Pattern of lymph node metastasis and p53 abnormal (p53abn) expression in preoperative early-stage endometrial cancer: A 5-year institutional experience.

Angeli Anne C ANG; Carolyn R ZALAMEDA-CASTRO; Cecile C DUNGOG; Michele H DIWA; Karen Cybelle J SOTALBO

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Pattern of lymph node metastasis and p53 abnormal (p53abn) expression in preoperative early-stage endometrial cancer: A 5-year institutional experience.

Author: Angeli Anne C. ANG ¹ ; Carolyn R. ZALAMEDA-CASTRO ¹ ; Cecile C. DUNGOG ² ; Michele H. DIWA ² ; Karen Cybelle J. SOTALBO ²
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1. Philippine General Hospital, University of the Philippines Manila, Manila, Metro Manila, NCR, Philippines
2. Department of Pathology, College of Medicine, University of the Philippines Manila, University of the Philippines, Metro Manila, NCR, Philippines
Publication Type:Journal Article, Original
MeSH: Therapeutics; Survival Rate; Risk Factors; Recurrence; Prognosis; Pathology; Endometrial Neoplasms; Immunohistochemistry; Tumor Suppressor Protein P53; Lymph Node Excision; Risk Assessment
From: Acta Medica Philippina 2026;60(8):98-106
CountryPhilippines
Abstract: BACKGROUND
Early-stage endometrial cancer often presents with favorable survival rates, but high-risk factors, including TP53 mutations and high-grade serous pathology, can lead to recurrence and poor prognosis. The standard primary treatment for endometrial cancer is surgical staging, and lymph node metastases significantly impact adjuvant therapy decisions. The subgroup of p53-abnormal (p53abn) indicates the worst prognosis and potential benefits from adjuvant chemotherapy. Molecular classification, while recommended, faces practical challenges due to resource constraints.
OBJECTIVES
The study aimed to assess the incidence of p53 abnormal expression in clinical stage 1 endometrial cancer cases that underwent surgery at a government tertiary hospital, and assess its relationship with clinicopathologic factors and pelvic and paraaortic lymph node metastasis (LNM).
METHODS
A cross-sectional retrospective analysis was conducted on clinical early-stage endometrial cancer cases that underwent surgical primary treatment between January 2018 and December 2022. Patient records were reviewed to gather demographics, surgical information, and pathological evaluations. Preoperative clinical staging was determined through imaging, and surgical staging involved comprehensive lymphadenectomy. Immunohistochemistry studies for p53 were carried out on formalin-fixed paraffin-embedded tissue samples.
RESULTS
A total of 233 endometrial cancer cases were included. The mean age at diagnosis was 53.7 years. Common comorbidities included hypertension (47.2%) and dyslipidemia (20.6%). Most cases were endometrioid histology (82.8%) and low-grade tumors (85.8%). Tumor grade (p=0.010), myometrial invasion (pCONCLUSION
Tumor grade, myometrial invasion, and LVSI were all significantly associated with lymph node involvement. While p53 immunohistochemical stains show promise in predicting metastasis and has been associated with tumor aggressiveness, this should still be correlated with clinicopathological parameters to carry out a more accurate risk stratification of early-stage patients.