Estrogen and Progesterone Expression in Colorectal Carcinoma: A Clinicopathological Study

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.

Progesterone suppresses the progression of colonic carcinoma by increasing the activity of the GADD45α/JNK/c‑Jun signalling pathway

“…Moreover, the relationship with PGR was revealed, and the growth inhibitory effects in CRC were analysed. PGR has been identified in normal and malignant tissues and is a highly structured transcription factor that regulates diverse physiological processes ( 39 , 40 ). However, the reported relationship between PGR expression and cancer progression is still contradictory.…”

“…This variation may be due to differences in the way specimens were prepared, the method or antibodies used, the location of the lesions or the level of staining required to consider a sample positive ( 44 ). In CRC tumours, low PGR levels are inversely associated with extensive primary tumours, poor prognosis and high recurrence rate of CRC ( 38 , 39 , 45 ). In addition, mifepristone, the PGR agonist, protects against CRC by modulating the effects of oestrogen on carcinogenesis ( 46 ).…”

“…In contrast, PGR is detected in normal and cancer tissues, but without any significant relationship with clinicopathological tumour characteristics and patient outcome ( 47 , 48 ). Recently, lower PGR expression levels are associated with more extensive CRC primary tumours and poorer prognosis ( 39 ). As the range of actions of PGR have limited its clinical use thus far, the present results revealed a positive correlation with progesterone level and a negative correlation with clinical characteristics.…”

Neutrophil to Lymphocyte Ratio as a Predictor of Severity in Colorectal Adenocarcinoma

“…19 Similarly, women taking hormone replacement therapy and oral contraceptive pills are found to have lesser chances of acquiring CRC. 20 A study done in Egypt in 2020 showed that the expression of oestrogen receptor(ER) is associated with smaller tumour size and that ER/PR (Progesterone Receptor) expression is associated with better survival and outcome. 20 Mean age of patients in this study was 53.4±13 years while the most common age group was 41-60 years.…”

Diagnostic and Prognostic Impact of Progesterone Receptor Immunohistochemistry: A Study Evaluating More Than 16,000 Tumors

“…Data on PR immunostaining in the literature typically lacks associations with patient age, gender, or stage in cancer [ 6 – 14 ] and is overall highly variable. For example, the reported range of PR positivity ranges from 0 to 76% in colorectal cancer [ 6 – 8 ], from 0 to 52% in adenocarcinoma of the gall bladder [ 9 , 10 , 15 , 16 ], from 0 to 85% in prostate cancer [ 11 , 17 , 18 ], from 0 to 63% in non-small-cell lung cancer [ 12 , 19 , 20 ], from 38.7 to 75.8% in papillary thyroid carcinoma [ 13 , 14 , 21 – 24 ], and from 15.2 to 100% in angiomyolipoma of the kidney [ 25 – 27 ]. These conflicting data are likely to be caused by the use of different antibodies, staining protocols, and interpretation criteria in these studies.…”