TY - JOUR
T1 - Immunohistochemical biomarkers are prognostic relevant in addition to the ESMO-ESGO-ESTRO risk classification in endometrial cancer
AU - Vrede, S. W.
AU - van Weelden, W. J.
AU - Visser, N. C. M.
AU - Bulten, J.
AU - van der Putten, L. J. M.
AU - van de Vijver, K.
AU - Santacana, M.
AU - Colas, E.
AU - Gil-Moreno, A.
AU - Moiola, C. P.
AU - Mancebo, G.
AU - Krakstad, C.
AU - Trovik, J.
AU - Haldorsen, I. S.
AU - Huvila, J.
AU - Koskas, M.
AU - Weinberger, V.
AU - Bednarikova, M.
AU - Hausnerova, J.
AU - van der Wurff, A. A.
AU - Matias-Guiu, X.
AU - Amant, F.
AU - Snijders, M. P. L. M.
AU - Küsters-Vandevelde, H. V. N.
AU - ENITEC Consortium
AU - Reijnen, C.
AU - Pijnenborg, J. M. A.
N1 - Publisher Copyright: © 2021 The Authors
PY - 2021/6
Y1 - 2021/6
N2 - Objective: Pre-operative immunohistochemical (IHC) biomarkers are not incorporated in endometrial cancer (EC) risk classification. We aim to investigate the added prognostic relevance of IHC biomarkers to the ESMO-ESGO-ESTRO risk classification and lymph node (LN) status in EC. Methods: Retrospective multicenter study within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), analyzing pre-operative IHC expression of p53, L1 cell-adhesion molecule (L1CAM), estrogen receptor (ER) and progesterone receptor (PR), and relate to ESMO-ESGO-ESTRO risk groups, LN status and outcome. Results: A total of 763 EC patients were included with a median follow-up of 5.5-years. Abnormal IHC expression was present for p53 in 112 (14.7%), L1CAM in 79 (10.4%), ER- in 76 (10.0%), and PR- in 138 (18.1%) patients. Abnormal expression of p53/L1CAM/ER/PR was significantly related with higher risk classification groups, and combined associated with the worst outcome within the ‘high and advanced/metastatic’ risk group. In multivariate analysis p53-abn, ER/PR- and ESMO-ESGO-ESTRO ‘high and advanced/metastatic’ were independently associated with reduced disease-specific survival (DSS). Patients with abnormal IHC expression and lymph node metastasis (LNM) had the worst outcome. Patients with LNM and normal IHC expression had comparable outcome with patients without LNM and abnormal IHC expression. Conclusion: The use of pre-operative IHC biomarkers has important prognostic relevance in addition to the ESMO-ESGO-ESTRO risk classification and in addition to LN status. For daily clinical practice, p53/L1CAM/ER/PR expression could serve as indicator for surgical staging and refine selective adjuvant treatment by incorporation into the ESMO-ESGO-ESTRO risk classification.
AB - Objective: Pre-operative immunohistochemical (IHC) biomarkers are not incorporated in endometrial cancer (EC) risk classification. We aim to investigate the added prognostic relevance of IHC biomarkers to the ESMO-ESGO-ESTRO risk classification and lymph node (LN) status in EC. Methods: Retrospective multicenter study within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), analyzing pre-operative IHC expression of p53, L1 cell-adhesion molecule (L1CAM), estrogen receptor (ER) and progesterone receptor (PR), and relate to ESMO-ESGO-ESTRO risk groups, LN status and outcome. Results: A total of 763 EC patients were included with a median follow-up of 5.5-years. Abnormal IHC expression was present for p53 in 112 (14.7%), L1CAM in 79 (10.4%), ER- in 76 (10.0%), and PR- in 138 (18.1%) patients. Abnormal expression of p53/L1CAM/ER/PR was significantly related with higher risk classification groups, and combined associated with the worst outcome within the ‘high and advanced/metastatic’ risk group. In multivariate analysis p53-abn, ER/PR- and ESMO-ESGO-ESTRO ‘high and advanced/metastatic’ were independently associated with reduced disease-specific survival (DSS). Patients with abnormal IHC expression and lymph node metastasis (LNM) had the worst outcome. Patients with LNM and normal IHC expression had comparable outcome with patients without LNM and abnormal IHC expression. Conclusion: The use of pre-operative IHC biomarkers has important prognostic relevance in addition to the ESMO-ESGO-ESTRO risk classification and in addition to LN status. For daily clinical practice, p53/L1CAM/ER/PR expression could serve as indicator for surgical staging and refine selective adjuvant treatment by incorporation into the ESMO-ESGO-ESTRO risk classification.
KW - Biomarker
KW - Endometrial carcinoma
KW - Immunohistochemistry
KW - Lymph node metastasis
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=85104059996&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ygyno.2021.03.031
DO - https://doi.org/10.1016/j.ygyno.2021.03.031
M3 - Article
C2 - 33858677
SN - 0090-8258
VL - 161
SP - 787
EP - 794
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 3
ER -