High glucocorticoid receptor expression predicts short progression-free survival in ovarian cancer

Objective. To investigate the association of tumor glucocorticoid receptor (GR) expression and patient outcome in ovarian cancer. Methods. GR expression was evaluated by immunohistochemistry using tissue microarrays of specimens from 481 patients with ovarian cancer and 4 patients with benign conditions. Low GR expression was defined as an intensity of 0 or 1 + and high GR as 2 + or 3 + in >1% of tumor cells. Analyses were performed to evaluate the relationship of GR expression with clinical characteristics, progression-free survival (PFS) and overall survival (OS). Results. GR protein was highly expressed in 133 of 341 (39.0%) tumors from patients who underwent upfront cytoreduction surgery followed by adjuvant chemotherapy. High GR expression was more common in serous tumors (p < 0.001), high grade tumors (p < 0.001), and advanced stage tumors (p = 0.037). Median PFS was significantly decreased in cases with high GR (20.4 months) compared to those with low GR (36.0 months, HR = 1.66, 95% CI 1.29-2.14, p < 0.001). GR remained an independent prognostic factor for PFS in multivariate analysis. OS was not associated with GR status. Conclusions. These data suggest that high GR expression correlates with poor prognosis and support the hypothesis that modulating GR activity in combination with chemotherapy may improve outcomes. (C) 2017 Elsevier Inc. All rights reserved.