Expression of pluripotency stem cell markers in endometrial hyperplasia.

BACKGROUND

Endometrial hyperplasia, a precursor to endometrial cancer, is increasing due to rising obesity and lifestyle risks. Scarce data exist on the molecular characterization of endometrial hyperplasia for prognostic and preventive applications,

Objectives

This study investigates the expression of core pluripotency stem cell markers in endometrial hyperplasia, given their emerging role in cancer stem cell regulation in various cancers, including endometrial cancer,

Design

This is a case-control study utilizing archival endometrial tissue blocks. In this study, we assessed the immunohistochemical expression of NANOG, OCT4, and SOX2 in hyperplastic endometrium compared to benign non-hyperplastic endometrium obtained from women with abnormal uterine bleeding,

Results

The investigation included 165 patients (83 cases with endometrial hyperplasia and 82 controls). The prevalence of endometrial hyperplasia in our cohort was 20.8% (of 500 patients). NANOG showed moderate to high expression in 60.2% of endometrial hyperplasia cases, significantly higher than in controls (19.5%), p < 0.0005. OCT4 showed moderate/high expression in 12% of endometrial hyperplasia cases compared to 3.7% of controls (p = 0.045). In comparison, SOX2 was expressed in 18% of endometrial hyperplasia with no significant difference from controls (19.7%), p = 0.823. Logistic regression showed that age and NANOG expression were significant predictors of endometrial hyperplasia risk, with women exhibiting moderate/high NANOG expression having an 11-fold increased risk of endometrial hyperplasia (95% confidence interval of odds ratio: 3.484-35.864, p < 0.001). Using receiver operating characteristic curves, women's age predicted SOX2 expression in endometrial hyperplasia cases (area under the curve (AUC) = 0.867, cutoff = 49 years, Youden's index = 0.722, sensitivity = 100%, specificity = 72.2%, p < 0.001), and NANOG in controls (AUC = 0.734, cutoff = 42 years, Youden's index = 0.37, sensitivity = 68.8%, specificity = 68.2%, p = 0.004).

CONCLUSION

NANOG shows promise for a potential predictive role in patients with endometrial hyperplasia, with moderate/high expression indicating a higher risk. SOX2's role was unclear but age-related. Further studies are needed to validate these findings and explore hormonal links.