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Open Access Highly Accessed Research article

Steroid hormone receptor expression in ovarian cancer: progesterone receptor B as prognostic marker for patient survival

Miriam Lenhard1*, Lennerová Tereza2, Sabine Heublein2, Nina Ditsch1, Isabelle Himsl1, Doris Mayr3, Klaus Friese12 and Udo Jeschke2

Author Affiliations

1 Department of Obstetrics and Gynecology, Grosshadern Campus, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, Munich, 81377, Germany

2 Department of Obstetrics and Gynecology, Campus Innenstadt, Ludwig-Maximilians-University Hospital, Maistrasse 11, Munich, 80337, Germany

3 Department of Pathology, Ludwig-Maximilians-University Hospital, Thalkirchner Str. 36, Munich, 80337, Germany

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BMC Cancer 2012, 12:553  doi:10.1186/1471-2407-12-553

Published: 24 November 2012

Abstract

Background

There is partially conflicting evidence on the influence of the steroid hormones estrogen (E) and progesterone (P) on the development of ovarian cancer (OC). The aim of this study was to assess the expression of the receptor isoforms ER-α/-β and PR-A/-B in OC tissue and to analyze its impact on clinical and pathological features and patient outcome.

Methods

155 OC patients were included who had been diagnosed and treated between 1990 and 2002. Patient characteristics, histology and follow-up data were available. ER-α/-β and PR-A/-B expression were determined by immunohistochemistry.

Results

OC tissue was positive for ER-α/-β in 31.4% and 60.1% and PR-A/-B in 36.2% and 33.8%, respectively. We identified significant differences in ER-β expression related to the histological subtype (p=0.041), stage (p=0.002) and grade (p=0.011) as well as PR-A and tumor stage (p=0.03). Interestingly, median receptor expression for ER-α and PR-A/-B was significantly higher in G1 vs. G2 OC. Kaplan Meier analysis revealed a good prognosis for ER-α positive (p=0.039) and PR-B positive (p<0.001) OC. In contrast, ER-β negative OC had a favorable outcome (p=0.049). Besides tumor grade and stage, Cox-regression analysis showed PR-B to be an independent prognostic marker for patient survival (p=0.009, 95% CI 0.251-0.823, HR 0.455).

Conclusion

ER-α/-β and PR-A/-B are frequently expressed in OC with a certain variability relating to histological subtype, grade and stage. Univariate analysis indicated a favorable outcome for ER-α positive and PR-B positive OC, while multivariate analysis showed PR-B to be the only independent prognostic marker for patient survival. In conclusion, ER and PR receptors may be useful targets for a more individualized OC therapy.

Keywords:
Estrogen receptor alpha (ER-α); Estrogen receptor beta (ER-β); Progesterone receptor A (PR-A); Progesterone receptor B (PR-B); Ovarian cancer; Survival; Prognosis