[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
Ethnicity	Hispanic	57.5%(23)	0.98	0.045
	Caucasian	20%(8)	2.28	0.034
	Asian	22.5%(9)	0.25
Pre-Rx ES	arc abn>/=3	27.5%(11)	0.37	0.028
	arc abn<3	72.5%(29)	1.23
First on Rx ES	>SH	60%(24)	0.49	0.007
		40%(16)	2.25
First on Rx ES	arc abn(+)	60%(24)	0.5	0.015
	arc abn(-)	40%(16)	1.74
First on Rx ES	nucleolus(+)	60%(24)	0.64	0.08
	nucleolus(-)	40%(16)	1.44
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
	lesion<1mm	27.5%(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