Multivariate Analysis Of Histopathological And Immunohistochemical Prognostic Factors In Endometrial Carcinoma. A Retrospective Pilot Study Of An Italian Regional Referral Center

OBJECTIVE: Endometrial carcinoma (EC) is the most common malignant disease of the female genital tract. We investigated the prognostic role of some histopathological and immunohistochemical factors in EC in term of disease free survival (DFS) and overall survival (OS). METHODS: Patients underwent to radical hysterectomy for EC in our institution for the period 1.1.2013 1.7.2016, with complete follow-up and no pre-operative treatments were retrospectively considered. For each patient a panel of histopathological and immunohistochemical prognostic markers were evaluated including, histologic type, stage, infiltration type, peritumoral desmoplasia, intratumoral necrosis, tumor infiltrating lymphocytes (TIL), limph-vascular space invasion (LVSI), ER, PR, Ki67, p53, beta-catenin, E-cadherin, BCL-2 and Cyclin D1. Survival univariate analysis was studied with Kaplan-Meier survival curves, while survival multivariate analysis was studied with Cox-Models. RESULTS: 99 cases resulted eligible: 69 low-grade endometrioid carconomas (LG-EC), 8 high-grade endometrioid carcinomas (HG-EC) and 22 high-grade non-endometrioid carcinomas (HG-NEC). At univariate analysis, cases with non-endometriod histology LVSI, FIGO III-IV, low PR and high Ki67 demonstrated a worse DFS; similary cases with non-endometrioid histology, desmoplasia, low PR and high Ki67 had a worse OS. The DFS multivariate analysis showed a strong positive correlation between poor prognosis and advanced stage. The OS multivariate analysis revealed a positive correlation between poor prognosis and advanced stage, presence of desmoplasia and high Ki67 proliferative index . Other factors that resulted significantly correlated with the prognosis in univariate analysis, lost their role after the multivariate analysis CONCLUSION: EC confirmed its heterogenous nature with different histologic types and biological behaviors. For all the cases, the multivariate analysis confirmed the central role of the disease staging as the main important prognostic factor in EC both in term of OS and DFS. Moreover both desmoplasia and Ki67 proliferative index have demonstrated to be significantly correlated with OS. Also PR and ER determination with IHC could have a relevant role in patients stratification and follow-up planning.