Estrogen receptor beta expression and prognosis of diffuse large B cell lymphoma.

ABSTRACT

OBJECTIVES: Estrogen receptor beta (ERß)-selective agonists inhibited B cell lymphoma growth in animal models. However, a recent study found that higher ERß expression in tissue from diffuse large B cell lymphoma (DLBCL) patients indicated a poorer survival. This study aimed to determine the ERß expression in DLBCL tissue using immunohistochemistry and correlate with clinical outcomes. METHODS: Diagnostic tissues from newly diagnosed adult DLBCL patients treated with Rituximab-Cyclophosphamide/Doxorubicin/Vincristine/Prednisolone were counted for ERß1-expressing cells. Nodal lymphoma (N = 41) was analyzed separately from extra-nodal DLBCL (N = 31). RESULTS: On immunohistochemistry, ERß1 was expressed in 73.6% of cases with the median expressing cells of 20%. For nodal lymphoma, high ERß expression (≥25%) was associated with poorer event free survival (EFS) independent of the international prognostic index with the adjusted hazard ratio (HR) of 2.49 (95% Confidence interval (CI) 1.03-6.00, P = 0.042). On the contrary, high ERß expression (≥25%) was associated with superior outcomes in extra-nodal DLBCL with the adjusted HR of 0.25 (95% CI 0.09-0.75, P = 0.013) for EFS and adjusted HR of 0.29 (95% CI 0.10-0.85, P = 0.024) for overall survival in multivariate analyses. CONCLUSION: ERß1 protein expression represented opposite prognostic factors in nodal vs. extra-nodal DLBCL.