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Frequent Loss of Expression of the Cyclin-Dependent Kinase Inhibitor p27^Kip1 in Estrogen-Related Endometrial Adenocarcinomas

Department of Pathology, Anatomy and Cell Biology, Jefferson Medical College, Philadelphia, Pennsylvania [V. M., A. Z., C.M.]; Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, Pennsylvania [A. G.]; Departments of Obstetrics and Gynecology [T. S., G. A.] and Surgical Pathology [D. M., G.T.], University of Florence, Florence, Italy; Department of Obstetrics and Gynecology, St. Orsola Hospital, University of Bologna, Bologna, Italy [A. B., P. D. I., M. C., L. B.]; and Departments of Obstetrics and Gynecology [S. M., G. S.] and Surgical Pathology [N. M.], Catholic University, Rome, Italy

Purpose: p27^Kip1 is a member of the Cip1/Kip1 family of cyclin-dependent kinase inhibitors and is a potential tumor suppressor gene. Low levels of p27 are associated with poor prognosis in a variety of gynecological tumors, including breast, ovarian, and cervical carcinomas. The role of p27 in endometrial cancer remains controversial.

Experimental Design: In the present study, p27 protein expression was investigated by immunohistochemistry in a series of 217 endometrial adenocarcinomas and, where present, in synchronous normal endometrium, simple and complex hyperplasia (with or without atypia), and cystic atrophy. The relationship between p27 expression and clinical outcome was also evaluated.

Results: Immunohistochemical analysis revealed a significant loss of p27 expression from normal (33%) through hyperplastic endometrium (50%) to endometrial adenocarcinomas (71%; P 0.001). In addition to nuclear staining, cytoplasmic localization of p27 was noted in 193 (91%) of 217 specimens examined. When the clinical outcome of the patients was evaluated in relation to p27 status, we found no significant correlation between the presence of p27 staining and clinicopathological parameters or survival.

Conclusions: These data indicate that p27 expression could progressively decrease from normal endometrium through hyperplastic endometrium to invasive endometrial carcinomas, suggesting that loss of this tumor suppressor may represent a novel and distinct molecular alteration involved in estrogen-related endometrial adenocarcinomas (type I). Despite the suggested role of the p27 protein in determining the prognosis of several human tumors, it was not found to be a predictor of clinical outcome in this large group of patients with endometrial cancer.

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