Endometrial carcinoma: association of steroid hormone receptor expression with low angiogenesis and bcl-2 expression

In endometrial tissues, malignant change may be accompanied by a loss of ho rmone dependence which is, usually, reflected in a parallel loss of oestrog en and progesterone receptors (ER and PR). In this study, the steroid recep tor status of 164 endometrial carcinomas was related to intratumoural angio genesis and the apoptotic proteins bcl-2 and p53. Relationships to conventi onal histopathological features and patient survival were also sought. Immu nohistochemistry was performed on formalin-fixed, paraffin-embedded tissues . The mean follow-up was 55 months (range 19-167 months). Specific nuclear staining for ER and PR was detected in 35% and 32% of endometrial carcinoma s, respectively, and was very commonly co-expressed (P<0.0001). The failure of demonstrating a steroid receptor complement in endometrial neoplasms wa s, in general terms, an adverse prognostic sign. Thus, ER or PR loss was si gnificantly associated with non-endometrioid carcinomas (ER P=0.01; PR P=0. 004) and with deep myometrial invasion (ER P<0.0002), high intratumoural an giogenesis (PR P<0.01) and the absence of bcl-2 expression (PR P<0.005). Th ere was a trend for patients with ER or simultaneous ER/PR expression to ha ve an improved survival, but this association did not reach the level of st atistical significance. In multivariate analysis tall stages), tumour cell type (endometrioid versus non-endometrioid carcinomas) and stage of disease were the only variables associated with prognosis (P=0.01 and P<0.0001, re spectively), with tumour cell type retaining its independent prognostic val ue and within stage-I endometrial carcinomas (P=0.02). It is suggested that the loss of steroid hormone receptors in endometrial carcinomas is associa ted with a more aggressive phenotype and the switching-on of angiogenic pat hways.