BACKGROUND: Identification of aggressive endometrioid endometrial carcinomas (EECs) and non-endometrioid carcinomas (NEECs) is essential to improve outcome. L1 cell adhesion molecule (L1CAM) expression is a strong prognostic marker in stage I EECs, but less is known about L1CAM expression in advanced-stage EECs and NEECs. This study analyses L1CAM expression in a clinically representative cohort of endometrial carcinomas. METHODS: The expression of L1CAM was immunohistochemically determined in 1199 endometrial carcinomas, treated at one of the European Network for Individualized Treatment of Endometrial Cancer (ENITEC) centres. Staining was considered positive when >10% of the tumour cells expressed L1CAM. The association between L1CAM expression and several clincopathological characteristics and disease outcome was calculated. RESULTS: In all, L1CAM was expressed in 10% of the 935 stage I EECs, 18% of the 160 advanced stage EECs, and 75% of the 104 NEECs. The expression of L1CAM was associated with advanced stage, nodal involvement, high tumour grade, non-endometrioid histology, lymphovascular space invasion, and distant recurrences in all cases, and with reduced survival in the EECs, but not in the NEECs. CONCLUSIONS: The expression of L1CAM is a strong predictor of poor outcome in EECs, but not NEECs. It is strongly associated with non-endometrioid histology and distant spread, and could improve the postoperative selection of high-risk endometrial carcinomas. The value of L1CAM expression in the preoperative selection of high-risk endometrial carcinomas should be studied.

Biomedical Research Group in Gynecology Vall Hebron Institute of Research Universitat Autònoma de Barcelona Passeig de la Vall d'Hebron 119 129 Barcelona 08035 Spain

Center for Cancer Biomarkers University of Bergen PO Box 7800 Bergen 5020 Norway

Department of Clinical Science University of Bergen PO Box 7800 Bergen 5020 Norway

Department of Gynecology and Obstetrics Faculty of Medicine Masaryk University Kamenice 5 Brno 625 00 Czech Republic

Department of Obstetrics and Gynaecology Canisius Wilhelmina Hospital Weg door Jonkerbos 100 Nijmegen 6532SZ The Netherlands

Department of Obstetrics and Gynaecology Radboud University Medical Center Geert Grooteplein 10 Nijmegen 6525GA The Netherlands

Department of Obstetrics and Gynaecology TweeSteden Hospital Doctor Deelenlaan 5 Tilburg 5042AD The Netherlands

Department of Obstetrics and Gynecology Bichat Claude Bernard Hospital 46 Rue Henri Huchard Paris 75018 France

Department of Obstetrics and Gynecology Division of Gynecologic Oncology University Hospital Gasthuisberg Herestraat 49 Leuven 3000 Belgium

Department of Obstetrics and Gynecology Haukeland University Hospital Jonas Lies vei 65 Bergen 5021 Norway

Department of Obstetrics and Gynecology Hospital del Mar Passeig Marítim 25 29 Barcelona 08003 Spain

Department of Obstetrics and Gynecology University Medical Center Freiburg Hugstetter Strasse 55 Freiburg 79106 Germany

Department of Pathology and Molecular Genetics and Research Laboratory Hospital Universitari Arnau de Vilanova University of Lleida IRBLLEIDA Avenida Alcalde Rovira Roure 80 Lleida 25198 Spain

Department of Pathology Anthoni van Leeuwenhoek Hospital Plesmanlaan 121 Amsterdam 1066CX The Netherlands

Department of Pathology Bichat Claude Bernard Hospital 46 Rue Henri Huchard Paris 75018 France

Department of Pathology Canisius Wilhelmina Hospital Weg door Jonkerbos 100 Nijmegen 6532SZ The Netherlands

Department of Pathology Hospital del Mar Passeig Marítim 25 29 Barcelona 08003 Spain

Department of Pathology Radboud University Medical Center Geert Grooteplein 10 Nijmegen 6525GA The Netherlands

Department of Pathology University of Turku PO Box 7245 Laskut Turku 01051 Finland

Department of Pathology Vall Hebron University Hospital Passeig de la Vall d'Hebron 119 129 Barcelona 08035 Spain

German Cancer Consortium Im Neuenheimer Feld 280 Heidelberg D 69120 Germany

Gynecological Department Vall Hebron University Hospital Passeig de la Vall d'Hebron 119 129 Barcelona 08035 Spain

Institute of Pathology Faculty of Medicine Masaryk University Kamenice 5 Brno 625 00 Czech Republic

Institute of Pathology University Medical Center Freiburg Hugstetter Strasse 55 Freiburg 79106 Germany

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