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Impact of Hormone Receptor Status and Ki-67 Expression on Disease-Free Survival in Patients Affected by High-risk Endometrial Cancer
  1. Violante Di Donato, MD, PhD*,
  2. Valentina Iacobelli, MD*,
  3. Michele Carlo Schiavi, MD*,
  4. Vanessa Colagiovanni, MD*,
  5. Irene Pecorella, MD,
  6. Innocenza Palaia, MD*,
  7. Giorgia Perniola, MD, PhD*,
  8. Claudia Marchetti, MD, PhD*,
  9. Angela Musella, MD, PhD*,
  10. Federica Tomao, MD, PhD*,
  11. Marco Monti, MD*,
  12. Ludovico Muzii, MD* and
  13. Pierluigi Benedetti Panici, MD*
  1. * Department of Gynecology Obstetrics Sciences and Urologic Sciences, and
  2. Department of Radiological Sciences, Oncology and Anatomical Pathology, Umberto I, University of Rome “Sapienza,” Viale Regina Elena, Rome, Italy.
  1. Address correspondence and reprint requests to Violante Di Donato, MD, PhD, Department of Gynecology and Obstetrics Science and Urologic Sciences, University of Rome “Sapienza,” Viale Regina Elena, 324, 00161 Rome, Italy. E-mail: violante.didonato{at}


Objectives The aim of this study was to evaluate the immunohistochemical (IHC) expression of Ki-67, estrogen receptors α (ERsα), and progesterone receptors (PRs) in high-risk endometrial cancer patients and to assess their prognostic impact.

Methods/Materials Immunohistochemical expression of Ki-67, ERsα, and PRs was evaluated in primary untreated endometrial cancer. The correlation among IHC staining and risk factors of recurrence such as age, Federation International of Gynecology and Obstetrics stage, grading, depth of invasion, and metastatic spread was assessed.

Results Eighty-two patients were available for the analysis. Mean ± SD age was 65.05 ± 10.48 years. The IHC assessment revealed a lack of ERα in 46.3% and of PR in 48.7% as well as a high Ki-67 in 31.7%. Loss of ERα and PR was associated with a significant higher rate of advanced stage of disease, a higher frequency of G3 tumors, and a myometrial invasion greater than 50%. A strong Ki-67 expression correlated with a deeper myometrial invasion. Analysis of the interrelationship between receptor immunonegativity revealed a relevant association of ERα immunolocalization with PR and with a high Ki-67 expression. The present study also showed that loss of ERα (P = 0.003), advanced Federation International of Gynecology and Obstetrics stage (P < 0.001), and high Ki-67 (P = 0.004) were independent prognostic factors of a shorter disease-free survival. Importantly, loss of ERα, loss of PR, and a high Ki-67 were correlated with a higher incidence of distant recurrence.

Conclusions A systematic immunohistochemistry should be a key step in the therapeutic algorithm and could contribute to the identification of high-risk tumors.

  • Endometrial cancer
  • Hormone receptors status
  • Immunohistochemistry
  • Prognostic factors

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  • The authors declare no conflicts of interest.