Prognostic factors of regression and relapse of complex atypical hyperplasia and well-differentiated endometrioid carcinoma with conservative treatment

Yang, Yufeng; Liao, Ying‐Yang; Liu, Xian-lian; Su, Shu-Guang; Li, Lin-Zhu; Peng, Ning-Fu

doi:10.1016/j.ygyno.2015.10.015

Cited by 34 publications

(46 citation statements)

References 31 publications

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“…Similar effects have been reported with the use of intrauterine progestin, the levonorgestrel intrauterine system (LNG‐IUS) . Some studies report lower response rates and higher relapse rates in patients with FIGO 1 EAC (compared with CAH) and/or with higher body mass indices (BMI) . A randomised control trial comparing LNG‐IUS and oral progestins has yet to be performed .…”

Section: Introductionmentioning

confidence: 76%

“…Studies evaluating endometrial adenocarcinomas in young women report a 16–34% incidence of abnormal immunochemistry (IHC) for DNA MMR proteins, and some describe its association with worse clinical outcomes . Certain clinical factors have been associated with poor response to progestins, but whether defective MMR is associated with likelihood of response to progestin treatment remains unclear …”

Section: Introductionmentioning

confidence: 99%

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Abnormal mismatch repair and other clinicopathologic predictors of poor response to progestin treatment in young women with endometrial complex atypical hyperplasia and well‐differentiated endometrial adenocarcinoma: a consecutive case series

Zakhour

Cohen

Gibson

et al. 2017

BJOG

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Section: Introductionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Abnormal mismatch repair and other clinicopathologic predictors of poor response to progestin treatment in young women with endometrial complex atypical hyperplasia and well‐differentiated endometrial adenocarcinoma: a consecutive case series

Zakhour

Cohen

Gibson

et al. 2017

BJOG

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“…Regarding risk of bias within study assessment, for the “Patient selection” domain, three studies were considered to be low risk of bias and 10 were considered unclear risk (because they did clearly not state that patients were consecutive and/or that only cancers with initial myometrial invasion were excluded).…”

Section: Resultsmentioning

confidence: 99%

“…In particular, most studies focused on the estrogen receptor (ER) and progesterone receptor (PR), whose expression is easily assessable by immunohistochemistry . Estrogens are indeed involved in the development of EH and EC, and progestins mediate their action through PR .…”

Section: Introductionmentioning

confidence: 99%

Should progesterone and estrogen receptors be assessed for predicting the response to conservative treatment of endometrial hyperplasia and cancer? A systematic review and meta‐analysis

Raffone

Travaglino

Saccone

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Progestins are used as conservative treatment of endometrial hyperplasia (EH) and early endometrial cancer (EEC). We aimed to assess whether immunohistochemical expression of estrogens and progesterone receptors (ER and PR) predicts the treatment response. Material and methods Electronic databases were searched for studies assessing ER and PR expression in EH and EEC treated with progestins. Relative risk for poor response, sensitivity, specificity, diagnostic odds ratio positive and negative likelihood ratios (LR+ and LR−) and area under the curve (AUC) on summary receiver operating characteristic curve were calculated. Subgroup analyses were based on administration route (oral progestin or levonorgestrel‐intrauterine device) and on histological diagnosis (atypical EH/EEC or non‐atypical EH). Only high accuracy (AUC > 0.9; LR+ >10; LR− <0.1) was considered determining for the clinical practice. Results Thirteen studies with 635 patients were included in the systematic review. Studies at high risk of bias were excluded from the meta‐analysis. Negative ER expression did not significantly predict poor response (P = 0.16), with low predictive accuracy (AUC = 0.637). Negative PR significantly predicted poor response (P = 0.01), with moderate accuracy (AUC = .806). In the oral progestin subgroup, neither ER (P = 0.55) nor PR (P = 0.18) had significant predictive value. In the levonorgestrel‐intrauterine device subgroup, both ER (P < 0.0001) and PR (P = 0.02) were significantly predictive of good response, although the accuracy was suboptimal (LR+ 6.02 and 2.48, respectively; LR− 0.59 and 0.55, respectively). The atypical EH/EEC subgroup showed non‐significant results. Data about non‐atypical EH were not extractable. Conclusions ER and PR expressions are significantly predictive of response in EH and EEC treated with a levonorgestrel‐intrauterine device but not with oral progestins. However, their accuracy is insufficient to be determining in the clinical practice.

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“…Clearance of PAX2 null glands demonstrates a response, especially to LNG‐IUS therapy . Reduction in the expression of the proliferative marker Ki67 and anti‐apoptotic protein Bcl2 are also consequent upon successful treatment.…”

Section: Conservative Treatment Of Endometrial Carcinoma Using Progesmentioning

confidence: 99%

Role of the pathologist in assessing response to treatment of ovarian and endometrial cancers

Williams

Ganesan

2019

Histopathology

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Standardisation of pathological evaluation of tissue responses to therapy permits robust stratification of patient outcomes for management decisions and allows comparison of results across clinical trials. In gynaecological pathology there are two major areas where pathological assessment of treatment response is currently used to determine ongoing therapy. High‐grade serous carcinoma (HGSC) of tubo‐ovarian origin frequently presents as high‐stage disease and may be managed by neoadjuvant chemotherapy with debulking surgery. The chemotherapy response score (CRS) is a reproducible, validated three‐tiered morphological scoring system to assess the response of HGSC to treatment. Interobserver agreement is shown to be substantial following online training, and women with CRS3 have significantly improved progression‐free and overall survival. Low‐grade endometrioid endometrial cancer and atypical hyperplasia/endometrioid intraepithelial neoplasia may be managed by progestogenic therapy in women who wish to preserve fertility or for whom medical co‐morbidities preclude surgical management. The response to treatment is assessed histologically in successive endometrial biopsies. The histological parameters are well described, but the pathological classification of treatment response is still under development. Pathological assessment of the response to treatment is incorporated into clinical guidelines.

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Prognostic factors of regression and relapse of complex atypical hyperplasia and well-differentiated endometrioid carcinoma with conservative treatment

Cited by 34 publications

References 31 publications

Abnormal mismatch repair and other clinicopathologic predictors of poor response to progestin treatment in young women with endometrial complex atypical hyperplasia and well‐differentiated endometrial adenocarcinoma: a consecutive case series

Abnormal mismatch repair and other clinicopathologic predictors of poor response to progestin treatment in young women with endometrial complex atypical hyperplasia and well‐differentiated endometrial adenocarcinoma: a consecutive case series

Should progesterone and estrogen receptors be assessed for predicting the response to conservative treatment of endometrial hyperplasia and cancer? A systematic review and meta‐analysis

Role of the pathologist in assessing response to treatment of ovarian and endometrial cancers

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