Stratification of Endometrial Carcinoma Patients Using Immunohistochemistry for Better Surgical Planning and Prognosis

Rashad, Heba M.; Abdelwahab, Mai Mohamed; Mohammed, Hanan Lotfy; Yassin, Mahmoud Abdou; Ismail, Adel Mohamed; Mahmoud, Asmaa A; Balata, Rawda; Elnagar, Walid Mohamed; Abdelrahman, Amr Ahmed

doi:10.21608/ebwhj.2024.286115.1322

	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, Page 435-446 PDF (1.13 MB)
Document Type: Original Article
DOI: 10.21608/ebwhj.2024.286115.1322
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Authors
Heba M. Rashad ¹; Mai Mohamed Abdelwahab ²; Hanan Lotfy Mohammed ²; Mahmoud Abdou Yassin ³; Adel Mohamed Ismail ⁴; Asmaa A Mahmoud ⁵; Rawda Balata ⁶; Walid Mohamed Elnagar ⁷; Amr Ahmed Abdelrahman ⁸
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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