The relationship between lymph node metastasis and immunohistochemical molecular subtypes in endometrial cancer: A cohort study of 339 patients

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AIM: This study evaluated the association between immunohistochemically (IHC) molecular subtypes and lymph node metastasis (LNM) in endometrial cancer. METHODS: The study included 339 patients diagnosed with endometrial cancer (EC) confined to the uterus and treated with pelvic ± para-aortic lymph node dissection (LND), who were included in the study. Patients were divided into two groups: LNM-negative (Group 1, n = 289) and LNM-positive (Group 2, n = 50). All patients underwent IHC-based molecular subtype analysis. Demographic, clinical, and histopathological characteristics were evaluated. RESULTS: The median age was 62 years (34-79) in Group 1 and 64 years (48-79) in Group 2 (p = 0.022). Body mass index (BMI) and parity were similar between the groups (p > 0.05). LNM was detected in 14.7% of patients (50/339). Among Group 1, 64.4% (186/289) had a non-specific molecular profile (NSMP), 20.1% (58/289) had mismatch repair deficiency (MMRd), and 15.5% (45/289) had the p53 abnormal (p53abn) subtype. In contrast, in Group 2, 44% (22/50) were NSMP, 24% (12/50) were MMRd, and 32% (16/50) were p53abn (p = 0.008). A statistically significant association was observed between LNM and the p53abn subtype. LNM was present in 26% (16/61) of patients with the p53abn subtype, compared to 17% (12/70) in the MMRd group and 11% (22/208) in the NSMP group. CONCLUSION: While our study identified an association between the p53abn subtype and lymph node metastasis, this finding alone does not support using p53 status in isolation to determine lymphatic staging; instead, it should be considered a complementary marker alongside established clinicopathologic factors.

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