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Comparison of Different Scoring Systems in the Assessment of Estrogen Receptor Status for Predicting Prognosis in Endometrial Cancer

Wang, Yue, M.S.; Ma, Xiaolong, M.B.S.; Wang, Yuxiang, M.D., Ph.D.; Liu, Yan, M.D., Ph.D.; Liu, Congrong, M.D., Ph.D.

International Journal of Gynecological Pathology: March 2019 - Volume 38 - Issue 2 - p 111–118
doi: 10.1097/PGP.0000000000000490

The objective of this article is to compare the effectiveness of various estrogen receptor (ER) scoring systems for predicting prognosis in endometrial cancer (EC). We retrospectively analyzed 195 cases of primary EC with complete follow-up information. Three different methods—the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) criterion, histochemistry score (H-score), and Allred scoring system—were used to assess the degree of staining, and comparisons were made to determine which method correlated best with clinical outcomes. The ASCO/CAP criterion, H-score (cutoff value, 51–300), and Allred (cutoff value, 4–8) scoring systems showed high concordance in the following aspects: the ER status was significantly associated with subtype (type I vs. type II EC), newly recommended histologic type (grade 1–2, type I vs. grade 3, type I+type II EC), progesterone receptor status, overall survival, and cancer-specific survival in EC patients. Considering International Federation of Gynecology and Obstetrics stage, lymphovascular space invasion, and lymph node metastasis, the ASCO/CAP criterion significantly exceeded the other 2 scoring systems. Furthermore, cases judged as ER positive by the ASCO/CAP criterion, but ER negative by the other 2 scoring systems, displayed similarly favorable outcomes to those cases that were consistently admitted as ER positive by all 3 scoring systems. The ASCO/CAP criterion was superior to both H-score and Allred score in terms of predictive and prognostic values. This easy, simple, and highly efficient criterion should be recommended for routine assessment of ER in EC patients.

Department of Pathology, School of Basic Medical Sciences, Third Hospital (Yue W., X.M., Yuxiang W., Y.L.)

Department of Pathology, Health Science Center (C.L.), Peking University

Department of Pathology, Peking University Shougang Hospital (Yue W.), Beijing, China

Supported by (1) National Natural Science Foundation of China (Grant No. 81472430), (2) Beijing Municipal Natural Science Foundation (7162102), (3) National Key Scientific Instruments and Equipment Development Program of China (2013YQ03065108).

The authors declare no conflict of interest.

Address correspondence and reprint requests to Congrong Liu, MD, PhD, Department of Pathology, Health Science Center, Peking University, Room 137, Pathology Building No. 38, Xueyuan Road, Haidian District, Beijing 100191, China. E-mail:

©2019International Society of Gynecological Pathologists