Differential Expression of Estrogen and Progesterone Receptors Before and After Surgery in Endometrial Cancer and Analysis of Recurrence Prediction Model

Background Endometrial cancer has rising incidence and mortality, with high recurrence rates (10–70%) post-surgery. Discrepancies between preoperative biopsy and postoperative pathology, particularly in estrogen receptor (ER) and progesterone receptor (PR) expression, may misguide treatment. This study explored ER/PR expression dynamics pre- and post-surgery and developed a recurrence prediction model. Methods A retrospective cohort of 600 stage I–III endometrial cancer patients (2017–2021) from a single center was analyzed. Preoperative biopsies (blind vs. hysteroscopy-guided) and postoperative specimens underwent ER/PR immunohistochemical testing. Concordance was assessed via Cohen’s kappa. Survival analysis (Kaplan-Meier), ROC curves, and Cox regression identified prognostic factors. A nomogram integrating PR expression dynamics and clinicopathological parameters was developed and validated. Results ER and PR expression showed moderate-to-substantial overall concordance (86.8%, κ = 0.481; 87.1%, κ = 0.676), with hysteroscopy-guided biopsies demonstrating superior agreement (ER: 94.0%, κ = 0.733; PR: 91.4%, κ = 0.742) versus blind biopsies. Combined pre-/postoperative PR expression improved recurrence prediction (AUC = 0.680). The integrated nomogram (AUC = 0.864) effectively stratified high-risk patients (3-year recurrence-free survival: 53.40% vs. 86.05% in non-high-risk), who benefited from adjuvant therapy. Conclusions Hysteroscopy-guided biopsy enhances ER/PR assessment accuracy. The nomogram integrating PR dynamics and clinical parameters enables precise recurrence risk stratification, aiding personalized adjuvant therapy decisions. Trial registration: Not applicable.