Estrogen and Progesterone Expression in Colorectal Carcinoma: A Clinicopathological Study.

Asmaa Abd Elghany Abd Ellateef,Ahmed As Elhakeem,Ahmed El Sayed Mohamed,Sheren Fm Ahmed

doi:10.31557/apjcp.2020.21.4.1155

Abstract

Sex steroids have been suggested to influence colorectal cancer (CRC) carcinogenesis. Also, exposure to exogenous hormones might contribute to its incidence. This study conducted to evaluate ER and PR expression as a prognostic factor in patients with CRC attending Sohag University Hospital (SUH) and Sohag Cancer Center (SCC). Materials and Methods: Tumor samples tested for Estrogen receptor (ER) / progesterone receptor (PR) expression using immunohistochemical staining (IHC). Association of this expression with overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS) were evaluated. Results: Thirty out of 50 CRC tissues were evaluable for hormone receptor expression. Expression of both ER and PR was cytoplasmic. ER and PR expressions were 60% and 76.66%, respectively. There was a significant difference between loss of ER expression and depth of invasion (p= 0.01). Also, ER and PR negative expression cases were significantly at higher risk for progression (p= 0.03; 0.009 respectively). High levels of ER and PR expression were associated with higher cumulative PFS at one year and at the end of follow up time (p=0.01; 0..02 respectively); however this did not reach statistical significance on Cox proportional hazards regression analysis for progression or OS (p= 0.05; HR= 0.22; p=0.5; HR=0.67 respectively) for ER level and (p=0.07; HR=0.22; p=0.6; HR=0.72 respectively) for PR level. Conclusions: This study suggests that lower ER/PR expression levels were associated with more extensive CRC primary tumors and poorer prognosis. These data suggest that ER/PR expression might possess a prognostic value for CRC cases.

Highlights

Colorectal cancer (CRC) is a major health problem worldwide with high mortality rates (Bray et al, 2018) and higher predominance in males than females (American Cancer Society, 2017)
This study suggests that lower Estrogen receptor (ER)/progesterone receptor (PR) expression levels were associated with more extensive colorectal cancer (CRC) primary tumors and poorer prognosis
Sex steroids have been suggested to influence CRC carcinogenesis (Stevanato Filho et al, 2018) and their possible role has been demonstrated in multiple epidemiologic studies (Williams et al, 2016)

Summary

Introduction

Colorectal cancer (CRC) is a major health problem worldwide with high mortality rates (Bray et al, 2018) and higher predominance in males than females (American Cancer Society, 2017). Estrogens have oncogenic and tumor promoter effect linked to different tissue types, breast (Jordan, 2007), ovary (Syed, 2001), uterus (Zannoni et al, 2013), and prostate (Härkönen and Mäkelä, 2004), lung (Siegfried, 2014) and colon (Hogan et al, 2009). Supported by a number of clinical and laboratory observations; CRC incidence tends to be lower in females than in males suggested that ovarian steroids may be contributing factors. Oral contraception and hormonal replacement therapy are associated with reduced CRC risk (Stevanato Filho et al, 2018). Presence of estrogens was associated with lower risk of CRC as shown by In-vitro and epidemiological studies (Weyant et al, 2001; Foster, 2013) and The Women’s Health Initiative findings supported that postmenopausal women treated with hormone replacement therapy had lower colon cancer incidence (Rossouw et al, 2002)

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Conclusion