title: L1 Cell Adhesion Molecule as a Predictor of Disease-Specific Survival and Patterns of Relapse in Endometrial Cancer.
abstract: The aim was to study the association of L1 cell adhesion molecule (L1CAM) expression with the outcome of patients with endometrial cancer, especially with regard to conventional risk variables, and to compare the patterns of relapse in L1CAM-positive and -negative cancers.
  
  
  
  This was a retrospective study of 805 women. The Kaplan-Meier method and univariate and multivariate Cox regression models were applied for survival analyses. Missing data were replaced using multiple imputation. The median follow-up time was 51 months (range, 1-98).
  
  
  
  One hundred twenty-one (15.0%) cases were L1CAM positive. L1CAM positivity was associated with high stage (I vs II-IV) (odds ratio [OR], 2.3), lymph node involvement (OR, 2.9), poor differentiation (OR, 6.1), non-endometrioid histology (OR, 9.9), lymphovascular space invasion (OR, 2.8), cervical stromal invasion (OR, 1.8), positive peritoneal cytology (OR, 4.1), and age older than 65 years (OR, 2.8). The frequencies of deep myometrial invasion (50% or deeper), tumor size 2 cm or greater, and body mass index 30 kg/m or greater were not significantly different between L1CAM-positive and -negative cases. L1CAM predicted poor disease-specific survival in endometrioid (P < 0.0001) but not in non-endometrioid carcinomas (P = 0.934). The negative impact of L1CAM on outcome was confirmed in a Cox multivariate disease-specific survival analysis. Univariate survival analyses in the different ESMO-ESGO-ESTRO endometrial cancer risk groups showed an association between L1CAM positivity and poor outcome in intermediate (hazard ratio, 12) and high-risk advanced metastatic (hazard ratio, 2.0) groups. Extra-abdominal relapses were more frequent in L1CAM-positive (13.2%) than L1CAM-negative (1.9%) stage I endometrioid carcinomas (P < 0.0001), whereas other site-specific relapses in local cancers were L1CAM independent.
  
  
  
  L1CAM is associated with the occurrence of poor prognostic variables and predicts advanced disease in endometrial cancer. L1CAM predicts extra-abdominal relapses and poor survival in endometrioid endometrial cancer, but seems not to be a prognostic factor in non-endometrioid carcinomas.
authors.affiliation: Departments of *Pathology, and †Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; ‡Laboratory of Cancer Biology, Institute of Biomedical Technology (BioMediTech), University of Tampere; and §Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
authors.forename: Annukka
authors.initials: A
authors.lastname: Pasanen
authors.forename: Taru
authors.initials: T
authors.lastname: Tuomi
authors.forename: Jorma
authors.initials: J
authors.lastname: Isola
authors.forename: Synnöve
authors.initials: S
authors.lastname: Staff
authors.forename: Ralf
authors.initials: R
authors.lastname: Bützow
authors.forename: Mikko
authors.initials: M
authors.lastname: Loukovaara
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000096:biosynthesis; D018269:Carcinoma, Endometrioid / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016889:Endometrial Neoplasms / Q000378:metabolism* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D039842:Neural Cell Adhesion Molecule L1 / Q000096:biosynthesis*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D046888:Tissue Array Analysis
chemical_list: D014408:Biomarkers, Tumor; D039842:Neural Cell Adhesion Molecule L1