Androgen Receptor Expression in Breast Carcinoma of Egyptian Patients

Androgen receptor expression in a Sri Lankan patient cohort with early breast carcinoma

BACKGROUND

Androgen receptor (AR) expression is emerging as a prognostic biomarker in breast carcinoma (BCa). The study aimed to determine the prevalence of AR expression by immunohistochemical analysis among a cohort of Sri Lankan women with early BCa and to evaluate its association with clinicopathological features including immunohistochemical molecular subtype and early survival.

METHOD

We studied the clinical and pathological features and immunohistochemical profile of 141 women undergoing primary surgery for early BCa, followed by standard adjuvant therapy. AR status was assessed by immunohistochemistry in all cases. Overall survival (OS) and disease-free survival (DFS) was determined. The relationship between AR expression and clinical and pathological parameters and immunohistochemical molecular subtype was analyzed using Student T test and chi-square tests. Cox regression analysis was used to analyze the prognostic impact of AR expression.

RESULTS

AR expression was seen in 40.8%(95%CI 33.10-49.07%) of the BCa study cohort. None of the clinical data studied showed a significant association with the AR status(p > 0.05). Ductal carcinoma in situ(p = 0.003), oestrogen receptor (ER) (p = 0.001) and progesterone receptor (PR) (p = 0.001) positivity and luminal IHC molecular subtype(p = 0.016) were significantly associated with AR-positive status. AR-negative status was significantly associated with tumour necrosis > 50%(p = 0.031), moderate to extensive lymphocytic infiltrate at the tumour margin(p = 0.025) and basal triple negative breast carcinoma(p = 0.016). The mean duration of patient follow-up was 46.70(95% CI 46.495-46.905) months (3.89 years). On univariate analysis, AR-positivity was associated with better OS among ER-positive tumours(p = 0.047), specifically in postmenopausal women (p = 0.030). In ER-negative tumours, AR positivity was associated with worse DFS (p = 0.036). On multivariate analysis, TNM stage and ER/AR status were predictive of survival. ER-positive/AR-positive (ER+/AR+) tumours demonstrated better OS than ER-positive/AR-negative (ER+/AR-) tumours(p = 0.015). ER-negative/AR-positive (ER-/AR+) tumours (p = 0.014) had a worse DFS than ER-negative/AR-negative (ER-/AR-) tumours.

CONCLUSIONS

AR prevalence obtained was low. AR positivity was associated with positivity for ER and PR. On multivariate analysis, apart from TNM stage only ER/AR status were predictive of OS and DFS, with concordant expression of ER/AR demonstrating a better, early survival.

Immunohistochemical Expression of Androgen Receptors (AR) in Various Breast Cancer Subtypes

BACKGROUND:

Breast carcinoma ranks the first among malignant tumours in females and is the chief cause of cancer-related mortality. Androgen in implicated in the induction of proliferation and growth of mammary cells through binding to their corresponding receptors. Androgens influence the risk of acquiring breast cancer through either direct binding to androgen receptors (AR) or indirectly through their transformation to estradiol or competing for steroid binding proteins.

AIM:

To study the expression of AR in various breast cancer subtypes and to elucidate its clinical significance by correlating it with clinicopathological parameters.

METHODS:

One hundred and fifty breast cancer cases were studied using AR immunohistochemistry, and its expression was correlated with different clinicopathologic parameters and with ER, PR, Her-2/neu and Ki 67 expression.

RESULTS:

AR was expressed in 91 breast carcinoma cases out of 150 examined. There was a statistically significant correlation between AR expression and tumour size, mitotic count, tumour necrosis, infiltrative borders, the hormonal status of the tumour and subsequently luminal subtypes (p < 0.05). A subset of studied TNBC (34.6%) also expressed AR. On the other hand, there was no significant correlation between AR expression and other clinicopathological parameters.

CONCLUSION:

Positive AR immunostaining was associated with favourable prognostic factors and luminal subtypes (A&B). Also, a subset of TNBC cases showed positive AR expression. These results introduce the current potent, next-generation AR- antagonist as possible target therapy in breast cancer. Further researches on AR expression in breast cancer are recommended on a larger scale with follow up and survival to validate the current results.

Expression of androgen receptor in invasive ductal breast carcinomas: a clinicopathological study from Jordan

BACKGROUND

The clinical relevance of androgen receptors (ARs) expressed in breast cancer cells and the suggested prognostic impact has been an area of active research. The prevalence rate of AR expression in breast cancer has never been reported among Jordanian patients.

OBJECTIVE

Determine the expression rate of ARs among invasive ductal breast cancer cases of different stages and molecular subtypes. Also, analyze the relationship between AR expression and clinicopathologic and immunohistochemical criteria, and assess the impact of AR expression on survival.

DESIGN

Retrospective medical record review.

SETTING

Tertiary care hospital in Amman, Jordan.

PATIENTS AND METHODS

Our study comprised only of cases of invasive ductal breast carcinoma of no special type among females from records during a 10-year period between 2006 and 2015. Immunohistochemical staining was considered positive if more than 10% of tumor nuclei showed positive staining.

MAIN OUTCOME MEASURES

The expression rate of ARs and the association of the expression rate with the clinicopathologic features of invasive breast cancer.

SAMPLE SIZE

293.

RESULTS

Immunohistochemical staining for AR revealed positive stain.ing in 180 (61.4%) cases, including approximately 50% of triple-negative breast cancer cases. AR positivity correlated with estrogen receptor (ER) status (P=.007) and smaller T size (P=.014). However, no significant association was found with any of the other variables. AR expression was positively associated with overall survival (P=.022) in general and in ER-positive cases (P=.012). However, in the multivariate Cox regression model, AR was not independently associated with survival.

CONCLUSIONS

These results were consistent with international reports showing a significant relationship of AR expression with ER status. In addition, AR expression was significantly associated with smaller tumor size. Although AR status was not independently associated with survival, our data suggest AR is a good prognostic factor.

LIMITATIONS

Some clinical data were missing.

CONFLICT OF INTEREST

None.