Prognostic effect of preoperative serum estradiol level in postmenopausal breast cancer

BMC Cancer

Ju-Yeon Kim²  Wonshik Han¹  Hyeong-Gon Moon¹  Soo Kyung Ahn¹  Jisun Kim¹  Jun Woo Lee¹  Min Kyoon Kim¹  Taeryung Kim³  Dong-Young Noh¹ 

[1] Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Seoul 110-744, Korea

[2] Department of Surgery, Gyeongsang National University Hospital, 90 Chilamdong, Jinju, Korea

[3] Department of Surgery, Gachon University Gil Hospital, 1198, Guwol-Dong, Incheon 405-760, Korea

关键词: Survival;    Metastasis;    Postmenopause;    Estradiol;   

Others  :  1079491
DOI  :  10.1186/1471-2407-13-503

 received in 2013-07-19, accepted in 2013-10-23,  发布年份 2013

【 摘 要 】

Background

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.

Methods

The 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.

Results

The 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).

Conclusions

Higher preoperative serum E2 level had a negative prognostic effect in postmenopausal women with breast cancer, especially in the ER-negative subgroup.

【 授权许可】

   
2013 Kim et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Cummings SR, Lee JS, Lui LY, Stone K, Ljung BM, Cauleys JA: Sex hormones, risk factors, and risk of estrogen receptor-positive breast cancer in older women: a long-term prospective study. Cancer Epidemiol Biomarkers Prev 2005, 14:1047-1051.
• [2]Key T, Appleby P, Barnes I, Reeves G: Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J Natl Cancer Inst 2002, 17:606-616.
• [3]Cummings SR, Tice JA, Bauer S, Browner WS, Cuzick J, Ziv E, et al.: Prevention of breast cancer in postmenopausal women: approaches to estimating and reducing risk. J Natl Cancer Inst 2009, 18:384-398.
• [4]Sieri S, Krogh V, Bolelli G, Abagnato CA, Grioni S, Pala V, et al.: Sex hormone levels, breast cancer risk, and cancer receptor status in postmenopausal women: the ORDET cohort. Cancer Epidemiol Biomarkers Prev 2009, 18:169-176.
• [5]Missmer SA, Eliassen AH, Barbieri RL, Hankinson SE: Endogenous estrogen, androgen, and progesterone concentrations and breast cancer risk among postmenopausal women. J Natl Cancer Inst 2004, 15:1856-1865.
• [6]Kaaks R, Rinaldi S, Key TJ, Berrino F, Peeters PH, Biessy C, et al.: Postmenopausal serum androgens, oestrogens and breast cancer risk: the European prospective investigation into cancer and nutrition. Endocr Relat Cancer 2005, 12:1071-1082.
• [7]Rock CL, Flatt SW, Laughlin GA, Gold EB, Thomson CA, Natarajan L, et al.: Reproductive steroid hormones and recurrence-free survival in women with a history of breast cancer. Cancer Epidemiol Biomarkers Prev 2008, 17:614-620.
• [8]Berrino F, Pasanisi P, Bellati C, Venturelli E, Krogh V, Mastroianni A, et al.: Serum testosterone levels and breast cancer recurrence. Int J Cancer 2005, 113:499-502.
• [9]Secreto G, Zumoff B: Paradoxical effects associated with supranormal urinary testosterone excretion in premenopausal women with breast cancer: increased risk of postmastectomy recurrence and higher remission rate after ovariectomy. Cancer Res 1983, 43:3408-3411.
• [10]Pike MC, Spicer DV, Dahmoush L, Press MF: Estrogens, progestogens, normal breast cell proliferation, and breast cancer risk. Epidemiol Rev 1993, 15:17-35.
• [11]Hulka BS: Epidemiology of susceptibility to breast cancer. Prog Clin Biol Res 1996, 395:159-174.
• [12]Pathak DR, Osuch JR, He J: Breast carcinoma etiology: current knowledge and new insights into the effects of reproductive and hormonal risk factors in black and white populations. Cancer 2000, 1(5 Suppl):1230-1238.
• [13]Pike MC, Spicer DV: Hormonal contraception and chemoprevention of female cancers. Endocr Relat Cancer 2000, 7:73-83.
• [14]Haakensen VD, Bjoro T, Luders T, Riis M, Bukholm IK, Kristensen VN, et al.: Serum estradiol levels associated with specific gene expression patterns in normal breast tissue and in breast carcinomas. BMC cancer 2011, 11:332. BioMed Central Full Text
• [15]Katzenellenbogen BS, Katzenellenbogen JA: Estrogen receptor transcription and transactivation: Estrogen receptor alpha and estrogen receptor beta: regulation by selective estrogen receptor modulators and importance in breast cancer. Breast Cancer Res 2000, 2:335-344. BioMed Central Full Text
• [16]Gupta PB, Kuperwasser C: Contributions of estrogen to ER-negative breast tumor growth. J Steroid Biochem Mol Biol 2006, 102:71-78.
• [17]Banka CL, Lund CV, Nguyen MT, Pakchoian AJ, Mueller BM, Eliceiri BP: Estrogen induces lung metastasis through a host compartment-specific response. Cancer Res 2006, 1:3667-3672.
• [18]Gupta PB, Proia D, Cingoz O, Weremowicz J, Naber SP, Weinberg RA, et al.: Systemic stromal effects of estrogen promote the growth of estrogen receptor-negative cancers. Cancer Res 2007, 1:2062-2071.
• [19]Early Breast Cancer Trialists' Collaborative Group: Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy. 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Lancet 1992, 11:71-85.
• [20]Nissen-Meyer R: Prophylactic endocrine treatment in carcinoma of the breast. Clin Radiol 1964, 15:152-160.
• [21]Rebbeck TR, Lynch HT, Neuhausen SL, Narod SA, Van’t Veer L, Garber JE, et al.: Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 2002, 23:1616-1622.
• [22]Rebbeck TR, Kauff ND, Domchek SM: Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst 2009, 101:80-87.
• [23]Eisen A, Lubinski J, Klijn J, Moller P, Lynch HT, Offit K, et al.: Breast cancer risk following bilateral oophorectomy in BRCA1 and BRCA2 mutation carriers: an international case–control study. J Clin Oncol 2005, 23:7491-7496.
• [24]Viale G, Regan MM, Maiorano E, Mastropasqua MG, Dell’Orto P, Rasmussen BB, et al.: Prognostic and predictive value of centrally reviewed expression of estrogen and progesterone receptors in a randomized trial comparing letrozole and tamoxifen adjuvant therapy for postmenopausal early breast cancer: BIG 1–98. J Clin Oncol 2007, 25:3846-3852.