Steroid hormone receptors and prognosis in breast cancer

A research on the level of urine neopterin to see if it may provide a vital clue for a provisional diagnosis of breast cancer in menopausal women

OBJECTIVES

To search the relation between the level of neopterin in urine and breast cancer developed in menopause.

METHODS

In this study, urine samples were collected from randomly selected menopausal and post-menopausal women who attended hospital, and from a control group. The participants were classified into two representative sample groups and a control group; 1st group: 30 menopausal and post-menopausal women whose ages varied from 45 to 80 and who suffered from breast cancer but had no viral infections, chronic inflammatory diseases and smoking habit; 2nd group: 30 menopausal and post-menopausal women aged between 48 and 63 with no complaint of any type of tumors, viral infections or chronic inflammatory diseases and with no smoking habit; 3rd group: A control group with 20 women aged between 20 and 28, who did not take part in sexual activities yet, and had no complaint of any type of tumors, viral infections or chronic inflammatory diseases and had no smoking habit. Urinalysis was carried out for each sample in order to measure the level of neopterin.

RESULTS

The mathematical results of neopterin levels for the groups showed that group I was significantly higher than group II and III (P = 0.0001 ); group II was significantly higher than group III (P = 0.003 ).

CONCLUSIONS

If the results of this study were not confounded by another factor, then can we deduce that this relationship can be used as a risk factor that should warrent further investigation of breast cancer during the care and treatment of menopausal women.

Neopterin Is an Independent Prognostic Variable in Females with Breast Cancer

Background: Neopterin, produced by human monocytes/macrophages upon stimulation by interferon-γ, is a sensitive marker for monitoring Th1-cell immune response in humans. In malignant diseases, the frequency of increases in neopterin in the serum and urine of patients depends on tumor stage and type.

Methods: In a retrospective study comprising 129 females with breast cancer, urinary neopterin/creatinine ratios were measured at the time of diagnosis. Tumor characteristics were determined concomitantly.

Results: Urinary neopterin was increased in 18% of the patients. It did not correlate with tumor size or lymph node status, but it was influenced by the presence of distant metastases (P <0.05) and by tumor differentiation (P = 0.01). When product-limit estimates were calculated after follow-up for up to 13 years (median follow-up, 56 months), the presence of distant metastases (P <0.001), neopterin (P <0.001), tumor size (P = 0.001), and lymph node status (P <0.01) were significant predictors of survival. By multivariate analysis, a combination of the variables presence of distant metastases (P <0.001), neopterin (P <0.01), and lymph node status (P <0.05) was found to jointly predict survival. In lymph node-negative patients without distant metastases, the relative risk of death associated with increased neopterin concentrations was 2.5 compared with patients with neopterin concentrations within the reference interval.

Conclusion: Urinary neopterin provides additional prognostic information in patients with breast cancer.

Estrogen and progesterone receptor content in bilateral breast cancer

Estrogen and progesterone receptor content was determined in 34 patients with synchronous and 23 patients with asynchronous bilateral breast cancer. Steroid receptor content was measured quantitatively by DCC method. It was shown that progesterone receptor content could not be predicted, as well as, that steroid receptor content of the second tumor significantly influenced the development of asynchronous bilateral breast cancer. The high discordance rate concerning histologic type between two tumors within synchronous as well as asynchronous biopsies was observed. The obtained results indicate that both synchronous and asynchronous bilateral breast tumors may be considered as biologically different tumors whose both steroid receptor levels should be determined whenever possible.

Immunocytochemical versus biochemical receptor determination in normal and tumorous tissues of the female reproductive tract and the breast

The development of highly specific and sensitive monoclonal antibodies directed against human estrogen (ER) and progesterone receptors (PR) provides a new approach in precise histochemical receptor location independent of hormone binding. Over the years receptor determination was the domain of the radioligand-binding assay, in which receptors are measured by tritiated ligand and unbound ligand is removed by the dextran-coated charcoal (DCC) procedure. Presented here are the results and experiences obtained by the classic DCC and the immunocytochemical method in the different normal and tumorous tissues of the female reproductive tract and the breast. The results of both methods were compared, and overall concordance of the results was found to vary considerably among the different types of tissue analyzed. Best agreement (86%) was found for PR determination in breast cancer, and the lowest rate of concordance for ER determination in fibrocystic disease of the breast. Special attention was directed toward the heterogeneity of receptor distribution in the specimens examined. In all tissues investigated, ER and PR were located in the nuclei of cells in both paraffin and frozen sections. Staining intensity varied among different cell types and from cell to cell for a single cell type, as well as in tumorous and normal tissues. In breast cancer, randomly scattered single cell receptor positivity was distinguished from focal/clonal positivity. Paraffin-embedded lymph node metastases showed significantly weaker staining as compared with their respective primary tumors. In the normal ovary, the corpus luteum and the stromal layer of the outer cortex were revealed as highly receptive elements for progestins, whereas ER was barely demonstrable in the normal ovary. Benign serous and mucinous ovarian tumors showed opposite ER and PR distribution among the stromal and epithelial components. Of special interest were the highly significant changes in ER and PR content in the stromal and glandular cells of the different layers of the normal endometrium throughout the menstrual cycle.

Progesterone receptors in routinely paraffin-embedded primary breast carcinomas and lymph node metastases

Described here is an immunohistochemical technique using the commercially available monoclonal progesterone receptor (PR) antibody KD 68 in routinely fixed and paraffin-embedded breast carcinomas and lymph node metastases. The authors' technique is compared with several incubation variations. The method applying the primary antibody in a dilution of 1:10 overnight followed by a biotinylated second antibody showed the best results when Triton X-100 was added to the buffer. Using this method, comparison with the results on frozen sections of 34 breast carcinomas yielded a significant concordance of 94%. Correlation between the results on paraffin sections and those obtained by the standard dextran-coated charcoal cytosol assay was 80%. The value of the method for predicting endocrine therapy response was shown in 20 patients. Thus the reliability of the method has been demonstrated and was applied on 151 lymph node metastases and the corresponding primary breast carcinomas from 50 patients. Generally PR content in the metastases was lower than in the primary tumors (p < 0.001). This finding indicates that evaluation of PR in lymph node metastases should be included in the decision for endocrine therapy of breast cancer.