Ovarian Cancer Canada

Western Regional Blog – BC, YK, AB, NWT and Nunavut

Progesterone and estrogen receptors expression may predict outcomes in certain ovarian cancers

Expression of estrogen and progesterone receptors was associated with improved survival in women with endometrioid and high-grade serous ovarian cancers, according to study results.

A global coalition of researchers investigated whether subtype-specific survival was impacted by tumor expression of the progesterone receptor (PR) and estrogen receptor (ER). The Ovarian Tumor Tissue Analysis consortium included clinical and microarray data from 12 studies that included a combined 2,933 women.
Eligible participants included individuals with invasive serous, mucinous, endometrioid or clear-cell carcinoma in the ovaries. The three layers of PR and ER staining included negative (<1% tumor cell nuclei), weak (1 to <50%), or strong (≥50%).
The analysis included 1,742 women with high-grade serous disease, 110 with low-grade serous cancer, 207 with mucinous disease, 484 with cancer of the endometrioid, and 390 with clear-cell disease.
Researchers observed an association between PR expression and increased disease-specific survival among women with endometrial disease (log rank P<.0001) and high-grade serous disease (log rank P=.0006). Researchers also observed an association between ER expression and improved disease-specific survival (log rank P<.0001).
Researchers did not observe significant associations for mucinous, clear-cell or low-grade serious disease.
In comparison with negative expression, all types of positive hormone-receptor expression — including weak and strong ER or PR expression, or both — improved disease-specific survival in endometrial disease. This association persisted across several variables, including age, grade, stage and study site (HR=0.33; 95% CI, 0.21-0.51).
Patients with high-grade serous disease with strong PR expression had improved disease-specific survival (HR=0.71; 0.55-0.91); however, no association was observed in patients with this subtype who had weak PR expression (HR=1.02; 0.89-1.18).
The findings should be beneficial for clinicians with regard to prognosis and hormone therapy among relapsed patients and young disease-free patients who have undergone oophorectomy, Charlie Gourley,

MD, PhD, of the Edinburgh Cancer Research UK Centre and Institute of Genetics and Molecular Medicine at the University of Edinburgh Western General Hospital, wrote in an accompanying editorial.
“The role of hormone replacement therapy after oophorectomy at young ages is another controversial and under-researched issue,” he wrote. “By providing a clear picture of the frequency of ER and PR expression in ovarian cancer subtypes, Sieh and colleagues provide a reminder that hormone replacement therapy could affect risk of cancer recurrence, especially in endometrioid carcinoma, low-grade serous carcinoma and high-grade serous carcinoma.”
The findings “imply the identification of important biological subgroups and should promote the reappraisal of endocrine therapy in ovarian cancer,” Gourley added.

(See abstract: Hormone-receptor expression and ovarian cancer survival: an Ovarian Tumor Tissue Analysis consortium study
http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2813%2970253-5/fulltext?_eventId=login )

September 11, 2013

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