我们研究了一种分子分类工具和基因改变对于预测日本子宫内膜癌患者预后的效用。两个独立队列的1029名子宫内膜癌患者被分为四个分子亚型组。主要和次要终点分别是无复发生存率（RFS）和总体生存率（OS）。265名根据免疫组织化学分类的初始手术患者中，DNA聚合酶epsilon外切酶结构域突变患者的预后（RFS和OS）非常好，没有特定分子表型（NSMP）和错配修复蛋白异常患者的预后中等，而蛋白质53异常表达（p53abn）患者的预后最差（P< 0.001）。在NSMP组中，KRAS突变和ARID1A野生型的患者，5年RFS明显较差（41.2％），比其他基因特征更差（P<0.001）。亚型分布在经过初步手术和测序分类的复发 / 进展患者（n = 764）和普通初步手术患者之间存在显着差异（P<0.001）。在复发/进展的患者中，51.4％有机会接受分子靶向治疗。分子分类器是一种在子宫内膜癌患者中确定预后和分子靶向治疗资格的有用工具。 ©2023年，作者。

We investigated the utility of a molecular classifier tool and genetic alterations for predicting prognosis in Japanese patients with endometrial cancer.A total of 1029 patients with endometrial cancer from two independent cohorts were classified into four molecular subtype groups. The primary and secondary endpoints were relapse-free survival (RFS) and overall survival (OS), respectively.Among the 265 patients who underwent initial surgery, classified according to immunohistochemistry, patients with DNA polymerase epsilon exonuclease domain mutation had an excellent prognosis (RFS and OS), patients with no specific molecular profile (NSMP) and mismatch repair protein deficiency had an intermediate prognosis, and those with protein 53 abnormal expression (p53abn) had the worst prognosis (P < 0.001). In the NSMP group, mutant KRAS and wild-type ARID1A were associated with significantly poorer 5-year RFS (41.2%) than other genomic characteristics (P < 0.001). The distribution of the subtypes differed significantly between patients with recurrence/progression and classified by sequencing (n = 764) and patients who underwent initial surgery (P < 0.001). Among patients with recurrence/progression, 51.4% had the opportunity to receive molecular targeted therapy.A molecular classifier is a useful tool for determining prognosis and eligibility for molecularly targeted therapy in patients with endometrial cancer.© 2023. The Author(s).