title: Immunosuppressive Glycodelin A is an independent marker for poor prognosis in endometrial cancer.
abstract: BACKGROUND
  Knowledge on immunosuppressive factors in the pathogenesis of endometrial cancer is scarce. The aim of this study was to assess Glycodelin (Gd) and its immunosuppressive isoform Glycodelin A (GdA) in endometrial cancer tissue and to analyze its impact on clinical and pathological features and patient outcome.
  
  
  METHODS
  292 patients diagnosed and treated for endometrial cancer were included. Patient characteristics, histology and follow-up data were available. Gd and GdA was determined by immunohistochemistry and in situ hybridization was performed for Gd mRNA.
  
  
  RESULTS
  Endometrial cancer shows intermediate (52.2%) or high (20.6%) expression for Gd in 72.8%, and GdA in 71.6% (intermediate 62.6%, high 9.0%) of all cases. The glycosylation dependent staining of GdA is tumour specific and correlates with the peptide-specific Gd staining though neither of the two is associated with estrogen receptor, progesterone receptor or clinic-pathological features. Also Gd protein positively correlates with Gd mRNA as quantified by in situ hybridization. Gd positive cases have a favourable prognosis (p = 0.039), while GdA positive patients have a poor outcome (p = 0.003). Cox-regression analysis proofed GdA to be an independent prognostic marker for patient survival (p = 0.002), besides tumour stage, grade and the concomitant diagnosis of hypertension.
  
  
  CONCLUSIONS
  Gd and GdA are commonly expressed in endometrial cancer tissue and seem to be of relevance in tumourigenesis. They differ not only in glycosylation but also in their biological activity, since only GdA holds prognostic significance for a poor overall survival in endometrial cancer patients. This finding might be explained by GdAs immunosuppressive capacity.
authors.affiliation: Department of Obstetrics and Gynecology, Ludwig-Maximilians-University Munich, Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany. Miriam.Lenhard@med.uni-muenchen.de.
authors.forename: Miriam
authors.initials: M
authors.lastname: Lenhard
authors.forename: Sabine
authors.initials: S
authors.lastname: Heublein
authors.forename: Christiane
authors.initials: C
authors.lastname: Kunert-Keil
authors.forename: Thomas
authors.initials: T
authors.lastname: Vrekoussis
authors.forename: Isabel
authors.initials: I
authors.lastname: Lomba
authors.forename: Nina
authors.initials: N
authors.lastname: Ditsch
authors.forename: Doris
authors.initials: D
authors.lastname: Mayr
authors.forename: Klaus
authors.initials: K
authors.lastname: Friese
authors.forename: Udo
authors.initials: U
authors.lastname: Jeschke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D016889:Endometrial Neoplasms / Q000235:genetics / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D005260:Female; D000071816:Glycodelin; D006023:Glycoproteins / Q000235:genetics / Q000378:metabolism*; D006031:Glycosylation; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D008875:Middle Aged; D011379:Prognosis; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D000071816:Glycodelin; D006023:Glycoproteins; C045246:PAEP protein, human; D012333:RNA, Messenger