Prognostic significance of the immunohistochemical status of the endometrium as markers of therapy for endometrial hyperplasia

Abstract

BACKGROUND: In patients of reproductive age with endometrial hyperplasia without atypia, hormonal treatment, and prognosis of response remain relevant issues. AIM: To increase the effectiveness of hormonal therapy for endometrial hyperplasia in patients of reproductive age with abnormal uterine bleeding, considering the receptivity, and proliferative activity of the endometrium. MATERIALS AND METHODS: A total of 179 patients of reproductive age with abnormal uterine bleeding and endometrial hyperplasia were examined. After the removal of the endometrial tissue, hormonal therapy was performed for 6 months: 101 patients received dydrogesterone 20 mg/day, and 78 patients received norethisterone acetate 10 mg/day. The expression levels of estrogen receptor- (Er), progesterone receptor (PR), and Ki67 in the endometrial tissue were determined by immunohistochemistry at baseline and 3 months after the treatment. The comparison group consisted of 18 women without gynecological pathology. Variation statistics methods were used to process the data, the differences between the indicators groups of patients were considered significant at p 0.05. RESULTS: Before treatment, the expression levels of ER, PR in both compartments, and Ki-67 in the glands were lower (p 0.05) in the endometrial hyperplasia group than in the control group. Remission was achieved in 77 (76.24%) (dydrogesterone) and 62 (79.49%) (norethisterone acetate) patients. Initially, the expression level of ER in the glands and stroma of endometrial hyperplasia was lower (p 0.05) than that in the comparison group; the resistant group had a lower (p 0.05) response to treatment. The expression of PR in the resistant group was lower (p 0.05) than that in the comparison group and remission group. The expression level of Ki67 in the response group was lower than that in the comparison group (p 0.05), and the expression in the stroma was lower than that in the resistant group (p 0.05). After treatment in both compartments, the expression levels of ER and PR were lower in the resistant group than in the comparison group and response group (p 0.05). A logistic regression equation was obtained with a set of predictors: ER (glands) + PR (glands and stroma) + Ki-67 (stroma) with a potential response to therapy of 93%. CONCLUSIONS: The specified predictive model is promising. The therapy was effective in 93% of cases.