Expression of L1CAM and KI-67 in Endometrial Cancer of Egyptian Females: Clinical Impact and Survival

Abstract

Introduction: Endometrial adenocarcinoma is characterized by a good prognosis. However, the disease response shows a significant heterogeneity. Treatment of endometrial cancer (EC) is still based on clinico-pathological parameters, which have limited role in risk stratification. There is a need for more determinant markers, such as L1 Cell Adhesion Molecule (L1CAM), to identify patients at higher risk of relapse and tailor a more convenient treatment. L1CAM has a capacity to enhance cell motility and promote tumor invasion in different malignancies. In Egypt, the incidence rate of EC is growing over time. Especially in Elgharbiah governorate (home of this study). L1CAM expression and Ki-67 was reported and compared with other clinico-pathological criteria. Method: Seventy-six female patients of endometrial carcinomas were involved in this prospective study. The patients were treated and followed up at Tanta University Hospitals in the period between January 2015 to April 2019. L1CAM expression and Ki-67 was detected by immuno-histochemical exam and compared with other clinico-pathological criteria. Survival was assessed and compared by Kaplan-Meier curves and log-rank test. Results: Positive L1CAM expression was detected in 17 patients (22.4%) and was significantly correlated with unfavorable prognostic factors such as higher stage and grade ( P= 0.021 and P =0.001 respectively), lympo-vascular invasion ( P <0.001), non-endometroid type ( P <0.027) and Ki-67 ( P= 0.003). Univariate analysis revealed that: positive L1CAM; higher tumor grade; high stage; and non-endometrioid type were significantly associated with shorter disease-free survival (DFS) but no significant correlation was detected between Ki-67 and DFS. In multivariate analysis, positive L1CAM remained statistically significant with DFS [P =0.045; 95%CI (1.028:11.17); HR=3.38]. Conclusion: Our study indicates that L1CAM expression and Ki-67 are significantly associated with poor tumor characteristics. L1CAM is significantly associated with shorter disease-free survival and may be a helpful tool as a part of a simple clinical molecular classification for EC.

Clarification of Ki67 Expression in Association with the Histological Picture of Endometrium in Cases with Abnormal Uterine Bleeding in Nineveh Province

“…Analysis of immunohistochemical expression of Ki67 in sections of women presented with AUB revealed that there is a relation with the age of patients. Similar observation was found in works of Jiang et al, 2020; Gharib et al, 2020 30,41 . On the contrary, this work concluded that the highest mean of percentage of Ki67 expression was in sections of proliferative endometrium.…”

“…Regarding the cases of carcinoma, this study revealed that 8/20 (40%) of sections exhibited expression of the Ki67 of more than 25%. Similar observation was found by others 23,29,30,41 Mean Ki67 values were higher in cases with proliferative endometrium compared to carcinomas and hyperplasia (P <0.01) and there is a marked variation was noticed between the mean Ki67 values of cases with proliferative endometrium and hyperplasia.…”

“…Therefore, no staining must be show when omitting the primary antibody For cases of endometrial carcinoma, manual scoring of Ki67 percentage were counted and recorded according to the Ki67 labeling index of ≤ 15%, and >15% respectively, and cases were classified as low and high proliferating. For statistical analysis, we grouped the patients according to the Ki67 labeling index to Ki67 ≤ 15% (low score) and Ki67 >15% (high score) 30 . According to Carangiu et al, the intensity of nuclear stain was recorded using the immunohistochemical score as 1, 2, and 3 28,31 .…”

“…According to the method of Gharib et al in 2020 (30) , the sections of endometrial adenocarcinoma were further analyzed. Tables 10 and 11.…”