Significance of progesterone receptors (PR-A and PR-B) expression as predictors for relapse after successful therapy of endometrial hyperplasia: a retrospective cohort study.

Abstract

OBJECTIVE:

After successful progestin therapy for endometrial hyperplasia (EH), the risk of relapse remains. We aimed to assess if immunohistochemical (IHC) expression of progesterone receptor isoforms, PR-A and PR-B, in endometrial glands and stroma in pre-treatment endometrial biopsies was related to relapse of EH.

DESIGN AND SETTING:

Biopsy material originated from women with low-risk and medium-risk EH recruited to a recent Norwegian multicentre randomised trial. Participants (n = 153) had been treated for 6 months with three different progestin regimens.

POPULATION:

One hundred and thirty-five of the 153 women achieved therapy response and underwent follow up for 24 months after therapy withdrawal. Fifty-five women relapsed during follow up. Pre-treatment endometrial biopsies from 94 of the 135 responding women were available for IHC staining.

METHODS:

Immunohistochemical staining was performed separately for PR-A and PR-B and IHC expression was evaluated in endometrial glands and stroma by a histological score (H-score) using light microscopy.

MAIN OUTCOME MEASURE:

Immunohistochemical expression of PR-A and PR-B in endometrial glands and stroma in women with or without relapse of EH.

RESULTS:

Low PR-A in endometrial glands (P = 0.013) and stroma (P < 0.001), and high PR-B in endometrial glands (P = 0.001) in pre-treatment endometrial biopsy have a statistically significant association with relapse of EH. Women with a pre-treatment ratio of PR-A:PR-B ≤ 1 have a higher risk of relapse (71%) compared with women with a ratio of PR-A:PR-B > 1 (19%; P < 0.001).

CONCLUSION:

Immunohistochemical expression of PR-A and PR-B in pre-treatment endometrial biopsy proves valuable as a predictor of relapse in EH.

TWEETABLE ABSTRACT:

Pre-treatment endometrial expression of PR-A and PR-B is a valuable predictor of relapse in endometrial hyperplasia.

• Authors: E T Sletten, M Arnes, L M Lyså, M Larsen, A Ørbo
• Journal: BJOG : an international journal of obstetrics and gynaecology (BJOG) Vol. 126 Issue 7 Pg. 936-943 (06 2019) ISSN: 1471-0528 [Electronic] England
• PMID: 30548528 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: © 2018 Royal College of Obstetricians and Gynaecologists.

Chemical References

• Biomarkers
• Progestins
• Receptors, Progesterone
• progesterone receptor A
• progesterone receptor B

Topics

• Adult
• Aged
• Biomarkers (metabolism)
• Endometrial Hyperplasia (complications, drug therapy)
• Female
• Humans
• Middle Aged
• Progestins (therapeutic use)
• Receptors, Progesterone (metabolism)
• Recurrence
• Retrospective Studies