L1 Cell Adhesion Molecule (L1CAM) expression in endometrioid endometrial carcinomas: A possible pre-operative surrogate of lymph vascular space invasion

Abstract

BackgroundRisk stratification of endometrial carcinomas is primarily based on surgical staging that requires extensive retroperitoneal lymph node dissection. One of the most powerful predictor of lymph node involvement is the lymph vascular space invasion (LVSI). The objective of this study was to determine the potential of L1 Cell Adhesion Molecule (L1CAM) to predict LVSI and its association with other risk factors in endometrioid endometrial carcinomas.Materials and methodsWe studied 47 consecutive patients aged 37–88 (61.34±10.52). Twenty-three patients (48.9%) were submitted to complete surgical staging. Nine patients (19.1%) underwent surgical staging without para-aortic dissection. Seven (14.9%) were submitted to hysterectomy with no lymph node dissection. Eight patients (17.0%) only had the biopsy material for analysis. The 32 patients submitted to lymphadenectomy were staged according to the FIGO system and classified among the risk categories of the ESMO-ESGO-ESTRO guidelines. The following histological characteristics were analyzed: tumor size (mm), depth of myometrial infiltration, presence of microcystic, elongated, and fragmented (MELF) pattern of myoinvasion, and lymph vascular space invasion (LVSI). Immunohistochemical analyses of mismatch repair (MMR) proteins MLH1, MSH2, MSH6, and PMS2, p53, and L1CAM were performed in formalin-fixed paraffin embedded whole tumor tissue sections.ResultsLVSI was identified in 26/41 (63,4%) of the cases. L1CAM was positive in 8/47 (17%) cases, all of them positive for LVSI and within the high-risk category of ESMO-ESGO-ESTRO. L1CAM-positive cases were associated with high histological grade and p53 aberrant immunohistochemical profile. Besides, it showed a trend to larger tumors, greater depth of myometrial infiltration, and with a higher frequency of the MELF pattern of myoinvasion. LVSI was also associated with FIGO stage, tumor size, depth of myometrial infiltration, and tumor grade.ConclusionsL1CAM is highly associated with LVSI and could be used as a pre-operative predictor of lymph node involvement in endometrioid endometrial carcinomas.

L1 cell adhesion molecule high expression is associated with poor prognosis in surgically resected brain metastases from lung adenocarcinoma

“…Patients with L1CAM high expression had unfavorable OS in comparison with the one with L1CAM low expression. These data are in line with previously published prognostic data on L1CAM expression in other human malignancies, such as NSCLC, 5 gastric cancer, 10 colorectal cancer, 4 , 23 endometrial carcinoma, 9 and glioblastoma. 7 , 13 In addition, the Human Protein Atlas database ( https://www.proteinatlas.org/ ) has also indicated that L1CAM is a prognostic marker.…”

“… 4 In the past few years, a host of research have been carried out around the world to discuss the expression and function of L1CAM in human malignancies of different patient samples. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 It has been demonstrated as a predictive factor of poor prognosis in Non-Small Cell Lung Cancer (NSCLC), cervical cancer, endometrial cancer, gastric cancer, glioma, renal cell cancer, ovarian carcinoma, melanoma, colon cancer, and pancreatic cancer. In addition, previous studies have also indicated the involvement of L1CAM in the tumor cell invasion, metastasis, and chemoresistance.…”

L1CAM is not a reliable predictor for lymph node metastases in endometrial cancer, but L1CAM positive patients benefit from radiotherapy

“…Our data indicate that preoperative L1CAM assessment using percentage assessment is not helpful in decision making regarding lymphadenectomy. Nevertheless, our data confirm previously demonstrated associations of L1CAM expression and other high-risk features such as FIGO stage [30], tumour grade [30][31][32], histological subtypes [30,31], LVSI [21,30,33], and ER and PR status [34]. We showed that L1CAM is a robust marker that indicates patients at higher risk for distant relapse.…”

Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes

“…In a previous study with 47 consecutive patients who had complete surgical staging, we found LVSI in 63.4% of cases, and L1CAM positivity in 17% of the cases. All L1CAM-positive cases had LVSI, suggesting a potential role of this molecule at the time of diagnostic biopsy, particularly in identifying patients in whom lymphadenectomy is crucial [24].…”