Sex hormone receptor expression and survival in esophageal adenocarcinoma: a prospective cohort study

Introduction: A striking epidemiological feature of esophageal adenocarcinoma (EAC) is its strong, unexplained male predominance but few studies have evaluated the prevalence of sex hormone receptor expression in EAC.

Results: A low proportion of EAC tumors stained positive for ERa (4%) and AR (3%) while approximately one third stained positive for ERß (31%). After a mean follow-up of 3 years (max 9 years), no significant associations were seen for ERa, ERß or AR expression and EAC recurrence or survival. A non-significant reduction in mortality was observed for positive ERß tumor expression, when restricting to patients with gastro-esophageal junctional (GEJ) cancer (HR 0.58, 95% CI 0.33, 1.03, p = 0.06).

Materials and Methods: We identified all EAC patients who underwent neoadjuvant chemotherapy prior to surgical resection between 2004-2012 in the Northern Ireland Cancer Centre. Immunohistochemical expression of ERa, ERß and AR was scored on triplicate cores to generate H-scores. Cox proportional hazards regression was used to evaluate the association between sex hormone receptor expression and overall, cancer-specific and recurrence-free survival.

Conclusion: We found little evidence of ERa or AR expression in EAC. A moderate proportion expressed ERß and there was suggestive evidence that its expression was associated with improved survival in GEJ cancer patients.