L1CAM in Early-Stage Type I Endometrial Cancer: Results of a Large Multicenter Evaluation

作者：Alain Gustave Zeimet, Daniel Reimer, Monica Huszar, Boris J. N. Winterhoff, Ulla Puistola, Samira Abdel Azim, Elisabeth Müller‐Holzner, Alon Ben‐Arie, Léon C.L.T. van Kempen, Edgar Petru, Stephan Wenzel Jahn, Yvette P. Geels, Leon F.A.G. Massuger, Frédéric Amant, Stephan Polterauer, Elisa Lappi‐Blanco, Johan Bulten, Alexandra Meuter, Staci Tanouye, Peter Oppelt, Monika Stroh-Weigert, Alexander Reinthaller, Andrea Mariani, Werner Oskar Hackl, Michael Netzer, Uwe Bernd Schirmer, Ignace B. Vergote, Peter Altevogt, Christian Marth, Mina Fogel · 发表于：JNCI Journal of the National Cancer Institute · 年份：2013 · DOI：10.1093/jnci/djt144 · 被引用次数：236 · 研究领域：Endometrial and Cervical Cancer Treatments、Cell Adhesion Molecules Research、Ovarian cancer diagnosis and treatment

BACKGROUND: Despite the excellent prognosis of Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage I, type I endometrial cancers, a substantial number of patients experience recurrence and die from this disease. We analyzed the value of immunohistochemical L1CAM determination to predict clinical outcome. METHODS: We conducted a retrospective multicenter cohort study to determine expression of L1CAM by immunohistochemistry in 1021 endometrial cancer specimens. The Kaplan-Meier method and Cox proportional hazard model were applied for survival and multivariable analyses. A machine-learning approach was used to validate variables for predicting recurrence and death. RESULTS: Of 1021 included cancers, 17.7% were rated L1CAM-positive. Of these L1CAM-positive cancers, 51.4% recurred during follow-up compared with 2.9% L1CAM-negative cancers. Patients bearing L1CAM-positive cancers had poorer disease-free and overall survival (two-sided Log-rank P < .001). Multivariable analyses revealed an increase in the likelihood of recurrence (hazard ratio [HR] = 16.33; 95% confidence interval [CI] = 10.55 to 25.28) and death (HR = 15.01; 95% CI = 9.28 to 24.26). In the L1CAM-negative cancers FIGO stage I subdivision, grading and risk assessment were irrelevant for predicting disease-free and overall survival. The prognostic relevance of these parameters was related strictly to L1CAM positivity. A classification and regression decision tree (CRT)identified L1CAM as the best v...