Skip to main content

Low Grade Serous Ovarian Cancer: Is disturbed Receptor Ratio (ER: PgR) an Etiogenic Factor?



Serous ovarian carcinomas (SOCs) are the commonest epithelial ovarian carcinomas (EOCs). EOCs are subdivided into low-grade serous ovarian carcinomas (LGSOCs) or type 1 and high-grade serous ovarian carcinomas (HGSOCs) or type 2. LGSOC are less common, occur at a younger age, have a better prognosis and are relatively chemoresistant. LGSOC have a higher expression of estrogen receptors (ER) and progesterone receptors (ER-PgR) and are said to be hormone sensitive. Studies have shown higher PgR positivity in LGSOC than in HGSOC. Literature states that the number of ER reduces in ovaries immediately after menopause, whereas PgR receptors persist for some time.


Receptor (ER-PgR) profile of 157 women (out of 202 women with diagnosed or suspected ovarian malignancy) with EOC (both LGSOC and HGSOC) who were treated at a tertiary care cancer hospital over a period of two years was retrospectively collected and analyzed. The ER-PgR profile of these women was also studied in relation to early and late menopausal period.


Analysis showed that ER-PgR profile was different for LGSOC and HGSOC. It was also found that the profile of hormone receptors and their ratio was different in early and late menopausal period keeping other variables constant.


LGSOC occurs in comparatively younger women and is mostly diagnosed in early postmenopause, i.e., within five years of menopause. Apart from showing a definite pattern, the ER-PgR ratio is also altered during this period. It can therefore be concluded that the altered ER-PgR ratio might be responsible for pathogenesis of LGSOC rather than absolute numbers or percentages of estrogen and progesterone receptors. This can lead to an alteration in the hormone therapy protocol for management of LGSOC if proven in further research.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Brodowska A, Starczewski A, Laszczyñska M, Szydowska I. Ovarian androgenesis in women after menopause. Pol Merkuriusz Lek. 2005;19:90–3.

    CAS  Google Scholar 

  2. 2.

    Konstantinos P, Mara S, Agni P, Ri Anna, Petroula T, Nikolaos N, et al. A case series on natural conceptions resulting in ongoing pregnancies in menopausal and prematurely menopausal women following platelet-rich plasma treatment. Cell Transp. 2019;28(9–10):1333–40.

    Article  Google Scholar 

  3. 3.

    Fang S, Xuyin Z, Yiqun Z, Jingxin D, Qi C. Hormone receptors expression in ovarian cancer taking into account menopausal status: a retrospective study in Chinese population. Oncotarget. 2017;8(48):84019–27.

    Article  Google Scholar 

  4. 4.

    Slotman BJ, Nauta JJ, Rao BR. Survival of patients with ovarian cancer apart from stage and grade, tumor progesterone receptor content is a prognostic indicator. Cancer. 1990;665:40–744.

    Google Scholar 

  5. 5.

    David MG, Diane CB, Robert LC, Karen HL, Anais M, Charlotte CS. Hormonal maintenance therapy for women with low-grade serous cancer of the ovary or peritoneum. J Clin Oncol. 2017;35(10):1103–11.

    Article  Google Scholar 

  6. 6.

    Peey-S K, Philip B, Rachel L, Peter G, Tony B, James S. PARAGON (ANZGOG-0903): a phase 2 study of anastrozole in asymptomatic patients with estrogen and progesterone receptor-positive recurrent ovarian cancer and CA125 progression. J Gynecol Oncol. 2019;30(5): e86.

    CAS  Article  Google Scholar 

  7. 7.

    Jorge E, Alexander CK, Michelle D, Pamela C, Jill GN, Gregg SN. Quantification of ER/PR expression in ovarian low-grade serous carcinoma. Gynecol Oncol. 2013;128(2):371–6.

    CAS  Article  Google Scholar 

  8. 8.

    Fernandez ML, et al. Hormone receptor expression and outcomes in low-grade serous ovarian carcinoma. Gynecol Oncol. 2020;157(1):12–20.

    Article  Google Scholar 

  9. 9.

    Matthew H, Marian MD, Frank Mc C, Martin MM. Targeting RAF kinases for cancer therapy: BRAF mutated melanoma and beyond. Nat Rev Cancer Nat Rev Cancer. 2014;14(7):455–67.

    CAS  Article  Google Scholar 

  10. 10.

    Harding M, Cowan S, Hole D, Cassidy L, Kitchener H, Davis J, Leake R. Estrogen and progesterone receptors in ovarian cancer. Cancer. 1990;65(3):486–91.

    CAS  Article  Google Scholar 

  11. 11.

    Marta LF, Amy D, Hannah K, Nicole L, Holly R, Maegan B. Hormone receptor expression and outcomes in low-grade serous ovarian carcinoma. Gynecol Oncol. 2020;157(1):12–20.

    CAS  Article  Google Scholar 

  12. 12.

    Brett MR, Jennifer BP, Thomas AS. Epidemiology of ovarian cancer: a review. Cancer Biol Med. 2017;14(1):9–32.

    CAS  Article  Google Scholar 

  13. 13.

    Voutsadakis IA. A systematic review and meta-analysis of hormone receptor expression in low-grade serous ovarian carcinoma. Eur J Obstet Gynecol Reprod Biol. 2021;256:172–8.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding authors

Correspondence to Ranu patni or Neha sethi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

patni, R., sethi, N. Low Grade Serous Ovarian Cancer: Is disturbed Receptor Ratio (ER: PgR) an Etiogenic Factor?. Indian J Gynecol Oncolog 19, 94 (2021).

Download citation


  • Ovarian serous
  • ER
  • PgR
  • Low grade