Prognostic value of steroid hormone receptors for 5-year survival in stage II endometrial cancer

Abstract

Background and Methods. In a prospective study, the 5‐year survival of 57 patients with Stage II endometrial cancer was correlated to the estrogen (ER) and progesterone (PR) receptor concentrations using the dextran‐coated charcoal (DCC) technique. The cutoff level was 3 fmol/mg of protein for ER and 6 fmol/mg of protein for PR. Results. An histopathologic examination of the tumor tissue samples before treatment demonstrated that 16% of the cases (9 patients) were well‐differentiated (Grade 1), 45% (26 patients) moderately differentiated (Grade 2), and 39% (22 patients) poorly differentiated (Grade 3). Only 3 were ER negative, whereas 19 were PR negative. The mean concentrations for ER and PR were 106 and 162 fmol/mg of protein, respectively. All patients received standard treatment, including preoperative irradiation. The total 5‐year survival rate was 82% (47 of 57 patients). Deep myometrial invasion was important in Grade 3, but not in Grades 1 and 2; in these two grades, all five patients with deep infiltration survived. There was a correlation between receptor concentration and grade, with a significant difference between Grades 1 and 2 versus Grade 3. All patients who were ER negative survived, as did all patients who were PR negative in Grades 1 and 2. Of the patients with Grade 3 disease who died, four of six (67%) were PR negative. Of the patients with Grade 3 disease who survived, 10 of 16 (63%) were PR negative. Conclusions. Patients who survived for 5 years did not have significantly different ER and PR concentrations than those who died. The mean ER and PR concentrations in patients who survived were 99 and 159 fmol/mg of protein, respectively, compared with 108 and 178 fmol/mg of protein, respectively, for those who died.

Endometrial carcinoma: association of steroid hormone receptor expression with low angiogenesis and bcl-2 expression

“…The reported incidence of ER and PR in endometrial carcinomas varies in several series from 35% to 70% [9,13,32,44,46], and our results are at the lower end of this range, sharing, in accordance with other studies [5,9,20], a frequent co-expression of both receptors. In most series, the lack of ER and PR expression by endometrial tumour cells has been a marker of aggressive tumour behaviour and, indeed, many investigators connected the loss of hormone dependence with nonendometrioid-type carcinomas [4,22] or with poorly differentiated endometrial tumours and advanced stage of disease [5,10,12,13,20,25,42]. In this series, the receptor status was unrelated to tumour differentiation or the stage of disease, but it was certainly related to the non-endometrioid carcinomas and deep myometrial invasion, particularly ER loss.…”

“…Moreover, Kauppila and colleagues found that the simultaneous presence of ER and PR is associated with a favourable survival for stage-I and -II endometrial tumours [20], and others extended this observation to include recurrent or advanced stage endometrial disease [5,7,9]. Others found that ER [5,13] or PR alone [10] is a better indicator of prognosis, and still others failed to attach any prognostic significance in the receptor status of endometrial malignancies [12,25]. In an earlier study, with a 10-year follow-up, we found a significant relationship between a high PR or ER/PR content and an improved disease-free survival in patients with endometrial carcinoma, but these results were based on the detection of cytoplasmic, rather than nuclear, receptors [41].…”

Oestrogen receptor β expression and depth of myometrial invasion in human endometrial cancer

“…Many studies have suggested that the progesterone receptor (PR)/ER concentration is significant as a prognostic parameter for endometrial cancer (Friberg and Noren, 1993;Kadar et al, 1993;Morris et al, 1995;Moutsatsou and Sekeris 1997), and that PR status significantly predicts the disease-free survival of patients with endometrial cancer. It has been shown that lymph node metastasis from endometrial cancer is correlated with negative PR protein expression (Iwai et al, 1999).…”