Correlation between overexpression of connective tissue growth factor, tumor progression, and clinical prognosis in endometrial cancer patients

Objective: To investigate the correlation between overexpression of connective tissue growth factor (CTGF), tumor progression, and clinical prognosis in patients with endometrial cancer. Methods: Tumor samples were obtained from 198 patients with endometrial cancer who underwent hysterectomy, and 50 samples were collected from normal endometrial tissue. Immunohistochemical staining was performed on all samples. Scoring was carried out by two independent pathologists experienced in evaluating immunohistochemical staining. Results: Normal endometrial specimens exhibited little or no CTGF immunoreactivity. CTGF was localized mainly in the cytoplasm of the tumor cells. Of the endometrial cancer specimens examined, 95 (48%) of 198 patients were negative for CTGF, whereas 103 (52%) of 198 patients were positive for CTGF. No significant correlation was noted between the level of CTGF and patient age (P=0.81), blood pressure (P=0.76), blood glucose (P=0.51) or vascular/lymphatic invasion (P=0.15). However, positive CTGF expression showed a strong association with the level of CA125 (P=0.02), histologic grade (P=0.004), depth of myometrial invasion (P=0.028), and FIGO stage (P=0.025). Independent predictive value for overall survival was shown for positive CTGF expression (P<0.001), lymph node status (P<0.001) as well as lymphovascular invasion (P=0.02). Conclusion: CTGF is an independent prognostic factor of endometrial cancer. CTGF expression may play a critical role in progression of endometrial cancer and is significantly associated with poor prognosis.