Previous studies including various
tumor types have shown different associations between
tumor tissue levels of
plasminogen activator inhibitor 2 (PAI-2) and patient survival. High
tumor tissue concentrations of
PAI-2 have been associated with good prognosis in patients with
breast cancer,
small cell lung cancer and
ovarian cancer, but with poor histologic differentiation and poor prognosis in patients with
colorectal cancer. On the other hand, high
tumor tissue concentrations of
urokinase plasminogen activator (uPA), uPA receptor (R) and
PAI-1 have more consistently been associated with poor histologic differentiation and poor prognosis. Our study quantified
PAI-2 and uPAR using specific
enzyme-linked
immunosorbent assays in homogenates of 274 samples of
endometrial cancer tissue. The prognostic power of each factor was analyzed in the subgroup of patients with early stage disease, i.e., International Federation of Gynecology and Oncology (FIGO) surgical stage I-II (n = 188). This group had a median follow-up time of 6.8 years (range 0.7-9.9), and 23 progressions were observed. The 80(th) percentile for
PAI-2 and uPAR was used to dichotomize the material, and the results were analyzed for associations with clinical data including progression-free survival. The results were also compared with
DNA ploidy status, S-phase fraction, uPA and
PAI-1, which we reported in a previous study (Fredstorp Lidebring et al., Eur J
Cancer 2001; in press). A high
PAI-2 level was associated with shorter progression-free survival in univariate analysis and was an independent prognostic factor in bivariate analyses, which included
PAI-1, uPA and
DNA ploidy status. In contrast, a high level of uPAR had no association with prognosis in early stage
endometrial cancer. The combination of high
PAI-2 and
PAI-1 levels in
tumors revealed a small group of stage I-II patients with an accumulative progression rate of 50%.