Molecular clustering of endometrial carcinoma based on estrogen-induced gene expression

Cancer Biol Ther. 2009 Nov;8(22):2126-35. doi: 10.4161/cbt.8.22.9740. Epub 2009 Nov 5.


Identification of biomarkers potentially provides prognostic information that can help guide clinical decision-making. Given the relationship between estrogen exposure and endometrial cancer, especially low grade endometrioid carcinoma, we hypothesized that high expression of genes induced by estrogen would identify low risk endometrioid endometrial cancers. cDNA microarray and qRT-PCR verification were used to identify six genes that are highly induced by estrogen in the endometrium. These estrogen-induced biomarkers were quantified in 72 endometrial carcinomas by qRT-PCR. Unsupervised cluster analysis was performed, with expression data correlated to tumor characteristics. Time to recurrence by cluster was analyzed using the Kaplan-Meier method. A receiver operating characteristic (ROC) curve was generated to determine the potential clinical utility of the biomarker panel to predict prognosis. Expression of all genes was higher in endometrioid carcinomas compared to non-endometrioid carcinomas. Unsupervised cluster analysis revealed two distinct groups based on gene expression. The high expression cluster was characterized by lower age, higher BMI, and low grade endometrioid histology. The low expression cluster had a recurrence rate 4.35 times higher than the high expression cluster. ROC analysis allowed for the prediction of stage and grade with a false negative rate of 4.8% based on level of gene expression in endometrioid tumors. We have therefore identified a panel of estrogen-induced genes that have potential utility in predicting endometrial cancer stage and recurrence risk. This proof-of-concept study demonstrates that biomarker analysis may play a role in clinical decision making for the therapy of women with endometrial cancer.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor
  • Body Mass Index
  • Carcinoma, Endometrioid / epidemiology
  • Carcinoma, Endometrioid / genetics*
  • Carcinoma, Endometrioid / metabolism
  • Carcinoma, Endometrioid / pathology
  • Cluster Analysis
  • Endometrial Neoplasms / epidemiology
  • Endometrial Neoplasms / genetics*
  • Endometrial Neoplasms / metabolism
  • Endometrial Neoplasms / pathology
  • Equilin / administration & dosage
  • Equilin / adverse effects
  • Equilin / analogs & derivatives*
  • Equilin / pharmacology
  • Estrogen Replacement Therapy* / adverse effects
  • Estrogens, Conjugated (USP) / adverse effects
  • Estrogens, Conjugated (USP) / pharmacology*
  • Estrogens, Conjugated (USP) / therapeutic use
  • Estrone / administration & dosage
  • Estrone / adverse effects
  • Estrone / analogs & derivatives*
  • Estrone / pharmacology
  • Female
  • Gene Expression Profiling*
  • Gene Expression Regulation, Neoplastic / drug effects*
  • Genetic Association Studies*
  • Humans
  • Middle Aged
  • Neoplasm Proteins / biosynthesis
  • Neoplasm Proteins / genetics*
  • Oligonucleotide Array Sequence Analysis
  • Prognosis
  • ROC Curve
  • Randomized Controlled Trials as Topic
  • Reverse Transcriptase Polymerase Chain Reaction


  • Biomarkers, Tumor
  • Estrogens, Conjugated (USP)
  • Neoplasm Proteins
  • Equilin
  • Estrone
  • equilin sulfate
  • estrone sulfate