Mustafa Sirri Kotanoglu

The prognostic value of tumor microenvironment in endometrioid type endometrial cancer: Effect of CD44 on oncologic outcome

AbstractObjectivesThe study aimed to evaluate the expression of CD44, CD47, interleukin‐1 (IL‐1), and tumor necrosis factor alpha (TNF‐α) in immunohistochemically stained (IHS) samples from endometrioid endometrial cancer (EEC) and to examine their correlation with clinicopathologic parameters.MethodsIHS was used to assess CD44, CD47, IL‐1, and TNF‐α expression in 53 EEC samples. Immunostaining was scored as negative (−), slightly positive (+), moderately positive (++), or strongly/diffuse positive (+++). The prognostic value of these markers was analyzed in relation to clinicopathologic features, including survival.ResultsIn endometrial cancer tissues, positivity rates were CD44 (81%), CD47 (81%), TNF‐α (40.5%), and IL‐1 (42.9%). Strong and diffuse CD44 staining was associated with improved survival and linked to endocervical invasion and stage. Patients with slightly positive CD47 had significantly higher rates of pelvic and para‐aortic lymph node metastases. Strong TNF‐α staining correlated with grade 3 EEC, while slightly positive IL‐1 staining was associated with increased endocervical invasion. No significant correlation was found between CD47, IL‐1, and TNF‐α expression and survival.ConclusionCD44 and CD47 were positive in most EEC specimens. CD44 expression was the only marker significantly correlated with overall survival and recurrence. TNF‐α showed a positive correlation with high‐grade tumors, and IL‐1 staining was inversely associated with endocervical invasion. These findings suggest that CD44 is a prognostic marker for survival, while TNF‐α and IL‐1 may have indirect prognostic roles in EEC.