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. 2021 Jun 7;11:11949. doi: 10.1038/s41598-021-90570-3

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Stromal ALDH1 expression in premalignant lesions predict future tumor development. (A) Stromal ALDH1 expression showed a step-wise decrease from normal endometrium to endometrial hyperplasia to atypical hyperplasia to endometrial cancer (Spearman rho = − 0.28, p = 5.9e−25). (B) Stromal ALDH1 expression reduced the likelihood of patients to develop cancer. Kaplan–Meier survival plot showing higher stromal ALDH1 expression (> 50% of cells) versus lower expression in hyperplastic lesions with or without atypia: difference in median time to cancer diagnosis 129 months vs 69 months, HR = 0.39, p = 0.012. E) Patients with ALDH1 positivity in the epithelium and low immunostaining in stroma (< 50%) also showed shorter times to cancer diagnosis compared to others (median time interval 6 months vs 129 months, p = 5.67e−06).