Predictors of resolution of complex atypical hyperplasia or grade 1 endometrial adenocarcinoma in premenopausal women treated with progestin therapy
Highlights
► Progestin for grade 1 endometrial cancer and CAH—clinical & pathological predictors of resolution. ► 43% resolution at 12 months; 63% resolution at 18 months. ► Lowest resolution rate if no response on 1st follow-up specimen & adjacent stromal decidualization.
Section snippets
Introduction and background
Endometrial cancer is the most common gynecologic malignancy in developed countries [1]. While typically a disease of postmenopausal women, 20–25% of endometrial cancer and complex atypical hyperplasia cases occur in premenopausal women, with 5–10% occurring in women under the age of 40 [2], [3]. For the subpopulation of fertility-seeking premenopausal women with complex atypical hyperplasia (CAH) or grade 1 endometrial adenocarcinoma (Grade 1 EA), progestin therapy may enable a delay of
Methods
Premenopausal women diagnosed with Grade 1 EA or CAH between 1998 and 2007 were identified from pathology and gynecologic oncology databases at Olive View-UCLA, Cedars-Sinai, and UCLA Medical Centers. Institutional review board approval was obtained from all three institutions. A retrospective chart review was performed to extract clinical, epidemiological, pathological, and treatment data. Inclusion criteria were a diagnosis of CAH or Grade 1 EA on pre-treatment sampling, followed by progestin
Results
Forty premenopausal patients with Grade 1 EA or CAH met study criteria. Demographic and clinical data are described in Table 1. Median time from diagnosis to first follow-up was 3.8 months (range 2.3–8.2 months). The initial diagnosis was Grade 1 EA in 35% of subjects and CAH in 65%. Concordance in the histopathological diagnosis of the pretreatment specimen was found in 90% of specimens (κ = 0.82, p < 0.00001); in the remaining 10%, additional review by a third pathologist confirmed the original
Discussion
Progestin therapy offers a potential medical treatment for premenopausal women with complex atypical hyperplasia (CAH) or grade 1 endometrial cancer (Grade 1 EA) who desire to maintain fertility. Combining cases of CAH and Grade 1 EA from the literature plus the data from this study shows 353 patients with 67% resolution (Table 3). This retrospective study is the first to further identify clinical and pathologic predictors of success of progestin treatment in premenopausal women. In our study
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowledgment
We thank Jeffrey Gornbein, PhD, Department of Biostatistics, David Geffen School of Medicine at University of California, Los Angeles, for assistance with the statistical analysis.
References (38)
- et al.
Can primary endometrial carcinoma stage I be cured without surgery and radiation therapy?
Gynecol Oncol
(1985) - et al.
Endometrial cancer in women 40 years old or younger
Gynecol Oncol
(2001) - et al.
Outcome of fertility-sparing treatment with progestins in young patients with endometrial cancer
Obstet Gynecol
(2003) - et al.
Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome
Cancer Lett
(2001) - et al.
Combined phospho-Akt and PTEN expressions associated with post-treatment hysterectomy after conservative progestin therapy in complex atypical hyperplasia and stage Ia, G1 adenocarcinoma of the endometrium
Cancer Lett
(2007) - et al.
Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40
Obstet Gynecol
(1997) - et al.
Mechanisms involved in the evolution of progestin resistance in human endometrial hyperplasia—precursor of endometrial cancer
Gynecol Oncol
(2003) - et al.
Clinical over- and under-estimation in patients who underwent hysterectomy for atypical endometrial hyperplasia diagnosed by endometrial biopsy: the predictive value of clinical parameters and diagnostic imaging
Eur J Obstet Gynecol Reprod Biol
(2003) Hormonal pathology of the endometrium
Mod Pathol
(2000)Cancer Facts & Figures 2010
(2010)