COMBINED BCL-2–KI-67 SCORE AND ITS CORRELATION WITH TUMOUR INFILTRATING LYMPHOCYTES IN ENDOMETRIAL CARCINOMA – A NOVEL STUDY
DOI:
https://doi.org/10.22159/ijcpr.2026v18i1.8032Keywords:
Bcl-2, Ki-67, Tumor Infiltrating Lymphocytes, Endometrial Carcinoma, ImmunohistochemistryAbstract
Objective: This study aimed to evaluate a combined Bcl-2–Ki-67 score and assess its correlation with TILs in endometrioid endometrial carcinoma.
Methods: A retrospective analysis was performed on 40 cases of endometrioid endometrial carcinoma, from January 2017 to June 2018. Immunohistochemically staining for Bcl-2 and Ki-67 was performed, and a combined score was generated by inverting the Bcl-2 score and summing with the Ki-67 score. TILs were evaluated as low (<10%), moderate (20–40%), and high (>50%). Correlation between the combined score and TILs was analyzed using Fisher’s exact test, and interobserver agreement for TIL assessment was calculated using the Kappa coefficient.
Results: Combined Bcl-2–Ki-67 scores ranged from 0–6. A significant inverse correlation was observed between the combined score and TILs (p=0.00105, Fisher’s exact test). Interobserver agreement for TIL scoring was high (κ = 0.82).
Conclusion: The combined Bcl-2–Ki-67 score inversely correlates with TIL levels in endometrioid endometrial carcinoma, highlighting its potential use as a prognostic marker. Further studies with larger cohorts are warranted to validate these findings.
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1. Srikantia N, Rekha B, Rajeev AG, Kalyan SN. Endometrioid endometrial adenocarcinoma in a premenopausal woman with multiple organ metastases. Indian J Med Paediatr Oncol. 2009;30(2):80-3. doi: 10.4103/0971-5851.60053, PMID 20596308.
2. Njoku K, Barr CE, Crosbie EJ. Current and emerging prognostic biomarkers in endometrial cancer. Front Oncol. 2022;12:890908. doi: 10.3389/fonc.2022.890908, PMID 35530346.
3. Kurman RJ, Carcangiu ML, Herrington CS, Young RH. WHO classification of tumours of female reproductive organs. 4th ed. Lyon: IARC; 2014. doi: 10.1016/B978-92-832-2431-5.00001-6.
4. Coll-de la Rubia E, Martinez Garcia E, Dittmar G, Gil-Moreno A, Cabrera S, Colas E. Prognostic biomarkers in endometrial cancer: a systematic review and meta-analysis. J Clin Med. 2020;9(6):1900. doi: 10.3390/jcm9061900, PMID 32560580.
5. Krishna Kumar K, Upadhyaya K, Cn RT. Bcl-2 may contribute to evolution of endometrial hyperplasia, but it isn’t a factor in subsequent carcinogenesis. Arch Razi Inst. 2024;79(4):827-32. doi: 10.32592/ARI.2024.79.4.827, PMID 40256590.
6. Kandaswamy S, Palanisamy P. Immunohistochemical expression of BCL-2 in endometrial carcinoma and its comparison with hormone receptor status and epidermal growth factor. Cureus. 2023;15(1):e33346. doi: 10.7759/cureus.33346, PMID 36751174.
7. Laban M, Ibrahim EA, Agur W, Elddin Ahmed AM. Bcl-2 may play a role in the progression of endometrial hyperplasia and early carcinogenesis, but not linked to further tumorigenesis☆. J Microsc Ultrastruct. 2015;3(1):19-24. doi: 10.1016/j.jmau.2014.11.001, PMID 30023177.
8. Zannoni GF, Bragantini E, Castiglione F, Fassan M, Troncone G, Inzani F. Current prognostic and predictive biomarkers for endometrial cancer in clinical practice: recommendations/proposal from the Italian study group. Front Oncol. 2022 Apr 8;12:805613. doi: 10.3389/fonc.2022.805613, PMID 35463299.
9. Rashidi B, Rad JS, Rad LR. Immunohistochemical (Ki-67) study of endometrial maturation in mice after use of phosphodiesterase type 5 inhibitor. Adv Biomed Res. 2015;4:154. doi: 10.4103/2277-9175.161581, PMID 26380239.
10. Bohiltea RE, Sajin M, Furtunescu F, Bohiltea LC, Mihart A, Baros A. Clinical and pathological correlations in endometrial pathology. J Med Life. 2015 Oct-Dec;8(4):552-62. PMID 26664489.
11. Jia M, Pi J, Zou J, Feng M, Chen H, Lin C. The potential value of Ki-67 in prognostic classification in early low-risk endometrial cancer. Cancer Control. 2023;30:10732748231206929. doi: 10.1177/10732748231206929, PMID 37924202.
12. Kitson S, Sivalingam VN, Bolton J, McVey R, Nickkho Amiry M, Powell ME. Ki-67 in endometrial cancer: scoring optimization and prognostic relevance for window studies. Mod Pathol. 2017;30(3):459-68. doi: 10.1038/modpathol.2016.203, PMID 27910946.
13. Ozturk C, Askan G, Ozturk SD, Okcu O, Sen B, Bedir R. High tumor infiltrating lymphocytes are associated with overall survival and good prognostic parameters in endometrial endometrioid carcinoma patients. Turk Patoloji Derg. 2023;39(1):75-82. doi: 10.5146/tjpath.2022.01596, PMID 36441005.
14. Rogers PA, Lederman F, Plunkett D, Affandi B. Bcl-2, Fas and caspase 3 expression in endometrium from levonorgestrel implant users with and without breakthrough bleeding. Hum Reprod. 2000;15(Suppl 3):152-61. doi: 10.1093/humrep/15.suppl_3.152, PMID 11041231.
15. Sakuragi N, Ohkouchi T, Hareyama H, Ikeda K, Watari H, Fujimoto T. Bcl-2 expression and prognosis of patients with endometrial carcinoma. Int J Cancer. 1998 Apr 17;79(2):153-8. doi: 10.1002/(SICI)1097-0215(19980417)79:2<153::AID-IJC10>3.0.CO;2-B, PMID 9583730.
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