1. ¹Department of Pathology, Baylor College of Medicine, Houston, TX, USA
2. ²The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
3. ³Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
4. ⁴Department of Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
5. ⁵Department of Pathology, Shihezi University School of Medicine, Shihezi, People's Republic of China

Correspondence: Dr J Liu, MD, PhD, Department of Pathology, Unit 085, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. E-mail: jliu@mdanderson.org

Received 16 January 2009; Revised 5 August 2009; Accepted 6 August 2009; Published online 9 October 2009.

Abstract

Mutations in the -catenin gene are common in ovarian endometrioid carcinoma. Few studies have addressed the association of -catenin expression with tumor characteristics and patient outcome, yielding controversial results. The purpose of this study was to retrospectively assess the expression of -catenin in ovarian endometrioid carcinoma and correlate its expression with the Gynecologic Oncology Group's (GOG) grading system, clinicopathological characteristics, and patient survival. A total of 49 patients with primary ovarian endometrioid carcinoma were included in this study. A four-tier score grading system was used for the membranous staining (negative, weak, moderate, and strong) and the percentage of positive cells for the nuclear staining of -catenin. The status of five morphometric parameters, nuclear morphology (uniform or pleomorphic), mitotic count, glandular pattern, degree of squamous differentiation, and status of papillary pattern, was assessed. We found that a low membranous expression of -catenin and a high mitotic count (>15 per 10 high-power fields) were significantly associated with poor prognosis and early recurrence of ovarian endometrioid carcinoma. In addition, cases with nuclear expression of -catenin showed an intermediate overall survival risk and late disease recurrence. Young age at the time of diagnosis, advanced disease stage, and suboptimal debulking were among the clinical factors predicting poor survival and early disease recurrence. The presence of squamous differentiation, a papillary pattern or nuclear pleomorphism did not show any correlation with overall survival or disease-free survival. Low membranous expression of -catenin and high mitotic count are poor prognostic indicators in patients with ovarian endometrioid carcinoma, whereas the GOG grading system showed no prognostic value. Our data suggest that there is a need to define a better grading system for ovarian endometrioid carcinoma. Molecular markers such as -catenin and mitotic count could aid in defining this grading system.