Stratification of Endometrial Carcinoma Patients Using Immunohistochemistry for Better Surgical Planning and Prognosis | ||
| Evidence Based Women's Health Journal | ||
| Volume 14, Issue 4, November 2024, Pages 435-446 PDF (1.13 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ebwhj.2024.286115.1322 | ||
| Authors | ||
| Heba M. Rashad1; Mai Mohamed Abdelwahab2; Hanan Lotfy Mohammed2; Mahmoud Abdou Yassin3; Adel Mohamed Ismail4; Asmaa A Mahmoud5; Rawda Balata6; Walid Mohamed Elnagar* 7; Amr Ahmed Abdelrahman8 | ||
| 1Pathology Department, Faculty of medicine, Banha University, Egypt. | ||
| 2Pathology Department, Faculty of medicine, Zagazig University, Egypt. | ||
| 3General surgery Department, Faculty of medicine, Zagazig University, Egypt | ||
| 4Surgical Oncology Department, Ismailia Teaching Oncology Hospital, Egypt | ||
| 5Medical Oncology Department y, Faculty of Medicine, Zagazig University, Egypt. | ||
| 6Clinical Oncology Department, Faculty of Medicine, Zagazig University, Egypt. | ||
| 7Associate Professor in Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Egypt. | ||
| 8Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Egypt. | ||
| Abstract | ||
| Background: Endometrial cancer (EC) incidence is rising, necessitating precise risk stratification for optimal therapy. ESMO-ESGO-ESTRO guidelines aid in determining lymph node dissection and adjuvant treatment. New prognostic markers are needed for accurate patient stratification. Our study aims to utilize preoperative IHC analysis of L1CAM, ER, PR, and p53 to enhance surgical planning and outcomes in EC patients. Patients and Methods: A retrospective-prospective cohort-study was conducted at multiple departments in Zagazig University Hospitals. Sixty patients with confirmed endometrial carcinoma scheduled for surgery between January 2019 and March 2022 were included. IHC staining for ER, PR, L1CAM, and p53 was performed and correlated with ESMO-ESGO-ESTRO guidelines and lymph node status. Results: Statistically significant correlations were found between IHC markers and histopathological findings, with abnormal-P53 and L1CAM not correlating with histological type and grade. Positive-ER/PR expression had a 3-year OS of 93.5%, while ER-negative patients had 64.3% (p = 0.002). Abnormal-P53 was linked to poorer OS (54.5%) compared to normal (93.9%) (p<0.001). L1CAM-negative patients had a better OS (94.2%) vs. L1CAM-positive (37.5%) (p<0.001). ER/PR-negative, abnormal-P53, and L1CAM-positive patients had poorer PFS (35.7%, 18.2%, 12.5%) (p<0.001). Poorer RFS was seen in P53-abnormal, L1CAM-positive, ER/PR-negative, and high-risk ESMO-ESGO-ESTRO subgroups (p<0.001). High-risk ESMO-ESGO-ESTRO subgroups were independently associated with reduced PFS, as were L1CAM-positive and P53-abnormal patients (p=0.002, p=0.07). Conclusion: We concluded that pre-operative IHC-biomarkers (L1CAM and P53) could be used as refinement for lymph node directed surgery and also adjuvant selective treatment by being integrated in the ESMO-ESGO-ESTRO risk classification. | ||
| Keywords | ||
| Cancer; endometrial; L1CAM; P53 | ||
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