title: In situ levels of oestrogen producing enzymes and its prognostic significance in postmenopausal breast cancer patients.
abstract: BACKGROUND
  The risk of developing breast cancer is strongly correlated with the overall exposure to oestrogen and most tumours are more or less dependent on oestrogen for their growth. A great majority of breast cancers occur after menopause when the ovaries have ceased to be functional, yet breast tumours in postmenopausal women maintain high intratumoural oestrogen concentrations, primarily through enzymatic conversion of androgenic precursors.
  
  
  METHODS
  with a hormone dependent tumour generally receive the anti-oestrogen tamoxifen that mediate its anti-tumour effect by competing with oestrogen for binding to the oestrogen-receptor (ER). We therefore propose that the levels of oestrogen producing enzymes may affect the prognosis in postmenopausal breast cancer patients treated with tamoxifen.
  
  
  METHODS
  We measured the mRNA and protein levels of aromatase and sulfatase by real-time PCR (n=161) and immunohistochemistry (n=131) in postmenopausal women with breast cancer.
  
  
  RESULTS
  A significant better recurrence-free survival was detected in patients with weak or high protein expression of stromal aromatase (P=0.0008), as also demonstrated by a decreased relative risk (RR=0.50, CI=0.33-0.76, P=0.003). When we combined patients with weak and high stromal aromatase and selected only ER-positive patients, the improved prognosis was even more evident (P=0.0000) and was shown to be a significant prognostic factor in a multivariate Cox-model (HR=0.15, CI=0.06-0.39, P=0.000). The mRNA expression of aromatase and sulfatase, as well as the protein expression of sulfatase revealed no prognostic significance.
  
  
  CONCLUSIONS
  Protein expression of stromal aromatase may serve as a significant prognostic marker in ER-positive patients.
authors.affiliation: Institution of Clinical and Experimental Medicine, Division of Cell Biology, Faculty of Health Sciences, Linköping University, Linkoping, Sweden.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Licznerska
authors.forename: Pia P
authors.initials: PP
authors.lastname: Wegman
authors.forename: Bo
authors.initials: B
authors.lastname: Nordenskjöld
authors.forename: Sten
authors.initials: S
authors.lastname: Wingren
mesh_terms: D001141:Aromatase / Q000235:genetics* / Q000378:metabolism; D001943:Breast Neoplasms / Q000201:enzymology* / Q000235:genetics* / Q000473:pathology; D004967:Estrogens / Q000378:metabolism*; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D009364:Neoplasm Recurrence, Local / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D017698:Postmenopause; D011379:Prognosis; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D012334:RNA, Neoplasm / Q000235:genetics / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017154:Stromal Cells / Q000201:enzymology / Q000473:pathology; D013429:Sulfatases / Q000235:genetics* / Q000378:metabolism; D015996:Survival Rate; D046888:Tissue Array Analysis
chemical_list: D004967:Estrogens; D012333:RNA, Messenger; D012334:RNA, Neoplasm; D011960:Receptors, Estrogen; D001141:Aromatase; D013429:Sulfatases