Asparaginase-like protein 1 expression in curettage independently predicts lymph node metastasis in endometrial carcinoma: a multicentre study

Objective: Correct preoperative identification of high-risk patients is important to optimise surgical treatment and improve survival. We wanted to explore if asparaginase-like protein 1 (ASRGL1) expression in curettage could predict lymph node metastases and poor outcome, potentially improving preoperative risk stratification. Design: Multicentre study. Setting: Ten hospitals in Norway, Sweden and Belgium. Population: Women diagnosed with endometrial carcinoma. Methods: ASRGL1 expression in curettage specimens from 1144 women was determined by immunohistochemistry. Main outcome measures: ASRGL1 status related to disease-specific survival, lymph node status, preoperative imaging parameters and clinicopathological data. Results: ASRGL1 expression had independent prognostic value in multivariate survival analyses, both in the whole patient population (hazard ratio (HR) 1.63, 95% CI 1.11–2.37, P = 0.012) and in the low-risk curettage histology subgroup (HR 2.54, 95% CI 1.44–4.47, P = 0.001). Lymph node metastases were more frequent in women with low expression of ASRGL1 compared with women with high ASRGL1 levels (23% versus 10%, P < 0.001), and low ASRGL1 level was found to independently predict lymph node metastases (odds ratio 2.07, 95% CI 1.27–3.38, P = 0.003). Conclusions: Low expression of ASRGL1 in curettage independently predicts lymph node metastases and poor disease-specific survival. Tweetable abstract: Low ASRGL1 expression in curettage predicts lymph node metastasis and poor survival in endometrial carcinoma.