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Background <p>Endometrial cancer has rising incidence and mortality, with high recurrence rates (10%–70%) post-surgery. Discrepancies between preoperative biopsy and postoperative pathology, particularly in estrogen receptor (ER) and progesterone receptor (PR) expression, may misguide treatment. This single-center study explored ER/PR expression dynamics pre- and post-surgery and developed a recurrence prediction model for clinical reference in comparable settings.</p> Methods <p>A retrospective cohort of 600 stage I–III endometrial cancer patients (2017–2021) exclusively from a single center was analyzed. Preoperative biopsies (blind vs. hysteroscopy-guided) and postoperative specimens underwent ER/PR immunohistochemical testing. Concordance was assessed via Cohen’s kappa. Survival analysis (Kaplan-Meier), ROC curves, and Cox regression identified prognostic factors. A nomogram integrating PR expression dynamics and clinicopathological parameters was developed and validated.</p> Results <p>ER and PR expression showed moderate-to-substantial overall concordance (86.8%, κ = 0.481; 87.1%, κ = 0.676), with hysteroscopy-guided biopsies demonstrating superior agreement (ER: 94.0%, κ = 0.733; PR: 91.4%, κ = 0.742) versus blind biopsies. Combined pre-/postoperative PR expression improved recurrence prediction (AUC = 0.680). The integrated nomogram (AUC = 0.864) effectively stratified high-risk patients (3-year recurrence-free survival: 53.40% vs. 86.05% in non-high-risk), who benefited from adjuvant therapy.</p> Conclusions <p>Hysteroscopy-guided biopsy enhances ER/PR assessment accuracy. The nomogram integrating PR dynamics and clinical parameters enables precise recurrence risk stratification, aiding personalized adjuvant therapy decisions in similar clinical settings.</p> Trial registration <p>Not applicable.</p>

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Differential expression of estrogen and progesterone receptors before and after surgery in endometrial cancer and analysis of recurrence prediction model

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月13日

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  • Ruixue Fan,
  • Peng Jiang,
  • Zhuoying Hu

摘要

Background

Endometrial cancer has rising incidence and mortality, with high recurrence rates (10%–70%) post-surgery. Discrepancies between preoperative biopsy and postoperative pathology, particularly in estrogen receptor (ER) and progesterone receptor (PR) expression, may misguide treatment. This single-center study explored ER/PR expression dynamics pre- and post-surgery and developed a recurrence prediction model for clinical reference in comparable settings.

Methods

A retrospective cohort of 600 stage I–III endometrial cancer patients (2017–2021) exclusively from a single center was analyzed. Preoperative biopsies (blind vs. hysteroscopy-guided) and postoperative specimens underwent ER/PR immunohistochemical testing. Concordance was assessed via Cohen’s kappa. Survival analysis (Kaplan-Meier), ROC curves, and Cox regression identified prognostic factors. A nomogram integrating PR expression dynamics and clinicopathological parameters was developed and validated.

Results

ER and PR expression showed moderate-to-substantial overall concordance (86.8%, κ = 0.481; 87.1%, κ = 0.676), with hysteroscopy-guided biopsies demonstrating superior agreement (ER: 94.0%, κ = 0.733; PR: 91.4%, κ = 0.742) versus blind biopsies. Combined pre-/postoperative PR expression improved recurrence prediction (AUC = 0.680). The integrated nomogram (AUC = 0.864) effectively stratified high-risk patients (3-year recurrence-free survival: 53.40% vs. 86.05% in non-high-risk), who benefited from adjuvant therapy.

Conclusions

Hysteroscopy-guided biopsy enhances ER/PR assessment accuracy. The nomogram integrating PR dynamics and clinical parameters enables precise recurrence risk stratification, aiding personalized adjuvant therapy decisions in similar clinical settings.

Trial registration

Not applicable.