Cytoplasmic expression of oestrogen receptor beta (ERß) as a prognostic factor in vulvar squamous cell carcinoma in elderly women

Aims: To investigate the prognostic value of cytoplasmic oestrogen receptor beta (ERb) expression in a series of untreated patients with non-human papillomavirus (HPV)-related vulvar cancer. Methods and results: Immunohistochemistry was carried out using a polyclonal rabbit anti-human ERb antibody. The nuclear and cytoplasmic expression of ERb was evaluated in 33 patients. Cytoplasmic immunoreactivity was correlated with histopathological and molecular parameters (Ki67, p21), disease-free survival (DFS) and overall survival (OS). The expression of cytoplasmic ERb was found to be associated with grade (P = 0.006), while no association was found with any of the remaining variables examined. Cases with high cytoplasmic ERb expression showed lower DFS and OS compared to cases with low cytoplasmic ERb (P = 0.007, P = 0.01, respectively). There was also a progressive decline in both the DFS and OS with increasing tumour size (P = 0.05, P = 0.07, respectively) and with increasing depth of infiltration (P = 0.14, P = 0.07, respectively). On multivariate analysis, only tumour size and cytoplasmic ERb staining retained an independent negative prognostic role for DFS and OS. Conclusions: The assessment of cytoplasmic ERb expression could be helpful to identify poor prognosis in elderly patients with non- HPV- related vulvar squamous cell carcinoma (SCC).