Estrogen/Progesterone Receptor Expression and Cancer Antigen 125 Level as Preoperative Predictors to Estimate Lymph Node Metastasis in Endometrioid Endometrial Cancer

Int J Gynecol Pathol. 2024 Jul 1;43(4):316-325. doi: 10.1097/PGP.0000000000000984. Epub 2023 Sep 8.

Abstract

Loss of estrogen receptor/progesterone receptor (ER/PR) in endometrial cancer (EC) is associated with tumor progression and poor outcomes. Elevated pretreatment cancer antigen 125 (CA 125) level is a risk factor for lymph node metastasis (LNM). We evaluated whether the combination of ER/PR expression and CA 125 level could be used as a biomarker to predict LNM. We retrospectively investigated patients with endometrioid EC who underwent complete staging surgery during January 2015 to December 2020. We analyzed ER/PR status using immunohistochemical staining, and quantified its expression using the sum of both ER/PR H -scores. Receiver operating characteristic curves were used to identify optimal cutoff values of H -score and CA 125 levels for predicting LNM. A nomogram for predicting LNM was constructed and validated by bootstrap resampling. In 396 patients, the optimal cutoff values of the ER/PR H -score and CA 125 were 407 (area under the receiver operating characteristic curve: 0.645, P =0.001) and 40 U/mL (area under the receiver operating characteristic curve: 0.762, P <0.001), respectively. Multivariate analysis showed that CA 125 ≥40 UmL (odds ratio: 10.02; 95% CI: 4.74-21.18) and ER/PR H -score <407 (odds ratio: 4.20; 95% CI: 1.55-11.32) were independent predictors. An LNM predictive nomogram was constructed using these 2 variables and our model yielded a negative predictive value and negative likelihood ratio of 98.3% and 0.14, respectively. ER/PR expression with pretreatment CA 125 levels can help estimate LNM risk and aid in decision-making regarding the need for lymphadenectomy in patients with endometrioid EC.

MeSH terms

  • Adult
  • Aged
  • Biomarkers, Tumor* / analysis
  • Biomarkers, Tumor* / metabolism
  • CA-125 Antigen* / blood
  • CA-125 Antigen* / metabolism
  • Carcinoma, Endometrioid* / diagnosis
  • Carcinoma, Endometrioid* / metabolism
  • Carcinoma, Endometrioid* / pathology
  • Carcinoma, Endometrioid* / surgery
  • Endometrial Neoplasms* / metabolism
  • Endometrial Neoplasms* / pathology
  • Endometrial Neoplasms* / surgery
  • Female
  • Humans
  • Lymph Nodes / pathology
  • Lymphatic Metastasis* / pathology
  • Middle Aged
  • Nomograms
  • ROC Curve
  • Receptors, Estrogen* / metabolism
  • Receptors, Progesterone* / metabolism
  • Retrospective Studies

Substances

  • Receptors, Progesterone
  • Receptors, Estrogen
  • CA-125 Antigen
  • Biomarkers, Tumor