Predictive value of immunohistochemical parameters combined with clinicopathological features in predicting...

To evaluate the predictive value of immunohistochemical markers combined with clinicopathological parameters for recurrence after lymph node dissection in patients with endometrial cancer (EC) and to construct a comprehensive risk assessment model.

A retrospective study was conducted on 118 EC patients who underwent radical surgery with systematic lymph node dissection between January 2023 and December 2025. Clinicopathological characteristics and expression of estrogen receptor (ER), progesterone receptor (PR), p53, and Ki-67 were collected. Kaplan-Meier (KM) analysis, Log-rank test, and Cox proportional hazards regression (Cox regression) models were used to identify prognostic factors. Receiver operating characteristic (ROC) curves and the DeLong test were applied to assess predictive performance.

During a median follow-up of 26 months, 28 patients (23.7%) experienced recurrence. Univariate analysis showed that advanced International Federation of Gynecology and Obstetrics stage (FIGO stage), poor differentiation, deep myometrial invasion, positive lymphovascular space invasion (LVSI), lymph node metastasis, aberrant p53 expression, and high Ki-67 expression were significantly associated with recurrence (all P<0.05). Multivariate analysis identified lymph node metastasis (P = 0.005), aberrant p53 expression (P = 0.008), Ki-67 ≥30% (P = 0.022), and LVSI positivity (P = 0.042) as independent risk factors. The combined model achieved an area under the curve (AUC) of 0.876 (95% confidence interval (CI): 0.807-0.945), with a sensitivity of 85.7% and specificity of 82.2%, outperforming individual predictors (all P<0.05).

Key clinicopathological and immunohistochemical factors are independently associated with recurrence after lymph node dissection in EC. The model may improve risk stratification and support postoperative follow-up and risk management.