Abstract
BackgroundThe prognostic role of serum estrogen level in breast cancer patients is unclear. We investigated the prognostic importance of preoperative serum estradiol (E2) level in postmenopausal women according to their estrogen receptor (ER) status.MethodsThe medical records of 313 postmenopausal breast cancer patients who underwent surgery between 2006 and 2008 at a single institution were retrospectively evaluated. Patients who received neoadjuvant chemotherapy, synchronous bilateral breast cancer, or those with metastasis at diagnosis were excluded. Serum E2 and follicular stimulating hormone (FSH) levels were measured by radioimmunoassay and immunoradiometric assay, respectively, within 3 months prior to surgery. After a median follow-up of 52.0 months (11–77 months), 21 women were found to have metastatic disease.ResultsThe overall, median E2 level was 13.0 pg/ml, and was slightly higher in ER-positive than ER-negative (p=0.69). The mean serum E2 level was significantly higher in patients with metastasis (17.41±8.34 pg/ml) than in those without metastasis (13.54±7.58 pg/ml) (p=0.02). Kaplan-Meier analysis using a cut-off of 13 pg/ml showed that, ER negative (p=0.02) but not ER positive (p>0.05) patients with higher E2 level showed significantly poorer metastasis-free survival. Multivariate analysis showed that, the high E2 level of ER negative tumors was an independent negative prognostic factor for metastasis- free survival (HR, 3.32; 95% CI, 1.05 to 10.51; p=0.04).ConclusionsHigher preoperative serum E2 level had a negative prognostic effect in postmenopausal women with breast cancer, especially in the ER-negative subgroup.
Highlights
The prognostic role of serum estrogen level in breast cancer patients is unclear
Mean serum estradiol level was significantly higher in patients with than without metastasis (17.41±8.34 pg/ml vs. 13.54±7.58 pg/ml, p=0.02)
Using the cut-off values 13 pg/ml, which is the median value in this study, we found that metastasis free survival was lower in estrogen receptor (ER)-positive patients with higher than with lower estradiol level, the difference was not statistically significant (Figure 2a)
Summary
The prognostic role of serum estrogen level in breast cancer patients is unclear. We investigated the prognostic importance of preoperative serum estradiol (E2) level in postmenopausal women according to their estrogen receptor (ER) status. The prognostic role of the serum level of these hormones in newly diagnosed breast cancer patients is still unclear. Several studies have reported that higher serum testosterone levels at diagnosis were associated with poor prognosis in postmenopausal women with breast cancer, other studies demonstrated no such association [7,8,9]. High serum estradiol levels were reported to be associated with specific gene expression patterns in breast cancer tissue. In estrogen-dependent tumors, estrogen promotes cell proliferation and, suppresses apoptosis, by directly modulating gene transcription, making estrogen an important target in treatment [15]
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