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Progesterone and Estrogen Receptor Expression Are Prognostic Markers for Endometrioid and High-grade Serous Ovarian Cancer

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Key Points

  • Progesterone receptor (PR) expression was associated with improved disease-specific survival in endometrioid and high-grade serous carcinoma and estrogen receptor (ER) expression was associated with improved disease-specific survival in endometrioid carcinoma.
  • Positive PR or ER expression was associated with significantly improved disease-specific survival in endometrioid carcinoma independent of study site, age, stage, and grade.
  • The investigators noted that clinical trials, stratified by subtype and biomarker status, are needed to establish whether hormone-receptor status predicts response to endocrine treatment, and whether it could guide personalized treatment for ovarian cancer.

Few markers of ovarian cancer prognosis have been established, perhaps because potential subtype associations are missed in studies including patients with all histopathologic subtypes. In a study reported in Lancet Oncology, Weiva Sieh, PhD, of Stanford University and colleagues assessed the prognostic effect of progesterone receptor (PR) and estrogen receptor (ER) status among nearly 3,000 women with invasive epithelial ovarian cancer. They found that ER- and PR-positivity are prognostic markers for endometrioid and high-grade serous ovarian cancers.

Study Details

In the study, 12 investigations participating in the Ovarian Tumor Tissue Analysis consortium contributed tissue microarray sections and clinical data from women who had been diagnosed with invasive serous, mucinous, endometrioid, or clear-cell carcinomas of the ovary. For a patient to be eligible, tissue microarrays, clinical follow-up data, age at diagnosis, and tumor grade and stage had to be available. PR and ER status was assessed by central immunohistochemistry analysis done by masked pathologists. PR and ER staining was defined as negative (< 1% tumor cell nuclei), weak (1% to < 50%), or strong (≥ 50%).

Findings

A total of 2,933 women with invasive epithelial ovarian cancer were included in the analysis, consisting of 1,742 with high-grade serous carcinoma, 110 with low-grade serous carcinoma, 207 with mucinous carcinoma, 484 with endometrioid carcinoma, and 390 with clear-cell carcinoma. PR expression was associated with improved disease-specific survival in endometrioid carcinoma (P < .0001) and high-grade serous carcinoma (P = .0006), and ER expression was associated with improved disease-specific survival in endometrioid carcinoma (P < .0001). No significant associations were found between ER or PR expression and mucinous, clear-cell, or low-grade serous carcinomas.

Positive hormone-receptor expression (weak or strong staining for PR or ER, or both) was associated with significantly improved disease-specific survival in endometrioid carcinoma compared with negative hormone-receptor expression independent of study site, age, stage, and grade (hazard ratio [HR] = 0.33, P < .0001). Strong PR expression was independently associated with improved disease-specific survival in high-grade serous carcinoma (HR = 0.71, P = .0080), but weak PR expression was not (HR = 1.02, P = .74).

The authors concluded: “PR and ER are prognostic biomarkers for endometrioid and high-grade serous ovarian cancers. Clinical trials, stratified by subtype and biomarker status, are needed to establish whether hormone-receptor status predicts response to endocrine treatment, and whether it could guide personalized treatment for ovarian cancer.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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