ArticleAmerican journal of cancer research2026
Evaluating the prognostic value of estrogen receptor status in stage III MMR-proficient endometrial cancer: real-world data from an Asian population.
Article in American journal of cancer research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
To evaluate the prognostic value of estrogen receptor (ER) expression in mismatch repair-proficient (MMRp) stage III endometrial cancer (EC) in an Asian cohort using an immunohistochemistry (IHC) - based molecular classification, we retrospectively analyzed patients with stage III EC classified by IHC into three molecular subtypes: mismatch repair-deficient (MMRd), TP53-mutant, and MMRp. The MMRp group was further stratified by ER expression (10% cutoff) into ER-positive and ER-negative subgroups, yielding four molecular subtypes. Clinicopathological features and survival outcomes were compared. Ninety-five patients were included: 7 (7.4%) with MMRp ER-negative, 34 (35.8%) with MMRp ER-positive, 27 (28.4%) with MMRd, and 27 (28.4%) with TP53-mutant tumors. With a median follow-up of 61 months, progression-free survival (PFS) and cancer-specific survival (CSS) differed significantly across four IHC-based subtypes (log-rank P = 0.0013 and P<0.0001, respectively). In multivariate Firth's penalized Cox regression, MMRp ER-negative status was an independent predictor of poor PFS (HR 4.91; 95% CI, 1.43-15.80) and CSS (HR 7.44; 95% CI, 1.85-30.80), independent of histologic grade. Even within low-risk MMRp endometrioid grade 1-2 tumors, ER-negativity identified a high-risk subset (12.1%, 4/33). To our knowledge, this is among the first studies to evaluate the prognostic relevance of ER expression in stage III MMRp EC in an Asian cohort using a pragmatic IHC-based approach. Low ER expression identified a distinct high-risk subgroup whose outcomes approached those of TP53-mutant tumors.
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