The cutoff for estrogen and progesterone receptor expression in endometrial cancer revisited: a European Network for Individualized Treatment of Endometrial Cancer collaboration study - UTU Research Portal

A1 Refereed original research article in a scientific journal

The cutoff for estrogen and progesterone receptor expression in endometrial cancer revisited: a European Network for Individualized Treatment of Endometrial Cancer collaboration study

Authors: van Weelden Willem Jan, Reijnen Casper, Küsters-Vandevelde Heidi VN, Bulten Johan, Bult Peter, Leung Samuel, Visser Nicole CM, Santacana Maria, Bronsert Peter, Hirschfeld Marc, Colas Eva, Gil-Moreno Antonio, Reques Armando, Mancebo Gemma, Huvila Jutta, Koskas Martin, Weinberger Vit, Bednarikova Marketa, Hausnerova Jitka, Snijders Marc PLM, Matias-Guiu Xavier, Amant Frédéric; ENITEC-Consortium

Publisher: Elsevier

Publication year: 2021

Journal: Human Pathology

Journal name in source: Human pathology

Journal acronym: Hum Pathol

Volume: 109

First page : 80

Last page: 91

ISSN: 0046-8177

eISSN: 1532-8392

DOI: https://doi.org/10.1016/j.humpath.2020.12.003

Web address : https://doi.org/10.1016/j.humpath.2020.12.003

Self-archived copy’s web address: https://biblio.ugent.be/publication/8698929/file/8698935.pdf

Abstract

There is no consensus on the cutoff for positivity of estrogen receptor (ER) and progesterone receptor (PR) in endometrial cancer (EC). Therefore, we determined the cutoff value for ER and PR expression with the strongest prognostic impact on the outcome. Immunohistochemical expression of ER and PR was scored as a percentage of positive EC cell nuclei. Cutoff values were related to disease-specific survival (DSS) and disease-free survival (DFS) using sensitivity, specificity, and multivariable regression analysis. The results were validated in an independent cohort. The study cohort (n = 527) included 82% of grade 1-2 and 18% of grade 3 EC. Specificity for DSS and DFS was highest for the cutoff values of 1-30%. Sensitivity was highest for the cutoff values of 80-90%. ER and PR expression were independent markers for DSS at cutoff values of 10% and 80%. Consequently, three subgroups with distinct clinical outcomes were identified: 0-10% of ER/PR expression with, unfavorable outcome (5-year DSS = 75.9-83.3%); 20-80% of ER/PR expression with, intermediate outcome (5-year DSS = 93.0-93.9%); and 90-100% of ER/PR expression with, favorable outcome (5-year DSS = 97.8-100%). The association between ER/PR subgroups and outcomes was confirmed in the validation cohort (n = 265). We propose classification of ER and PR expression based on a high-risk (0-10%), intermediate-risk (20-80%), and low-risk (90-100%) group.