Estrogen Receptor- And Progesterone Receptor-Positive Thresholds in Predicting the Recurrence of Early Low-Risk Endometrial Cancer

Abstract

Background: Estrogen receptors (ER) and progesterone receptors (PR) have important prognostic value in endometrial cancer, but there is no recognized positive immunohistochemical threshold for predicting the recurrence of early low-risk endometrial cancer. The purpose of this study was to clarify the optimal positive thresholds of the immunohistochemical parameters the ER and PR in early low-risk endometrial cancer. Methods: A total of 332 patients with stage IA endometrial cancer were enrolled from the First Affiliated Hospital of Chongqing Medical University and People’s Hospital of Sha ping ba District in Chongqing between January 2013 and December 2018. First, univariate and multivariate Cox regression analyses were used to analyze the correlation between various clinical factors and the prognosis of early low-risk endometrial cancer. Then, the receiver operating characteristic curve (ROC curve) and Youden index were used to determine the positive thresholds of ER and PR. Results: The positive thresholds of ER and PR for predicting the recurrence of early low-risk endometrial cancer were 12% and 8%, respectively. Multivariate analysis showed that ER ( P = 0.004), PR ( P = 0.026), and p53 ( P = 0.021) were risk factors for the prognosis of patients with early low-risk endometrial cancer. The recurrence-free survival and the overall survival in the low ER group and PR group were much lower than those in the high ER group and PR group ( P < 0.001 of all). Conclusions: ER and PR positive thresholds of 12% and 8%, respectively, are the most suitable for predicting the recurrence of early low-risk endometrial cancer.

The prognostic value of P53 index in predicting the recurrence of early low‐risk endometrial cancer

“…Previous studies have shown that ER and PR status and Ki67 and P53 indices are independent prognostic factors for EC recurrence. 1,7,8,10,[15][16][17][18][19] Although ER, PR, and P53 were found to be independent risk factors for recurrence in univariate analysis in our study, ER lost its significance in multivariate analysis. The reason why ER lost its significant may be that P53, PR are more strongly associated with early low-risk EC recurrence or due to the small number of patients.…”

“…In the study of Li et al, which is similar to our study in terms of patient population, it has been shown that the P53 index is a prognostic factor for recurrence in early low-risk EC; but the optimal cut-ff value of P53 index for predicting the recurrence of early low-risk EC has not been determined. 7 Although the study of Li et al is similar to our study in terms of patient population, it has not been clearly stated which patient group underwent pelvic or paraaortic lymph node dissection. Paraaortic lymph node dissection was not performed in any patient in our study and pelvic lymphadenectomy was performed for patients whose frozen section analysis reveals tumor size ≥2 cm and grade 2 histology or in case of clinical suspicion.…”

“…Although many studies have shown the prognostic value of immunohistochemical evaluation of P-53, Ki-67, ER, and PR in EC, molecular prognostic markers such as PTEN, PIK3CA, and ARID1A can be candidates to predict the risk of recurrence in early low-risk EC. 4,[7][8][9][10][11][15][16][17]19,[22][23][24][25][26][27][28][29] The limitations of our study are (1) single institution and retrospective design, (2) the calculation of indices of immunohistochemical markers is affected by various factors (detection methods, fixation etc. ), (3) the structure of the study patients which results in small number of recurrences, (4) the degree of myometrial invasion is not specified in millimeters.…”

“…5,6 Nevertheless, these traditional clinical parameters may be insufficient to predict the risk of recurrence of early low-risk EC. 7 In recent years, in addition to traditional clinical and pathological features, immunohistochemical markers such as Ki 67, ER, PR, and P53 have been investigated for their effects on prognosis in EC. [8][9][10] Although there are studies investigating the effect of p53 index on recurrence in patients with advanced high-risk EC, the number of studies investigating the effect of p53 index on recurrence in patients with early low-risk EC is not sufficient.…”

“…[8][9][10] Although there are studies investigating the effect of p53 index on recurrence in patients with advanced high-risk EC, the number of studies investigating the effect of p53 index on recurrence in patients with early low-risk EC is not sufficient. [7][8][9][10][11] Therefore, we aimed to clarify the clinical value of P53 index in patients with early low-risk EC and find an optimal cut-off value of P53 index for predicting the recurrence of these patients. All patients were operated by gynecologic oncologists.…”