Expression of estrogen and androgen receptors in differentiated thyroid cancer: an additional criterion to assess the patient's risk

Estrogen receptor (ER) and androgen receptor (AR) may be expressed in thyroid tumors, but their prognostic role is controversial. We investigated whether ER and AR expressions could confer a more aggressive phenotype to thyroid tumors. We enrolled 91 patients (13 males and 78 females, mean age 49.3+/-14.8 years) bearing small (T1 in the 2006 TNM system) differentiated thyroid cancers (DTC). Thirty-eight tumors were incidental histological findings. Using immunohistochemistry, we evaluated ER alpha, ER beta, and AR expressions in tumors and in its correspondent extra-tumor parenchyma. In tumors, 13 (16.7%) women and one (7.7%) man expressed ER alpha; 42 (53.8%) women and six (46%) men expressed ER beta; and 16 (20.5%) women and three (23.1%) men expressed AR. In normal thyroid parenchymas, ER beta was expressed in 52 (66.7%) women and nine (69.2%) men, ER alpha in three (3.8%) women, and AR in 13 (16.7%) women. Compared with normal thyroid parenchyma, tumors gained ER alpha and lost ER beta expressions. Incidental cancers were more commonly ER alpha(-) than ER alpha(+) (47.7 vs 14.3%, P=0.037). Postsurgical serum thyroglobulin was higher in ER alpha(+) tumors than in the ER alpha(-) tumors (P=0.04). ER beta(-) tumors showed vascular invasion more frequently than the ER beta(+) tumors (26.2 vs 4.1%, P=0.005). AR(+) tumors showed capsular invasion more frequently than the AR(-) tumors (77.8 vs 46.6%, P=0.014). In conclusion, ER alpha positivity, ER beta negativity, and AR expressions are associated with a more aggressive phenotype of small T1-DTC. ER and AR expressions may represent an additional criterion in deciding whether to perform radioiodine ablation in these tumors. Endocrine-Related Cancer (2012) 19 463-471