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JPTM > Ahead-of Print

doi: https://doi.org/10.4132/jptm.2019.02.12    [Epub ahead of print]
Potential Role for a Panel of Immunohistochemical Markers in the Management of Endometrial Carcinoma
Amany Salama1, Mohammad Arafa1,4, Eman ElZahaf2, Abdelhadi Mohamed Shebl1, Azmy Abd El-Hameed Awad1, Sylvia A. Ashamallah1, Reda Hemida3, Anas Gamal3, Abd AlRahman Foda1, Khaled Zalata1, El-Said M. Abdel-Hady3
1Pathology Department, Faculty of Medicine, Mansoura University, Mansoura,
2Clinical oncology and nuclear medicine department, Faculty of Medicine, Mansoura University, Egypt
3Obstetrics and Gynecology Department, Faculty of Medicine, Mansoura University, Egypt
4Pathology Department, College of Medicine and health Sciences, Sultan Qaboos University, Oman
Corresponding Author: Mohammad Arafa ,Email: marafa8@yahoo.com
Received: August 31, 2018;  Revised: February 11, 2019  Accepted: February 12, 2019.  Published online: February 28, 2019.

In order to improve the efficacy of endometrial carcinoma (EC) treatment, identifying prognostic factors for high risk patients is a high research priority. This study aimed to assess the relationships among the expression of estrogen receptors (ER), progesterone receptors (PR), HER2, Ki-67, and the different histopathological prognostic parameters in endometrial carcinoma and to assess the value of these in the management of EC.
We examined 109 cases of EC. Immunohistochemistry for ER, PR, HER2, and Ki-67 were evaluated in relation to age, tumour size, FIGO stage and grade, depth of infiltration, cervical and ovarian involvement, lymphovascular space invasion (LVSI), and lymph node (LN) metastasis.
The mean age of patients in this study was 59.8 ± 8.2 years. Low ER and PR expression scores and high Ki-67 expression showed highly significant associations with non-endometrioid histology (P=0.007, P<0.001, P<0.001, respectively) and poor differentiation (P=0.007, P<0.001, P<0.001, respectively). Low PR score showed a significant association with advanced stage (P=0.009). Low ER score was highly associated with LVSI (P=0.006), and low PR scores were associated significantly with LN metastasis (P=0.026). HER2 expression was significantly related to advanced stages (P=0.04), increased depth of infiltration (P=0.02), LVSI (P=0.017), ovarian involvement (P=0.038), and LN metastasis (P=0.038). There was a close relationship between HER2 expression and uterine cervical involvement (P=0.009). Higher Ki67 values were associated with LN involvement (P=0.012).
The over-expression of HER2 and Ki-67 and low expression of ER and PR indicate a more malignant EC behavior. An immunohistochemical panel for the identification of high risk tumors can contribute significantly to prognostic assessments.
Key Words: Endometrial carcinoma, prognostic factors, steroid receptors, HER2, Ki-67