Journal Article

Exploring biomarkers and prognostic factors in uterine carcinosarcoma: An insight into L1CAM, CDX2, p53, and MSI status

Rodrigues, Fabiana Resende, de Albuquerque, Lucas Zanetti, Barroso, Elisa Bouret Campos, Small, Isabele Avila, da Silva, Jesse Lopes, Fernandes, Daniel de Souza, de Melo, Andreia Cristina, Cordero, Fernando Lopes, Paulino, Eduardo, Bastos, Nina Carrossini

2023

Overview

Uterine Carcinosarcomas (UCS) are a rare type of cancer composed of an admixture of high-grade carcinomatous and sarcomatous elements. Clinicopathological prognostic factors in UCS are well established, but studies that approach the impact of biomarkers in this unusual disease are scarce. The study objective was to evaluate the prevalence and prognostic impact of a panel of prominent biomarkers in uterine carcinosarcoma (UCS) using an immunohistochemical characterization with four biomarkers. The internal database of a single Brazilian institution was carefully explored to select women diagnosed with UCS who were submitted to surgery and postoperative chemotherapy with carboplatin and paclitaxel between January 2012 and December 2017. Tissue microarrays containing UCS samples were evaluated by immunohistochemistry for L1CAM, CDX2, p53 and microsatellite instability markers. A total of 57 cases were included. The mean age was 65.3 years (standard deviation, SD 7.0). L1CAM was negative (score 0, no staining) in 27 (47.4%) patients. Of L1CAM-positive, 10 (17.5%) showed weak (score 1, <10%), 6 (10.5%) showed moderate (score 2, between 10-50%), and 14 (24.6%) showed strong L1CAM staining (score 3, ≧50%). dMMR occurred in 3 (5.3%) cases. The p53 was aberrantly expressed in 15 (26.3%) tumors. CDX2 was positive in 3 (5.3%) patients. The three-year progression-free survival (PFS) rate in the general population of the study was 21.2% (95% CI: 11.7-38.1) and the three-year overall survival (OS) rate was 29.4% (95% CI: 18.1-47.6). By multivariate analysis, the presence of metastases and CDX2-positive were significantly associated with poorer PFS (p < 0.001 and p = 0.002, respectively) and OS (p < 0.001 and p = 0.009, respectively). The strong influence of CDX2 on prognosis requires further investigation. Biological or molecular variability may have impaired the assessment of the impact of the other markers on survival.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Analysis / Biological markers / Biology and Life Sciences / Biomarkers / Biomarkers, Tumor - analysis / Biomarkers, Tumor - genetics / Cancer / Carboplatin / Carcinosarcoma / CDX2 protein / CDX2 Transcription Factor - genetics / Chemotherapy / Cloning / Colorectal cancer / Data collection / Development and progression / Diagnosis / Endometrial cancer / Female / Gastrointestinal cancer / Genetic aspects / Gynecology / Health aspects / Humans / Immunohistochemistry / Medical prognosis / Medical research / Medicine and Health Sciences / Medicine, Experimental / Metastases / Microsatellite instability / Multivariate analysis / Neural Cell Adhesion Molecule L1 / Ovaries / p53 Protein / Paclitaxel / Patients / Physical Sciences / Population studies / Prevalence studies (Epidemiology) / Prognosis / Radiation therapy / Research and Analysis Methods / Retrospective Studies / Sarcoma / Stability analysis / Staining / Survival / Survival analysis / Tumor proteins / Tumor Suppressor Protein p53 - genetics / Tumors / Uterine cancer / Uterine Neoplasms - genetics / Uterus / Variables