[997] Factors Predicting Response to Progestin Treatment for Complex Atypical Hyperplasia/Well Differentiated Endometrial Carcinoma in Premenopausal Patients.

Chisa Aoyama, Kristine Penner, Nora Ostrzega, Jianyu Rao, Christine Walsh, Oliver Dorigo, Ilana Cass, Bonnie Balzer, Christine Holschneider. Olive View-UCLA Medical Center, Sylmar, CA; UCLA Medical Center, Los Angeles, CA; Cedar-Sinai Medical Center, Los Angeles, CA

Background: Response rates of complex atypical hyperplasia (CAH) and/or Grade 1 endometrial carcinoma (G1EAC) to progestin treatment are approximately 70 % with median time to resolution being 5 months. Little is known about factors associated with patient's response to this hormone therapy. Purpose: To establish clinical and histologic indicators for predicting response to progestin treatment in premenopausal patients with CAH and/or G1EAC.
Design: In 40 premenopausal patients with CAH and/or G1EAC, clinical data (age, ethnicity, parity, BMI) and histologic features from pre- and first-on-(minimum 8 weeks of progestin)-treatment endometrial sampling (ES) were analyzed for distinguishing Responders from Non-Responders. ESs were reviewed by 2 pathologists independently, and the diagnosis, architectural abnormalities (papillary; polypoid; cribriform; back-to-back; budding), nuclear abnormalities (nuclear stratification; nucleolus; N/C ratio >0.67), cytoplasm eosinophilia, cytoplasm squamoid changes, and decidual changes were recorded. Responders were defined by absence of atypia or carcinoma in 2 consecutive ESs and/or hysterectomy.
Results:

Variables associated with Response in univariate analysis
Factor %(N)standardized resolution ratio (SRR)p value
EthnicityHispanic57.5%(23)0.980.045
 Caucasian20%(8)2.280.034
 Asian22.5%(9)0.25 
Pre-Rx ESarc abn>/=327.5%(11)0.370.028
 arc abn<372.5%(29)1.23 
First on Rx ES>SH60%(24)0.490.007
 40%(16)2.25 
First on Rx ESarc abn(+)60%(24)0.50.015
 arc abn(-)40%(16)1.74 
First on Rx ESnucleolus(+)60%(24)0.640.08
 nucleolus(-)40%(16)1.44 
First on Rx ESmitosis >/=2/10 glands17.5%(7)0.350.02
 mitosis <2/10 glands82.5%(33)1.25 
First on Rx ESlesion>/=1mm72.5%(29)0.680.04
 lesion<1mm27.5%(11)2.38 
SRR>1 indicates response rate higher than baseline


Conclusions: Non-response to hormone treatment in CAH and G1EAC was associated with (1) Pre-treatment ES with significantly abnormal architecture; (2) First-treatment ES with diagnosis worse than simple hyperplasia (SH); (3) First-treatment ES with persistent abnormal architecture; (4) First-treatment ES with persistent nuclear atypia (nucleolus, mitosis > 2/10 glands) and (5) First-treatment ES with >1mm lesion.
Category: Gynecologic & Obstetrics

Wednesday, March 2, 2011 1:00 PM

Poster Session VI # 144, Wednesday Afternoon

 

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