Androgen receptor as a prognostic biomarker in breast cancer: A systematic review and meta-analysis

Breast cancer (BC) is the most prevalent malignancy and a leading cause of cancer-related death among women globally. The androgen receptor (AR), a nuclear receptor, exhibits both pro- and anti-tumorigenic effects, but its prognostic value in BC remains unclear.

To evaluate the association between AR expression and clinical outcomes like disease-free survival (DFS) and overall survival (OS) in BC across different subtypes.

This study is registered with PROSPERO (CRD4251023927) and follows PRISMA guidelines. We searched PubMed, Scopus, Web of Science, Embase, and Cochrane Library. Inclusion criteria encompassed original studies with female patients, survival data based on AR status, and at least one additional clinicopathological marker (e.g., ER, PR, HER2, TNBC). Pooled hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I² statistics.

Twenty-four studies with 17329 patients were included. In multivariate analysis, AR positivity showed a trend towards better OS (HR=0.59, 95 % CI: 0.18-1.95, p = 0.39) and DFS (HR=0.62, 95 % CI: 0.30-1.25, p = 0.18), though not statistically significant. Subgroup analysis showed significant benefits in AR and ER-positive BC for both OS (HR=0.66, 95 % CI: 0.56-0.77) and DFS (HR=0.78, 95 % CI: 0.60-1.02), while it was ambiguous in other subsets.

AR expression is associated with improved prognosis in ER-positive BC, but its role in TNBC and HER2-positive BC remains unclear due to heterogeneity and non-significant results. Standardized AR evaluation and prospective studies are needed to confirm its prognostic and predictive value for personalized BC treatment.