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

WEELDEN, Willem Janvan, Casper REIJNEN, Heidi V.N. KÜSTERS-VANDEVELDE, Johan BULTEN, Peter BULT, Samuel LEUNG, Nicole C.M. VISSER, Maria SANTACANA, Peter BRONSERT, Marc HIRSCHFELD, Eva COLAS, Antonio GIL-MORENO, Armando REQUES, Gemma MANCEBO, Jutta HUVILA, Martin KOSKAS, Vít WEINBERGER, Markéta BEDNAŘÍKOVÁ, Jitka HAUSNEROVÁ, Marc P.L.M. SNIJDERS, Xavier MATIAS-GUIU and Frédéric AMANT. The cutoff for estrogen and progesterone receptor expression in endometrial cancer revisited: a European Network for Individualized Treatment of Endometrial Cancer collaboration study. Human Pathology. Philadelphia: Elseveir, 2021, vol. 109, March 2021, p. 80-91. ISSN 0046-8177. Available from: https://dx.doi.org/10.1016/j.humpath.2020.12.003.

Basic information

• Original name: The cutoff for estrogen and progesterone receptor expression in endometrial cancer revisited: a European Network for Individualized Treatment of Endometrial Cancer collaboration study
• Authors: WEELDEN, Willem Janvan (guarantor), Casper REIJNEN, Heidi V.N. KÜSTERS-VANDEVELDE, Johan BULTEN, Peter BULT, Samuel LEUNG, Nicole C.M. VISSER, Maria SANTACANA, Peter BRONSERT, Marc HIRSCHFELD, Eva COLAS, Antonio GIL-MORENO, Armando REQUES, Gemma MANCEBO, Jutta HUVILA, Martin KOSKAS, Vít WEINBERGER (203 Czech Republic, belonging to the institution), Markéta BEDNAŘÍKOVÁ (203 Czech Republic, belonging to the institution), Jitka HAUSNEROVÁ (203 Czech Republic, belonging to the institution), Marc P.L.M. SNIJDERS, Xavier MATIAS-GUIU and Frédéric AMANT.
• Edition: Human Pathology, Philadelphia, Elseveir, 2021, 0046-8177.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30109 Pathology
• Country of publisher: United States of America
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Impact factor: Impact factor: 3.526
• RIV identification code: RIV/00216224:14110/21:00121057
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1016/j.humpath.2020.12.003
• UT WoS: 000632654300007
• Keywords in English: Endometrial cancer; Estrogen receptor; Progesterone receptor; Cutoff; Prognostic biomarker
• Tags: 14110212, 14110230, 14110411, rivok
• Tags: International impact, Reviewed

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.