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

ObjectiveThe 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.MethodsTissue 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.ResultsPatients were classified as FIGO stage I (59.0%), stage II (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 multivariate 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.ConclusionWe 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.