Immunohistochemical Expression of Estrogen and Progesterone Receptors and Outcomes in Patients with Newly Diagnosed Uterine Leiomyosarcoma
MM Leitao, Jr, ML Hensley, R O'Cearbhaill, RA Soslow. Memorial Sloan-Kettering Cancer Center, New York
Background: The objective was to assess the immunohistochemical (IHC) expression of estrogen receptors (ER) and progesterone receptors (PR) in uterine leiomyosarcomas (LMSs) and the prognostic significance of ER and PR expression in LMS.
Design: We identified all patients with uterine LMS seen at our institution from 7/82 to 7/07 for whom ER and PR IHC analysis was performed at the time of initial diagnosis. We only included cases that were considered conventional LMS (i.e. "high grade") and in which IHC was performed at our institution. ER and PR IHC expression was considered positive (+) if more that 5% of cells were stained. Progression-free (PFS) and overal survival (OS) were estimated using Kaplan-Meier estimates and compared with log-rank test where indicated.
Results: We identified 43 patients with a median age of 52 years (range 26-73). Disease was confined to the uterine body in 20 (47%) cases. 18/43 (42%) cases were ER(+) and 17/42 (41%) cases were PR(+). At last follow-up, 33 (77%) tumors had recurred or progressed and 23 (54%) patients had died. The median follow-up for survivors was 48.4 months (range 4-142.4). PR(+) was associated with improved PFS (P=0.002) and OS (P=0.03) in the entire cohort but not ER(+). Adjusting for stage, ER expression was associated with PFS (P=0.01) but not OS (P=0.3). PR expression maintained its significant association with both PFS (P=0.002) and OS (P=0.05) after adjusting for stage. Neither ER nor PR expression was associated with outcome in patients with disease outside the uterine body. However, when disease was confined to the uterine body, the median PFS for ER(+) and PR(+) cases was not reached for either compared to 16.9 months (95%CI:8.1-25.7) for ER(-) cases (P=0.03) and 13.5 months (95%CI:5.9-21.1) for PR(-) cases (P=0.001). In the 10 PR(+) cases, only one patient experienced recurrence and died compared to the 10 PR(-) cases in which 9 recurred and 5 died.
Conclusions: ER and PR expression is associated with outcome in patients with uterine LMS confined to the uterine body. PR expression identifies tumors confined to the uterine body with the best outcomes.
Category: Gynecologic & Obstetrics
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 150, Wednesday Morning