Expression of estrogen receptor-alpha and -beta and progesterone receptor-A and -B in a large cohort of patients with endometrioid endometrial cancer

Objective. The estrogen receptor (ER)-alpha and -beta and progesterone receptor (PR)-A and -B were determined in endometrioid endometrial cancer, and their prognostic values were assessed. Methods. Tissue microarrays were constructed from 315 endometrioid endometrial cancer patients. Receptor expression was assessed by immunostaining, and their semi-quantitatively determined expression levels were correlated to classical clinico-histopathological parameters in addition to disease free and disease specific survival. Results. Patients were classified as FIGO stage 1 (59.0%), stage 11 (17.1%), stage III (19.4%) and stage IV (4.1%) Sixty five patients (20.6%) developed recurrent disease and 38 (12.1%) died due to endometrial cancer. In univariate analysis, expression of ER-alpha was related to early stage endometrial cancer (p=0.020), while expression of ER-alpha, PR-A and PR-B was associated with lower grade tumours (p-=0.0001, p=0.001 and p=0.001 respectively). A ratio of ER-alpha/ER-beta = 1 was related to a shorter disease free survival (p=0.027), while the ratio of PR-A/PR-B<1 both was associated with a shorter disease free survival as well as a shorter overall survival (p=0.044 and p=0.005, respectively). In early stage disease, using multivatiate analysis, absence of ER-alpha was independently related to death of disease (p=0.017, OR 7.28, 95% CI 1.42-37.25), while absence of PR-A (p=0.015, OR 4.2, 95% CI 1.32-13.33) appeared to be an independent prognostic factor for relapse of disease. Conclusion. We conclude that in early stage endometrioid endometrial cancer absence of PR-A is an independent prognostic factor for disease-free survival, while patients with ER-alpha positive tumours have a better overall survival. (C) 2008 Elsevier Inc. All rights reserved.