Prognostic significance of ER, PR, Ki67, c-erbB-2, and p53 in endometrial carcinoma.

Objective: To better discern the prognostic significance of estrogen-progesterone (ER-PR) receptor proliferative index, tumor suppressor gene, and over expression of oncogene c-erbB-2 in correlation with survival time and recurrence of tumor.

Material And Method: Paraffin blocks from 65 cases of endometrial carcinoma diagnosed and treatment at Rajavithi Hospital, Bangkok, Thailand with a follow-up time of at least 60 months were immunohistochemical studiedfor ER and PR status, tumor proliferative index (Ki-67), tumor suppressor gene (p53), and overexpression of oncogene c-erbB-2. Survival analysis was performed with the Cox proportional hazards.

Results: The mean age of the patients was 54.94 years with a range of 24 to 80 years. The mean follow-up time was 50.35 months. Nine patients (13.8%) had recurrent tumors, 5 years after treatment. Ten patients (15.4%) died of the primary disease during the follow-up period. ER was positive in 50 cases (76.9%) and negative in 15 cases (23.1%). PR was positive in 47 cases (72.3%) and negative in 18 cases (27.7%). Both ER and PR showed significant correlation (p<0.01). Ki-67 showed 27 cases (41.5%) having >35% positive nuclear staining and 38 cases (58.5%) had < or =35% positive nuclear staining. p53 was positive in 31 cases (47.7%) and negative in 34 cases (52.3%). c-erbB-2 was positive in one case (1.5%), equivocal in six cases (9.2%), and negative in 58 cases (89.3%).

Conclusion: Survival analysis showed that cases with low-stage, low-grade, no recurrent tumor, ER and PR positive, and Ki-67 < or =35% had good survival compared to cases with high-stage, high-grade, presence of recurrent tumor, ER-PR-negative, and Ki-67 > 35% (p<0.05). Cox regression analysis showed ER-PR status and Ki-67 were significant independent prognostic indicators for survival time. Ki-67 expression was also a significant independent prognostic indicator for recurrent tumor p53 and c-erbB-2 displayed no statistical significance related to survival time.