a strictly selected group of patients. However, despite the strict selection criteria, organ-sparing hormonal treatment is not always effective. One of the reasons for the non-effective treatment is the limitations in the morphological diagnosis of AEH and endometrial cancer. In 2023, as part of The Cancer Genome Atlas project, a molecular classification of endometrial cancer was created with the identification of four main biological subtypes of the tumor: POLE-mutated, MMR-deficient, NSMP and p53-aberrant. The NSMP subtype, particularly where hormone receptor expression is preserved, is considered the most favorable in the context of organ-sparing treatment. MMR-deficient tumors are associated with a less predictable response to hormone therapy and require a more cautious approach, whilst the p53-aberrant subtype is considered the most unfavorable for conservative treatment strategies. The POLEmut subtype, despite its extremely favorable prognosis with standard treatment, remains a subject of debate in the context of deferring surgical intervention.
Articles examining the efficacy and clinical significance of the molecular genetic and immunohistochemical status of endometrial cancer and AEH were selected for inclusion in this review using the MEDLINE, Goo UpToDate, Web of Science and Scopus databases.
Conclusion. The current paradigm for the diagnosis and treatment of AEH and early-stage endometrial cancer undergoes a significant transformation, moving away from a predominantly morphologically-based model towards a multi-level, biologically integrated risk stratification system. However, molecular genetic and immunohistochemical markers are an important addition to histological examination, improving the accuracy of risk stratification and personalized treatment, but they do not and cannot replace morphological diagnosis.
Authors’ contributions. Dvoynishnikova A.O., Alekhin A.A. – selecting and processing of articles, design, writing the text; Shebzukhova Z.R., Pronin S.M., Ovodenko D.L., Ashrafyan L.A. – editing the article.
Conflicts of interest. Authors declare lack of the possible conflicts of interests.
Funding. The work was carried out without financial support.
Generative Artificial Intelligence. No generative artificial intelligence technologies were used in the preparation of this article.
For citation: Dvoynishnikova A.O., Alekhin A.A., Shebzukhova Z.R., Pronin S.M., Ovodenko D.L., Ashrafyan L.A.
The role of immunohistochemical and molecular genetic markers in organ-sparing treatment of
early-stage cancer and atypical endometrial hyperplasia.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (10): 36-44 (in Russian)
https://dx.doi.org/10.18565/aig.2026.225
Keywords
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Received 17.07.2026
Accepted 01.10.2026
About the Authors
Arina O. Dvoynishnikova, PhD student, Obstetrician-Gynecologist, Oncologist, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(996)529-40-43, a_dvoynishnikova@oparina4.ru,https://orcid.org/0009-0006-4287- 9107
Anton A. Alekhin, PhD student, Obstetrician-Gynecologist, Oncologist, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)438-85-40, a_alekhin@oparina4.ru
Zalina R. Shebzukhova, Obstetrician-Gynecologist, Oncologist, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)438-85-40, z_shebzukhova@oparina4.ru, https://orcid.org/0000-0002-6889-5803
Stanislav M. Pronin, PhD, Oncologist, Obstetrician-Gynecologist, Senior Researcher at the Department of Innovative Oncology and Gynecology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str. 4, +7(495)438-85-40, s_pronin@oparina4.ru, https://orcid.org/0009-0006-4422-7305
Dmitriy L. Ovodenko, Dr. Med. Sci., Oncologist, Obstetrician-Gynecologist, Head of the Department of Innovative Oncology and Gynecology, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str. 4, +7(495)438-85-40, d_ovodenko@oparina4.ru, https://orcid.org/0000-0003-0700-8374
Lev A. Ashrafyan, Dr. Med. Sci., Professor, Academician of RAS, Oncologist, Obstetrician-Gynecologist, Head of the Institute of Oncogynecology and Mammology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow,
Ac. Oparina str. 4, +7(495)438-85-40, l_ashrafyan@oparina4.ru, https://orcid.org/0000-0001-6396-4948



