High expression of progesterone receptor may be an adverse prognostic factor in oestrogen receptor-negative/progesterone receptor-positive breast cancer: results of comprehensive re-evaluation of multi-institutional case series

Oestrogen receptor (ER)-negative (-) progesterone receptor (PgR)-positive (+) is the least common combination of steroid receptor expression observed in breast cancer. There are many controversies regarding the actual existence of ER-/PgR+ phenotype. In the current study, we aimed to perform comprehensive immunohistochemical re-evaluation of ER-/PgR+ breast cancers from multiple institutions. A total of 135 cases of ER-/PgR+ breast cancer were collected from 11 institutions from the period 2006-2020 and subsequently stained with three clinically validated anti-ER antibody clones: SP1 (Roche), 1D5 (Dako), and EP1 (Dako), and two anti-PgR antibody clones: 636 (Dako), and 1E2 (Roche). Clinicopathological characteristics of confirmed and re-categorised cases were analysed. Seventy-six cases retained the original ER-/PgR+ phenotype, including 21 HER2+ and 55 HER2- tumours. Forty-seven cases were ER+ with at least one anti-ER antibody, and 12 cases were re-categorised as double-negatives across all anti-ER and anti-PgR antibodies. No significant differences in survival were observed between groups in the HER2+ category. In the HER2- cohort, confirmed ER-/PgR+, ER+ tumours with discrepant ER staining, and triple negatives had inferior overall survival compared to concordant ER+ cases. Progesterone receptor expression in >20% of cells was identified as an adverse prognostic factor in ER-/PgR+/HER2- breast cancer in a multivariable model adjusted by stage (HR 5.0, 95% CI 1.3-19.2, p=0.019). We performed one of the largest validation studies so far on ER-/PgR+ breast cancer and confirmed the existence of this subgroup. Moreover, we identified high PgR expression as an adverse prognostic factor.

ER-/PgR+ breast cancer is a separate entity characterized by distinct phenotype: Comprehensive reevaluation of cases from Polish and Hungarian centers

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Background: ER negative (-)/PgR positive (+) breast cancer (BC) is very uncommon and questioned by many experts. We comprehensively reevaluated ER-/PgR+ BCs in the large cohort from Polish and Hungarian centers. Methods: FFPE blocks from 105 ER-/PgR+ tumors (45 breast biopsies and 64 post-operative samples from tumors not exposed to systemic therapy) were collected from 10 Polish and 3 Hungarian centers. In 60 cases available original slides with ER/PgR staining underwent reevaluation by 3 pathologists (MK, RP, WB) for ER and PgR expression by ASCO/CAP criteria. Subsequently, all samples were stained with 3 antibodies against ER (Dako monoclonal (MC) mouse anti-ERα, clone 1D5; Dako MC rabbit anti-ERα, clone EP1; VENTANA Roche MC rabbit anti-ERα, clone SP1), and PgR (Dako MC mouse anti-PgR, clone 636). If available, > 1 tissue block was used (av. 2.04 blocks/case, range 1-6). In 5 cases ESR1/PGR/ERBB2/MKi67 mRNA was measured by the Xpert® Breast Cancer STRAT4 (Cepheid, Sunnyvale, CA, USA). Results: 13 cases were excluded from immunohistochemical steps of the study due to insufficient amount of tissue and 8 - due to misdiagnosis after ER/PgR reevaluation of original slides. After re-staining, 42 cases (41.5%) retained the original phenotype, in 34 (33.67%) the ER status was corrected to ER+, and 16 (15.84%) tumors were ER/PgR-double-negative. The general agreement between anti-ER clones was moderate (Fleiss’ κ = 0.54). There were 56 ER- and 16 ER+ cases across all three assays. Five cases showed ER positivity with 2 antibodies (either SP1/EP1 or SP1/1D5), 5 tumors reacted exclusively with SP1 clone, and 2 - with 1D5 clone. Xpert Breast Cancer STRAT4 confirmed the ER-/PgR+ phenotype in 4 of 5 analyzed cases. The confirmed ER-/PgR+ BCs were characterized by lower percentage of PgR+ cells (median 5%) than BCs reclassified to ER+ (median 70%) (p = 0.022) and higher Ki67 expression than ER+ cases (median 54.5% vs 25%, respectively; p = 0.003). 39 (92.85%) ER-/PgR+ BCs presented with grade 3. Besides “conventional” high-grade cancers, we identified two distinct morphologies of ER-/PgR+ BC: resembling apocrine carcinoma (n = 5, 11.9%) and carcinoma with central acellular zone (n = 4, 9.5%). Conclusions: ER-/PgR+ BCs confirmed in the current study were defined by high-grade histology, high proliferation index and low percentage of PgR+ cells. We postulate ER-/PgR+ BC is a real albeit rare entity, and its diagnosis should be made cautiously, utilizing retesting with an alternative tissue block and anti-ER antibody.

The effect of low vitamin D status on sexual functioning and depressive symptoms in apparently healthy men: a pilot study

Hypovitaminosis D is associated with sexual dysfunction in apparently healthy women and with erectile dysfunction in men with the presence of concomitant disorders. This study was aimed at investigating sexual functioning and depressive symptoms in young men with low vitamin D status. The study included 15 apparently healthy men (18-40 years old) with vitamin D deficiency (group A), 16 subjects with vitamin D insufficiency (group B), and 16 men with normal vitamin D status (group C). All participants of the study completed questionnaires investigating their sexual function (the International Index of Sexual Function-15-IIEF-15 for heterosexual men), as well as the presence and severity of depressive symptoms (Beck Depression Inventory-Second Edition-BDI-II). Compared with healthy men, subjects with vitamin D deficiency obtained lower scores for erectile function, orgasmic function, and sexual desire, while individuals with vitamin D insufficiency lower scores only for erectile function. Erectile dysfunction was more prominent in group A than group B. The total BDI-II score was higher in group A than in the other study groups. The results of the study suggest that low vitamin D status impairs male sexual functioning and severity of sexual dysfunction correlates with the degree of hypovitaminosis D.

The effect of vitamin D supplementation on sexual functioning and depressive symptoms in young women with low vitamin D status

BACKGROUND

Hypovitaminosis D is associated with abnormal female sexual functioning. The aim of our study was to assess whether vitamin D supplementation affects sexual functioning and depressive symptoms in young women with low vitamin D status.

METHODS

The study included 47 women with vitamin D deficiency or insufficiency. All women with vitamin D deficiency were treated with oral vitamin D, while women with vitamin D insufficiency were either treated with vitamin D or left untreated. At the beginning of the study and six months later, all patients completed questionnaires evaluating female sexual function (FSFI) and depressive symptoms (BDI-II).

RESULTS

The total FSFI score and scores in three domains (sexual desire, orgasm and satisfaction) were lower while the overall BDI-II score was higher in women with vitamin D deficiency than in women with vitamin D insufficiency. Vitamin D improved sexual desire in women with both vitamin D deficiency and vitamin D insufficiency, increased the total FSFI score and scores for orgasm and sexual satisfaction, as well as decreased the total BDI-II score in women with vitamin D deficiency.

CONCLUSIONS

The obtained results indicate that vitamin D supplementation improves female sexual functioning and mood in women with low vitamin D status. < p > < /p >.