Association of HER2, p53, and lymphovascular space invasion with lymph node metastasis in endometrial cancer: a retrospective cohort study

Background The assessment of lymph node metastasis (LNM) in endometrial carcinoma is critical for optimizing the extent of surgical resection and formulating individualized therapies. This study aimed to investigate the associated factors of the LNM in endometrial carcinoma. Methods 438 patients with endometrial carcinoma who underwent primary surgical staging between June 2014 and June 2025 were retrospectively analyzed. Clinicopathological data and immunohistochemical expression profiles of ER, PR, HER2, p53, Ki67, ERCC1, and GST-π were systematically collected. Univariate and multivariate logistic regression analyses were performed to identify independent associated factors for LNM. Results The overall incidence of LNM in the study was 10.27% (45/438). Univariate analysis revealed that menopausal status, histological grade, Bokhman pathological subtype, depth of myometrial invasion, lymphovascular space invasion (LVSI), and the expression levels of ER, PR, Ki67, p53, and HER2 were significantly associated with LNM (all P < 0.05). Subsequent multivariate analysis identified each one-category increase in HER2 staining level was associated with higher odds of LNM (OR 3.859, 95% CI 2.314–6.436, P < 0.001), as was each one-category increase in p53 staining level (OR 1.932, 95% CI 1.212–3.082, P = 0.006). The presence of LVSI was also an independent associated factor for LNM. Conclusions Higher p53 and HER2 staining levels and the presence of LVSI are independently associated with LNM in endometrial carcinoma.