Loss of estrogen receptor/progesterone receptor (ER/PR) in endometrial cancer (EC) is associated with tumor progression and poor outcomes. Elevated pretreatment cancer antigen 125 (CA 125) level is a risk factor for lymph node metastasis (LNM). We evaluated whether the combination of ER/PR expression and CA 125 level could be used as a biomarker to predict LNM. We retrospectively investigated patients with endometrioid EC who underwent complete staging surgery during January 2015 to December 2020. We analyzed ER/PR status using immunohistochemical staining, and quantified its expression using the sum of both ER/PR H-scores. Receiver operating characteristic curves were used to identify optimal cutoff values of H-score and CA 125 levels for predicting LNM. A nomogram for predicting LNM was constructed and validated by bootstrap resampling. In 396 patients, the optimal cutoff values of the ER/PR H-score and CA 125 were 407 (area under the receiver operating characteristic curve: 0.645, P=0.001) and 40 U/mL (area under the receiver operating characteristic curve: 0.762, P<0.001), respectively. Multivariate analysis showed that CA 125 ≥40 UmL (odds ratio: 10.02; 95% CI: 4.74-21.18) and ER/PR H-score <407 (odds ratio: 4.20; 95% CI: 1.55-11.32) were independent predictors. An LNM predictive nomogram was constructed using these 2 variables and our model yielded a negative predictive value and negative likelihood ratio of 98.3% and 0.14, respectively. ER/PR expression with pretreatment CA 125 levels can help estimate LNM risk and aid in decision-making regarding the need for lymphadenectomy in patients with endometrioid EC.

中文翻译：

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雌激素/孕激素受体表达和癌症抗原 125 水平作为估计子宫内膜样子宫内膜癌淋巴结转移的术前预测因子。

子宫内膜癌 (EC) 中雌激素受体/孕激素受体 (ER/PR) 的丧失与肿瘤进展和不良预后相关。治疗前癌抗原 125 (CA 125) 水平升高是淋巴结转移 (LNM) 的危险因素。我们评估了 ER/PR 表达和 CA 125 水平的组合是否可以用作预测 LNM 的生物标志物。我们回顾性调查了 2015 年 1 月至 2020 年 12 月期间接受完整分期手术的子宫内膜样 EC 患者。我们使用免疫组织化学染色分析 ER/PR 状态，并使用 ER/PR H 评分之和量化其表达。接受者操作特征曲线用于确定预测 LNM 的 H 分数和 CA 125 水平的最佳截止值。通过自举重采样构建并验证了用于预测 LNM 的列线图。在396名患者中，ER/PR H评分和CA 125的最佳截止值为407（受试者工作特征曲线下面积：0.645，P=0.001）和40 U/mL（受试者工作特征曲线下面积：0.645，P=0.001）和40 U/mL（受试者工作特征曲线下面积： 0.762，P<0.001）。多变量分析显示，CA 125 ≥40 UmL（优势比：10.02；95% CI：4.74-21.18）和 ER/PR H 评分 <407（优势比：4.20；95% CI：1.55-11.32）是独立预测因子。使用这两个变量构建了 LNM 预测列线图，我们的模型产生的阴性预测值和阴性似然比分别为 98.3% 和 0.14。治疗前 CA 125 水平的 ER/PR 表达有助于估计 LNM 风险，并有助于子宫内膜样 EC 患者是否需要进行淋巴结切除术的决策。