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L1CAM: amending the “low-risk” category in endometrial carcinoma

  • Original Article – Cancer Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Low- and intermediate-risk endometrial carcinomas have an excellent prognosis. Nonetheless, a small subgroup of such patients will experience unexpected relapse. Recently L1CAM was suggested to be a strong prognosticator in endometrial carcinoma. The focus of our study was on low- and intermediate-risk disease, where no or only limited adjuvant treatment is recommended according to current guidelines.

Methods

Endometrial carcinomas of low, intermediate and high-intermediate risk according to published 2016 consensus guidelines were identified. The study was limited to cases with previous central pathology review focusing on histotype, depth of myometrial invasion, presence of lymphovascular space invasion (LVSI) and MELF pattern of invasion. Standard L1CAM immunohistochemistry was performed. Disease-specific uni- and multivariate survival analyses were calculated.

Results

A total of 344 cases were available for immunohistochemistry (low-risk: n = 250; intermediate-risk: n = 67; high-intermediate-risk: n = 27). L1CAM positivity rates were: 29/344 (8.4 %; all cases), 18/250 (7.2 %; low-risk), 6/67 (9.0 %; intermediate-risk) and 5/27 (18.5 %; high-intermediate-risk). Expression of L1CAM was independent of LVSI and MELF. L1CAM was a significant independent prognosticator for disease-specific survival with a hazard ratio of 5.98 [CI 1.50–22.14, p = 0.012]. Adverse prognostic significance of L1CAM positivity was maintained after low-risk subgroup analysis (5-year disease-specific survival rates 71.8 vs. 100 %, p < 0.0001). All four tumour-related deaths in the subgroup of low-risk disease occurred in patients with L1CAM-positive tumours.

Conclusion

The current definition of “low-risk” in endometrial carcinoma should be amended. “Low-risk carcinomas” should be limited to L1CAM-negative tumours. L1CAM status will play a key role in future algorithms to tailor adjuvant treatment and patient follow-up strategies.

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Abbreviations

LVSI:

Lymphovascular space invasion

L1CAM:

L1-cell adhesion molecule, CD 171

EMT:

Epithelial–mesenchymal transition

MELF:

Microcystic elongated and fragmented pattern invasion

IHC:

Immunohistochemistry

Type I:

Endometrioid histotype

Type II:

Serous and clear cell histotype

OS:

Overall survival

DSS:

Disease-specific survival

HR:

Hazard ratio

CI:

Confidence interval

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Authors and Affiliations

  1. Department für Frauengesundheit, Universitätsklinikum Tübingen, Calwerstr. 7, 72076, Tübingen, Germany

    Felix Kommoss, Friederike Grevenkamp, Anne-Kathrin Bunz, Florin-Andrei Taran, Sara Y. Brucker, Diethelm Wallwiener, Birgitt Schönfisch & Stefan Kommoss

  2. Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada

    Friedrich Kommoss

  3. Institut für Pathologie, Universitätsklinikum Tübingen, Tübingen, Germany

    Falko Fend, Karen Greif & Annette Staebler

  4. Institut für Pathologie, LKH Graz West, Graz, Austria

    Sigurd Lax

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  1. Felix Kommoss
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Correspondence to Stefan Kommoss.

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The authors declare that they have no conflict of interest.

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This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Ethical approval

Study approval was obtained from the Independent Ethics Committee of the University of Tübingen. All procedures were performed in accordance with the ethical standards of the institutional research committee.

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Kommoss, F., Kommoss, F., Grevenkamp, F. et al. L1CAM: amending the “low-risk” category in endometrial carcinoma. J Cancer Res Clin Oncol 143, 255–262 (2017). https://doi.org/10.1007/s00432-016-2276-3

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