ReviewClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2026
Deciphering survival disparities in endometrial cancer: a focus on mismatch repair pathway integrity (systematic review and meta-analysis).
Review in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEndometrial cancer (EC) exhibits significant molecular heterogeneity, with mismatch repair deficiency (MMR-d) identifying a key subtype. While MMR-d is a known predictive biomarker for immunotherapy, its independent prognostic role remains debated. This systematic review and meta-analysis evaluates the association between MMR status and survival outcomes in EC.
methodsA comprehensive search of PubMed, EMBASE, Web of Science, and ScienceDirect was conducted for studies published through July 1, 2025, reporting hazard ratios (HR) for survival based on MMR status. Pooled HRs and 95% confidence intervals (CIs) for overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS) were calculated using random-effects models.
resultsSixteen high-quality studies encompassing 7486 patients (25.6% MMR-d) were included. MMR-d status was significantly associated with OS (pooled HR 1.25, 95% CI 1.02-1.53, $P < 0.001), though significant regional variation existed. Subgroup analysis revealed a survival benefit in Asian cohorts (HR 0.24, P = 0.02) but a trend toward poorer OS in European studies (HR 1.39, P = 0.05). No statistically significant associations were found for DSS (HR 1.22, P = 0.34) or PFS (HR 1.08, P = 0.04). Meta-regression indicated that follow-up duration did not moderate these outcomes.
conclusionMMR deficiency in EC is associated with variable survival outcomes heavily influenced by geographic and clinical context. While its independent prognostic value for DSS and PFS is limited, it remains a vital predictive biomarker for modern therapeutic stratification.
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