Clinicopathological significance of expression of Estrogen Receptor-Beta (ERβ), Progesterone Receptor(PR) and Vascular Endothelial Growth Factor-A (VEGF-A) in colorectal cancer

Background: Estrogen-receptor-beta (ER β), Progesterone-receptor (PR) and Vascularendothelial-growth-factor have been implicated to have a role in colorectal cancer. The expression of these markers and the clinicopathological significance of the same remain unclear. Purpose: The purpose of this study was to determine the expression of these biological markers: ERβ, PR and VEGF in colorectal cancer cells and their prognostic significance. Methods: An immunohistochemical assay of ER β, PR and VEGF was performed in 72 patients with colonic adenocarcinoma. Normal colonic tissue from the same cases was assessed as a control. The correlation of the presence of these markers with other clinicopathological features as well as survival was then determined. Results: None of the cases showed expression of ERβ or PR by the malignant cells of the tumor. Whereas, in two of the cases, ERβ was detected in the normal colonic mucosa. VEGF was expressed strongly in the malignant colonic cells in 64 cases, in comparison with 10 cases of normal colonic mucosa. VEGF expression was observed in 37/40(92%) patients with colorectal cancer metastatic to nodes or distant organs, whereas 24/27 (88.8%) patients with disease limited to the colon expressed the factor. Strong VEGF expression did not correlate with tumor grade, angiolymphaticinvolvement, stage, disease-free and overall survival. 23/26(88.4%) patients with recurrence had strong VEGF expression, whereas 41/47(87.2%) patients with no recurrence had strong VEGF expression. Conclusions: Colorectal cancers do not express ERβ or PR. Absence of ERβ expression by normal mucosa contests the previous reports of a protective effect of ERβ with decreased levels associated with colorectal tumorigenesis in females. VEGF expression in colorectal cancer compared to normal mucosa indicates that it may have a role in tumorigenesis. However VEGF expression cannot be used as a prognostic marker.