Prognostic refinement of NSMP high-risk endometrial cancers using oestrogen receptor immunohistochemistry

Lisa Vermij, Jan J. Jobsen, Alicia León-Castillo, Mariel Brinkhuis, Suzan Roothaan, Melanie E. Powell, Stephanie M. De boer, Pearly Khaw, Linda R. Mileshkin, Anthony Fyles, Alexandra Leary, Catherine Genestie, Ina M. Jürgenliemk-Schulz, Emma J. Crosbie, Helen J. Mackay, Hans. W. Nijman, Remi A. Nout, Vincent T. H. B. M. Smit, Carien L. Creutzberg, Nanda HorewegTjalling Bosse, Stephanie M. De boer

Research output: Contribution to journalArticlepeer-review


Risk-assessment of endometrial cancer (EC) is based on clinicopathological factors and molecular subgroup. It is unclear whether adding hormone receptor expression, L1CAM expression or CTNNB1 status yields prognostic refinement.

Paraffin-embedded tumour samples of women with high-risk EC (HR-EC) from the PORTEC-3 trial (n = 424), and a Dutch prospective clinical cohort called MST (n = 256), were used. All cases were molecularly classified. Expression of L1CAM, ER and PR were analysed by whole-slide immunohistochemistry and CTNNB1 mutations were assessed with a next-generation sequencing. Kaplan–Meier method, log-rank tests and Cox’s proportional hazard models were used for survival analysis.

In total, 648 HR-EC were included. No independent prognostic value of ER, PR, L1CAM, and CTNNB1 was found, while age, stage, and adjuvant chemotherapy had an independent impact on risk of recurrence. Subgroup-analysis showed that only in NSMP HR-EC, ER-positivity was independently associated with a reduced risk of recurrence (HR 0.33, 95%CI 0.15–0.75).

We confirmed the prognostic impact of the molecular classification, age, stage, and adjuvant CTRT in a large cohort of high-risk EC. ER-positivity is a strong favourable prognostic factor in NSMP HR-EC and identifies a homogeneous subgroup of NSMP tumours. Assessment of ER status in high-risk NSMP EC is feasible in clinical practice and could improve risk stratification and treatment.
Original languageEnglish
JournalBritish Journal of Cancer
Publication statusPublished - 23 Jan 2023

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre


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