Comparison of Different Scoring Systems in the Assessment of Estrogen Receptor Status for Predicting Prognosis in Endometrial Cancer

The objective of this article is to compare the effectiveness of various estrogen receptor (ER) scoring systems for predicting prognosis in endometrial cancer (EC). We retrospectively analyzed 195 cases of primary EC with complete follow-up information. Three different methods-the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) criterion, histochemistry score (H-score), and Allred scoring system-were used to assess the degree of staining, and comparisons were made to determine which method correlated best with clinical outcomes. The ASCO/CAP criterion, H-score (cutoff value, 51-300), and Allred (cutoff value, 4-8) scoring systems showed high concordance in the following aspects: the ER status was significantly associated with subtype (type I vs. type II EC), newly recommended histologic type (grade 1-2, type I vs. grade 3, type I+type II EC), progesterone receptor status, overall survival, and cancer-specific survival in EC patients. Considering International Federation of Gynecology and Obstetrics stage, lymphovascular space invasion, and lymph node metastasis, the ASCO/CAP criterion significantly exceeded the other 2 scoring systems. Furthermore, cases judged as ER positive by the ASCO/CAP criterion, but ER negative by the other 2 scoring systems, displayed similarly favorable outcomes to those cases that were consistently admitted as ER positive by all 3 scoring systems. The ASCO/CAP criterion was superior to both H-score and Allred score in terms of predictive and prognostic values. This easy, simple, and highly efficient criterion should be recommended for routine assessment of ER in EC patients.