Prognostic refinement of NSMP high-risk endometrial cancers using oestrogen receptor immunohistochemistry

BackgroundRisk-assessment of endometrial cancer (EC) is based on clinicopathological factors and molecular subgroup. It is unclear whether adding hormone receptor expression, L1CAM expression or CTNNB1 status yields prognostic refinement.MethodsParaffin-embedded tumour samples of women with high-risk EC (HR-EC) from the PORTEC-3 trial (n = 424), and a Dutch prospective clinical cohort called MST (n = 256), were used. All cases were molecularly classified. Expression of L1CAM, ER and PR were analysed by whole-slide immunohistochemistry and CTNNB1 mutations were assessed with a next-generation sequencing. Kaplan-Meier method, log-rank tests and Cox's proportional hazard models were used for survival analysis.ResultsIn total, 648 HR-EC were included. No independent prognostic value of ER, PR, L1CAM, and CTNNB1 was found, while age, stage, and adjuvant chemotherapy had an independent impact on risk of recurrence. Subgroup-analysis showed that only in NSMP HR-EC, ER-positivity was independently associated with a reduced risk of recurrence (HR 0.33, 95%CI 0.15-0.75).ConclusionsWe confirmed the prognostic impact of the molecular classification, age, stage, and adjuvant CTRT in a large cohort of high-risk EC. ER-positivity is a strong favourable prognostic factor in NSMP HR-EC and identifies a homogeneous subgroup of NSMP tumours. Assessment of ER status in high-risk NSMP EC is feasible in clinical practice and could improve risk stratification and treatment.

Automated summary

This study aimed to investigate whether adding hormone receptor expression, L1CAM expression or CTNNB1 status can improve the accuracy of risk assessment in endometrial cancer (EC). The study found that the expression of ER, PR, L1CAM, and CTNNB1 did not have independent prognostic value in EC, while age, stage, and adjuvant chemotherapy had an independent impact on the risk of recurrence. However, in high-risk EC of non-serous/mixed papillary (NSMP) subgroup, ER positivity was independently associated with a reduced risk of recurrence.