Purpose: Several studies evidenced the potential of
L1CAM as a prognostic marker in
endometrial cancer. The aim of this study was to investigate whether
L1CAM can predict
lymph node metastasis and could therefore be used preoperatively to identify patients with low to high-intermediate risk
endometrial cancer who would profit from a
lymphadenectomy and an adjuvant treatment. To avoid unnecessary morbidity, de-escalating strategies are still required. Methods: Immunohistochemistry for
L1CAM was performed on
curettage or
hysterectomy specimens from 212 patients diagnosed with
endometrial cancer who were treated at the University Hospital Basel during 2011-2019.
L1CAM expression was correlated with clinicopathological features such as histological subtype, FIGO stage,
lymph node metastasis,
lymphadenectomy, adjuvant treatment and outcome. Results: Using a cut off ≥10%,
L1CAM was positive in 41/212 patients (19.3%) and negative in 171/212 patients (80.7%).
L1CAM was associated with high-risk features such as non-endometrioid histology, high tumour grade, and high FIGO stage. There was no significant correlation between
L1CAM expression and
lymph node metastasis. However, patients with
L1CAM positive tumours showed improved disease-specific survival if treated with
adjuvant radiotherapy. Conclusion: Although
L1CAM expression pointed towards aggressive tumour biology, preoperative
L1CAM analysis did not add any substantial predictive information regarding
lymph node metastasis in low to high-intermediate risk groups. Therefore,
L1CAM status is not suitable to tailor the surgical algorithm for lymph node staging. Nevertheless, our results suggest that
L1CAM could be used as a predictive
biomarker to select patients who may benefit the most from
adjuvant radiotherapy.