Download Steroid Hormone Receptor Expression And Survival In Lung Cancer

Steroid Hormone Receptor Expression And Survival In Lung Cancer
SM Sitterding1, M Tretiakova1, L Faoro2, R Salgia2, S Conzen2, AN Husain1, and T Krausz1
1 Department
of Pathology and 2 Department of Medicine,
The University of Chicago Medical Center, Chicago IL
INTRODUCTION
A
REINER SCORING SYSTEM
B
Lung cancer is the second most common cancer in
both men and women and is the leading cause of
cancer-related death in both.
Scoring of each immunohistochemical stain was based
on the Reiner 4-tiered system incorporating combined
scores of intensity (none-0, weak-1, moderate-2, and
strong-3) and percent of nuclei staining (0%-0, <10%-1,
10-50%-2, 51-80%-3, >80%-4). A combined score of
0-3 was then assigned (0-2, score 0; 3, score 1; 4-5,
score 2; 6-7, score 3).
Various studies have reported sex differences in
susceptibility and survival of lung cancer suggesting a
relationship between hormones and lung cancer risk.
Estrogen receptor (ER) acts as a tumor promoter via
a receptor mediated mechanism to induce cell
proliferation in breast cancer, endometrial cancer, and
ovarian cancer and is a useful target for hormonal
therapy in the treatment of breast cancer.
DISCUSSION
C
GR is differentially expressed on various primary
lung carcinomas.
D
Glucocorticoids (GCs) are produced in times of
physiologic stress and have medical applications for
their immunosuppressive and anti-toxic effects and, as
such, are often used in cancer treatment in combination
with chemotherapy.
Mean scores of expression of steroid hormone receptors. GR
levels were highest in AdCa (mean score of 2.4) while SCLC
showed significantly lower levels (means score of 0.7).
GCs are also used as a treatment for acute
lymphoblastic leukemia because they induce apoptosis
in leukemic cells.
However, in breast cancer cell lines, pretreatment
with GCs can inhibit chemotherapy induced apoptosis
in a glucocorticoid receptor (GR) dependent manner.
E
F
Examples of steroid hormone receptor staining. A. ERalpha, AdCa 20X. B. AR, SCC 20X C. ERbeta, AdCa
20X. D. ERbeta, SCLC 20X. E. GR, AdCa 20X. F. GR, SCLC 20X.
In patients with SCLC, low expression correlates with
worse prognosis, suggesting that GR expression may
be a useful predictor of survival in patients with SCLC.
Because of the common use of steroids in
combination with chemotherapy for the treatment of
lung cancer, further studies are needed to specifically
analyze survival data following GC treatment and
chemotherapy to determine the combined effect on
patient outcome.
Thus, GR expression, effects of GC therapy, and
correlation with patient outcome are not well
understood and may, in fact, be cell type specific.
Our study examines steroid hormone receptor
expression, including GR, ERalpha, ERbeta, and
androgen receptor (AR), in primary non small cell lung
cancer (NSCLC) including adenocarcinoma (AdCa),
squamous cell carcinoma (SCC), and large cell
carcinoma, and small cell lung cancer (SCLC) and
correlates these data with patient survival.
In patients with NSCLC, no difference in survival was
seen based on low versus high GR expression.
Survival analysis of GR expression in patients with SCLC. High
expression of GR (2-green) correlated with better survival (8/9,
89% alive at a mean of 1 year) compared with low expression of
GR (1-blue) (11/32, 34% alive at a mean of 1 year).
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