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Quantitative Measurement of Progesterone Receptor Immunohistochemical Expression to Predict Lymph Node Metastasis in Endometrial Cancer

Background: Previous studies have shown that loss of progesterone receptor (PR) in endometrial cancer (EC) is associated with poor outcomes. Evaluating lymph node metastasis (LNM) is essential, especially before surgical staging. The aim of this study was to investigate the role of PR expression and...

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Autores principales: Hsiao, Yu-Yang, Fu, Hung-Chun, Wu, Chen-Hsuan, Lan, Jui, Ou, Yu-Che, Tsai, Ching-Chou, Lin, Hao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9031886/
https://www.ncbi.nlm.nih.gov/pubmed/35453837
http://dx.doi.org/10.3390/diagnostics12040790
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author Hsiao, Yu-Yang
Fu, Hung-Chun
Wu, Chen-Hsuan
Lan, Jui
Ou, Yu-Che
Tsai, Ching-Chou
Lin, Hao
author_facet Hsiao, Yu-Yang
Fu, Hung-Chun
Wu, Chen-Hsuan
Lan, Jui
Ou, Yu-Che
Tsai, Ching-Chou
Lin, Hao
author_sort Hsiao, Yu-Yang
collection PubMed
description Background: Previous studies have shown that loss of progesterone receptor (PR) in endometrial cancer (EC) is associated with poor outcomes. Evaluating lymph node metastasis (LNM) is essential, especially before surgical staging. The aim of this study was to investigate the role of PR expression and other clinicopathological parameters in LNM and to develop a prediction model. Methods: We retrospectively evaluated endometrioid-type EC patients treated with staging surgery between January 2015 and March 2020. We analyzed PR status using immunohistochemical staining, and the expression was quantified using the H-score. We identified optimal cut-off values of H-score and CA125 for predicting LNM using receiver operating characteristic curves, and used stepwise multivariate logistic regression analysis to identify independent predictors. A nomogram for predicting LNM was constructed and validated using bootstrap resampling. Results: Of the 310 patients evaluated, the optimal cut-off values of PR H-score and CA125 were 162.5 (AUC 0.670, p = 0.001) and 40 U/mL (AUC 0.739, p < 0.001), respectively. Multivariate analysis showed that CA125 ≥ 40 U/mL (OR: 8.03; 95% CI: 3.44–18.77), PR H-score < 162.5 (OR: 5.22; 95% CI: 1.87–14.60), and tumor grade 2/3 (OR: 3.25; 95% CI: 1.33–7.91) were independent predictors. These three variables were incorporated into a nomogram, which showed effective discrimination with a concordance index of 0.829. Calibration curves for the probability of LNM showed optimal agreement between the probability as predicted by the nomogram and the actual probability. Our model gave a negative predictive value and a negative likelihood ratio of 98.4% and 0.14, respectively. Conclusions: PR H-score along with tumor grade and CA125 are helpful to predict LNM. In addition, our nomogram can aid in decision making with regard to lymphadenectomy in endometrioid-type EC.
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spelling pubmed-90318862022-04-23 Quantitative Measurement of Progesterone Receptor Immunohistochemical Expression to Predict Lymph Node Metastasis in Endometrial Cancer Hsiao, Yu-Yang Fu, Hung-Chun Wu, Chen-Hsuan Lan, Jui Ou, Yu-Che Tsai, Ching-Chou Lin, Hao Diagnostics (Basel) Article Background: Previous studies have shown that loss of progesterone receptor (PR) in endometrial cancer (EC) is associated with poor outcomes. Evaluating lymph node metastasis (LNM) is essential, especially before surgical staging. The aim of this study was to investigate the role of PR expression and other clinicopathological parameters in LNM and to develop a prediction model. Methods: We retrospectively evaluated endometrioid-type EC patients treated with staging surgery between January 2015 and March 2020. We analyzed PR status using immunohistochemical staining, and the expression was quantified using the H-score. We identified optimal cut-off values of H-score and CA125 for predicting LNM using receiver operating characteristic curves, and used stepwise multivariate logistic regression analysis to identify independent predictors. A nomogram for predicting LNM was constructed and validated using bootstrap resampling. Results: Of the 310 patients evaluated, the optimal cut-off values of PR H-score and CA125 were 162.5 (AUC 0.670, p = 0.001) and 40 U/mL (AUC 0.739, p < 0.001), respectively. Multivariate analysis showed that CA125 ≥ 40 U/mL (OR: 8.03; 95% CI: 3.44–18.77), PR H-score < 162.5 (OR: 5.22; 95% CI: 1.87–14.60), and tumor grade 2/3 (OR: 3.25; 95% CI: 1.33–7.91) were independent predictors. These three variables were incorporated into a nomogram, which showed effective discrimination with a concordance index of 0.829. Calibration curves for the probability of LNM showed optimal agreement between the probability as predicted by the nomogram and the actual probability. Our model gave a negative predictive value and a negative likelihood ratio of 98.4% and 0.14, respectively. Conclusions: PR H-score along with tumor grade and CA125 are helpful to predict LNM. In addition, our nomogram can aid in decision making with regard to lymphadenectomy in endometrioid-type EC. MDPI 2022-03-23 /pmc/articles/PMC9031886/ /pubmed/35453837 http://dx.doi.org/10.3390/diagnostics12040790 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hsiao, Yu-Yang
Fu, Hung-Chun
Wu, Chen-Hsuan
Lan, Jui
Ou, Yu-Che
Tsai, Ching-Chou
Lin, Hao
Quantitative Measurement of Progesterone Receptor Immunohistochemical Expression to Predict Lymph Node Metastasis in Endometrial Cancer
title Quantitative Measurement of Progesterone Receptor Immunohistochemical Expression to Predict Lymph Node Metastasis in Endometrial Cancer
title_full Quantitative Measurement of Progesterone Receptor Immunohistochemical Expression to Predict Lymph Node Metastasis in Endometrial Cancer
title_fullStr Quantitative Measurement of Progesterone Receptor Immunohistochemical Expression to Predict Lymph Node Metastasis in Endometrial Cancer
title_full_unstemmed Quantitative Measurement of Progesterone Receptor Immunohistochemical Expression to Predict Lymph Node Metastasis in Endometrial Cancer
title_short Quantitative Measurement of Progesterone Receptor Immunohistochemical Expression to Predict Lymph Node Metastasis in Endometrial Cancer
title_sort quantitative measurement of progesterone receptor immunohistochemical expression to predict lymph node metastasis in endometrial cancer
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9031886/
https://www.ncbi.nlm.nih.gov/pubmed/35453837
http://dx.doi.org/10.3390/diagnostics12040790
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