Clinicopathological significance of immunohistochemical expression of p53 and PTEN in endometrial carcinoma

Background: Endometrial carcinoma (EC) is prognostically heterogeneous; p53 immunohistochemistry (IHC) is an established marker for risk stratification, while phosphatase and tensin homolog (PTEN) has also been investigated as a complementary biomarker alongside p53. This study evaluated the relationship between p53 and PTEN IHC expression and clinicopathologic characteristics in EC. Methods: Seventy-eight patients with EC who underwent primary surgical staging between 2019 and 2020 were retrospectively analysed. Clinicopathological variables, IHC expression of p53 and PTEN, and survival outcomes were assessed. Overall survival (OS) and disease-specific survival (DSS) were analysed using Kaplan-Meier estimates and Cox proportional hazards models. Results: Of the 78 cases, 70 (89.7%) were endometrioid, 5 (6.4%) serous, 2 (2.6%) clear cell, and 1 (1.3%) carcinosarcoma. Immunohistochemically, 16 (20.5%) tumours showed abnormal p53 expression, and 62 (79.5%) showed a p53 wild-type pattern. Compared with p53 wild-type group, p53 abnormal expression was associated with significantly higher frequencies of lymphovascular space invasion (LVSI) (p = 0.028), myometrial invasion (MI) >50% (p = 0.044), and grade 3(G3) tumours (p = 0.014 and p = 0.004). Low/negative PTEN expression correlated with LVSI (p = 0.023). Combined analysis of p53 and PTEN showed significant associations with LVSI (p = 0.015) and histologic grade (p = 0.038 and p = 0.011). Significant differences in OS and DSS were observed according to p53 expression (p = 0.004; p = 0.001). Multivariate Cox regression showed that abnormal p53 expression remained an independent prognostic factor for both OS and DSS in EC. Conclusions: Aberrant p53 expression was associated with adverse clinicopathological features and poorer survival in EC. PTEN loss was associated with LVSI but did not demonstrate independent prognostic value. Prospective studies are needed to validate these findings.

Endometrial carcinoma (EC); p53; PTEN; Lymphovascular space invasion (LVSI); Myometrial invasion (MI); Histologic grade (G)

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