Prognostic role of age, hormonal status, and tumour subtype on estrogen receptor expression in breast cancer: a retrospective cohort study

Background Breast cancer prognosis depends on patient and tumour factors, yet the prognostic interplay between age, hormonal status, and molecular subtype remains unclear. Estrogen receptor alpha (ERα) and beta (ERβ) show distinct expression patterns that may influence survival, but their independent contribution is debated. Methods A retrospective cohort of 116 women with invasive breast cancer treated in Surakarta was analysed. Immunohistochemistry determined ERα/ERβ expression (Allred score) and molecular subtype (Luminal A, Luminal B, HER2-enriched, triple-negative). Associations with age, menopausal status, and 5-year overall survival were tested using non-parametric statistics, multivariate logistic regression, and Kaplan–Meier analysis (SPSS v29). Results Younger patients (≤ 40 years) showed higher ERβ expression than older patients (median 54.7% vs 37.4%, p = 0.095), but age was not an independent survival predictor (p = 0.235). Premenopausal women demonstrated a near-significant survival advantage (OR = 2.78, p = 0.055). Triple-negative breast cancers (TNBC) exhibited the lowest ERα (12.8%) and the highest ERβ (70.3%) compared with other subtypes (all p < 0.01). Multivariate and stepwise regression confirmed tumour subtype as the sole independent determinant of 5-year survival (p = 0.019), with TNBC conferring 42% poorer outcomes (OR = 0.58). Conclusions Molecular subtype is the dominant prognostic factor in breast cancer and should guide therapeutic decision-making. The distinctive ERβ enrichment in TNBC highlights a potential biomarker and therapeutic target, warranting future studies of ERβ isoforms and subtype-specific interventions. Trial registration Not applicable (retrospective observational study).