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.
|Factor||%(N)||standardized resolution ratio (SRR)||p value|
|Pre-Rx ES||arc abn>/=3||27.5%(11)||0.37||0.028|
|First on Rx ES||>SH||60%(24)||0.49||0.007|
|First on Rx ES||arc abn(+)||60%(24)||0.5||0.015|
|First on Rx ES||nucleolus(+)||60%(24)||0.64||0.08|
|First on Rx ES||mitosis >/=2/10 glands||17.5%(7)||0.35||0.02|
|mitosis <2/10 glands||82.5%(33)||1.25|
|First on Rx ES||lesion>/=1mm||72.5%(29)||0.68||0.04|