Journal of Cancer Research and Therapeutics Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI) ISSN: 0973-1482 EISSN: 1998-4138 Vol. 7, Num. 1, 2011, pp. 19-22

Journal of Cancer Research and Therapeutics, Vol. 7, No. 1, January-March, 2011, pp. 19-22

Original Article

Steroid receptor status and its clinicopathological correlation in post-menopausal breast cancer patients of Kumaon region of Uttarakhand

KS Shahi, Geeta Bhandari, Abhishek Singh

Department of Surgery, Radiation and Clinical Oncology, Government Medical College, Haldwani, Nainital, Uttarakhand, India

Correspondence Address: K S Shahi, Department of Surgery, Government Medical College, Haldwani, Nainital, Uttarakhand, India, kedar_shahi@rediffmail.com

Code Number: cr11005

PMID: 21546737

DOI: 10.4103/0973-1482.80433

Abstract

Keywords: Breast carcinoma, post-menopausal, steroid receptors

Introduction

Estrogens, progesterone and certain glucocorticoids are known to influence differentiation of both parenchymatous and mesenchymal components. ^[1],[2],[3] Steroid receptors appear to be a biological prerequisite for responsiveness to a hormonal perturbation. These receptors are also found in many breast cancers. Breast cancer patients most likely to respond to an additive or ablative endocrine manipulation may be identified from analysis of sex hormone receptors. ^{[4],[5],[6],[7],[8]}

Estrogen receptor (ER) and progesterone receptor (PR) status has been used since the mid-1970s in the clinical management of breast cancer, both as an indicator of endocrine responsiveness and as a prognostic factor for early recurrence. ^[9] Evidence from studies indicates that patients with ER-positive/PR-negative tumors benefit less from adjuvant endocrine therapy. ^[10],[11]

This study aims at determining the prevalence of estrogen and progesterone receptors in post-menopausal breast cancer patients in Kumaon region of Uttarakhand state in northern India and their relevance in terms of clinico-pathological features and therapeutic outcome.

Material and Methods

Materials

In this study, retrospective data were collected on hormonal receptor status of 80 post-menopausal breast cancer patients admitted in our hospital and information was recorded from the year 2006 to June 2007. Prospective study conducted from June 2007 to May 2009 consisted of 68 patients.

Methods

1. Post-menopausal was defined by more than 12 months since last menstrual period.
2. Clinical history, physical examination, histopathological or cytological evidence of breast cancer.
3. Immunohistochemistry profile for ER and PR was done on formalin-fixed paraffin tissue blocks, using ER antibody clone (AER1 D5) and PR antibody clone (PR10 A9) by antigen retrieval technique on an automated analyzer.
4. During the entire study period, patients were followed up monthly.

Results

Discussion

Tumor receptor status has been shown earlier to correlate with various patient and tumor characteristics. In our study of 148 patients, we found no difference in incidence of ER positive and PR positive tumors in various post-menopausal patients of breast cancer in different age groups though the incidence of receptor positivity increased with increasing age. This trend was statistically insignificant.

Earlier studies have reported an incidence of 55-64% of receptor positive tumor in post-menopausal breast cancer patients. ^{[12],[13],[14],[15]} In contrast, our study shows a lower incidence of 37.83% receptor positive tumors in post-menopausal women. ER was positive in 27.03% patients out of whom 16.2% were also PR positive and the rest were ER/PR negative. ER was negative in 72.47% patients of whom PR was positive in 10.8% patients and negative in the rest. Discordant findings in the study may be attributed to the race, as earlier reports were based on western population. ^{[16],[17],[18],[19],[20],[21]} Variability in the result may also be because of small sample size for the study and technical errors in tissue handling and processing and staining and transportation of biopsy specimen to the laboratory. ^{[22],[23],[24],[25],[26],[27],[28]} An Indian study of 300 patients including both pre-menopausal as well as post-menopausal women showed 128 (42.67%) patients had ER- and PR-negative, 157 (52.33%) had ER- and PR-positive, 12 (4%) had ER-positive/PR-negative, and 3 (1%) had ER-negative/PR-positive tumor. ^[29]

Receptor positive tumors were smaller in size as compared to receptor negative tumors at the time of presentation. Tumor size and receptor status had no statistical significance. ^[30],[31] Skin infiltration, peau de′ orange, ulceration/fungation and fixity to chest wall were more commonly seen in receptor negative tumors but were not statistically significant [Table - 3]. These observations correlate well with earlier reports which have shown that receptor negative tumors are more aggressive than receptor positive tumors. Receptor positive tumors are less aggressive and have a more indolent course. ^{[31],[32],[33],[34],[35]} Axillary lymphadenopathy was more common in receptor negative tumors though it was statistically insignificant as compared to receptor positive tumors [Table - 5]. Earlier studies have reported no correlation between receptor status and axillary lymph node involvement in breast cancer. ^{[36],[37],[38]}

There was no association between supraclavicular lymph node involvement and receptor status (P-0.193). Exactly 36.48% of postmenopausal breast cancer patients presented with metastatic disease. Metastases were more common in receptor negative patients. ER positive tumors had more incidences of metastases. However, no association was found between metastases and ER (P-0.39) or PR (P-0.841). Visceral and skeletal metastases were more common in receptor negative patients. Earlier studies have reported a higher incidence of metastases in receptor negative tumors. Metastases and local recurrence are usually detected approximately at the same time in pre-menopausal and post-menopausal women, independent of receptor status. ^{[39],[40],[41]}

Findings in the study of histological grades of tumors and receptor status are in agreement with reports of earlier studies which have shown that poorly differentiated tumors are more common in receptor negative patients. Infiltrating ductal carcinoma was the most common histologic type found in the study, with an incidence of 97.29%. However, as with earlier studies, there seems to be no correlation between receptor status and histological type of the tumors. ^{[12],[28],[42],[43],[44]}

Conclusion

The receptor positivity of steroid receptors was more in higher age groups, but the incidence of receptor positivity was lower in higher age groups than that reported in earlier studies. No statistically significant association was found between receptor status and clinical presentation of breast cancer, histopathological status of tumor and metastases in post-menopausal women with carcinoma breast in Kumaon region of Uttarakhand, India.

References

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