Retrospective cohort study on the symptomatic recurrence pattern after hysteroscopic polypectomy

García, Jorge Cea; Caraballo, Antonio Jiménez; Vallejo, María del Mar Ríos; Zapardiel, Ignacio

doi:10.4103/gmit.gmit_102_19

“…With the development of minimally invasive techniques, transcervical resection of polyp (TCRP) has become the preferred treatment for EPs, with many advantages such as high accuracy, low blood loss, and postoperative recurrence rate [ 11 ]. Among them, hysteroscopic curettage as a traditional surgical method can temporarily control polyp bleeding, but it may cause abnormal uterine bleeding because polyps are easy to remain in the uterine cavity [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Multivariate Analysis of Recurrence after Hysteroscopic Diagnosis and Treatment of Endometrial Polyps following IVF-ET Failure

Xu

¹

,

Liu

²

,

Feng

³

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To explore the risk factors affecting the recurrence of endometrial polyps (EPs) after hysteroscopic diagnosis and treatment of EPs following in vitro fertilization-embryo transfer (IVF-ET) failure by multivariate analysis. Methods. The clinical data of 369 patients with EPs hysteroscopically treated in our department due to IVF-ET failure from January 2017 to January 2020 were retrospectively analyzed, including the number and size of polyps, postoperative treatment, endometriosis (EM), hydrosalpinx (HSP), and polycystic ovarian syndrome (PCOS), and the effects of these factors on EP recurrence were observed. Results. Of the patients enrolled, 184 cases (49.9%) were treated by curettage, and 185 cases (50.1%) by electrotomy. A total of 72 cases (19.5%) of postoperative recurrence were determined, including 34 cases (9.2%) without postoperative medication, 31 cases (8.4%) with one month of postoperative Didroxyprogesterone (DG) administration, and 7 cases (1.9%) with three months of postoperative DG administration. Surgical methods, 3 months of postoperative medication, PCOS, and polyp number and size significantly influence the recurrence of EPs, which were all the influencing factors of polyp recurrence. After controlling for other factors, the risk of EP recurrence after electrotomy was found to be lower than that after curettage, with an odds ratio (OR) (95% confidence interval (CI)) of 0.354 (0.163–0.767); the risk of EP recurrence after 3 months of postoperative medication was lower than that without postoperative medication, with an OR (95% CI) of 0.024 (0.005–0.104); the risk of EP recurrence in patients with PCOS was higher than that without PCOS, and the OR (95% CI) was 2.505 (1.113–5.639); patients with multiple polyps (≥2) were at an increased risk of recurrence than those with a single polyp, with an OR (95% CI) of 66.552 (14.711–301.084); patients with polyp diameter ≥ 2 cm had a higher risk of recurrence than those with polyp diameter < 2 cm, and the OR (95% CI) was 1084.76 (148.743–7910.999). Conclusions. PCOS patients are at an elevated risk of EP recurrence than non-PCOS patients. In patients with multiple polyps, those with a diameter ≥ 2 cm have an increased risk of polyp recurrence compared with those with polyp diameter < 2 cm; electrotomy is associated with a lower recurrence risk of EPs than curettage. The risk of EP recurrence in patients treated with postoperative progesterone for 3 months is lower than that of patients without postoperative medication.

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“…Our results suggest that the tight link between hormone exposure, gene methylation, and immune function plays a pivotal role in the etiology of EP. Because polyp size is an important index of EP recurrence [ 36 ], our results might also have implications for disease prognosis.…”

Section: Discussionmentioning

confidence: 99%

cfDNA Methylation Profiles and T-Cell Differentiation in Women with Endometrial Polyps

Li

¹

,

Lu

²

,

Niu

³

et al. 2022

Cells

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DNA methylation is a part of the regulatory mechanisms of gene expression, including chromatin remodeling and the activity of microRNAs, which are involved in the regulation of T-cell differentiation and function. However, the role of cfDNA methylation in T-cell differentiation is entirely unknown. In patients with endometrial polyps (EPs), we have found an imbalance of T-cell differentiation and an aberrant cfDNA methylation profile, respectively. In this study, we investigated the relationship between cfDNA methylation profiles and T-cell differentiation in 14 people with EPs and 27 healthy controls. We found that several differentially methylated genes (DMGs) were associated with T-cell differentiation in people with EPs (ITGA2-Naïve CD4, r = −0.560, p = 0.037; CST9-EMRA CD4, r = −0.626, p = 0.017; and ZIM2-CM CD8, r = 0.576, p = 0.031), but not in healthy controls (all p > 0.05). When we combined the patients’ characteristics, we found a significant association between ITGA2 methylation and polyp diameter (r = 0.562, p = 0.036), but this effect was lost when adjusting the level of Naïve CD4 T-cells (r = 0.038, p = 0.903). Moreover, the circulating sex hormone levels were associated with T-cell differentiation (estradiol-Naïve CD4, r = −0.589, p = 0.027), and the cfDNA methylation profile (testosterone-ZIM2, r = −0.656, p = 0.011). In conclusion, this study has established a link between cfDNA methylation profiles and T-cell differentiation among people with EPs, which may contribute to the etiology of EPs. Further functional studies are warranted.

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“…Because all these patients have the intention to future pregnancy, no loss to follow-up has been reported in this study. The recurrence status was verified by ultrasonic imaging and pathological examinations according to two criteria: the same type of histology and the same location, which differentiates it from a new polyp [ 5 ]. We collected the patients' information from their electronic medical records, including age, menarche age, menses, parity, gravidity, dysmenorrhea, abnormal uterine bleeding, endometritis, pelvic infection, salpingitis, endometriosis, intrauterine adhesion, and blood analysis before polypectomy, the number, size and location of polyps, endometrial thickness, type of hysteroscopic polypectomy, and follow-up duration (disease-free interval until symptomatic recurrence).…”

Section: Methodsmentioning

confidence: 99%

“…Hysteroscopic polypectomy is commonly used to treat EP in infertile patients, which can improve spontaneous conception as well as assisted reproduction [2][3][4]. However, the rate of polyp recurrence after polypectomy remains 2.5 ~44%, which hinders the improvement of fertility in these patients [2][3][4][5]. Therefore, postoperative recurrence of EP is now a concern for clinical counseling and decision making in reproductive-age women.…”

Section: Introductionmentioning

confidence: 99%

LIN28B Polymorphisms Confer a Higher Postoperative Recurrence Risk in Reproductive-Age Women with Endometrial Polyps

Lu

¹

,

Li

²

,

Niu

³

et al. 2022

Disease Markers

2

0

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The RNA-binding protein LIN28B is an important factor for cell proliferation. Because LIN28B polymorphisms have been shown to be relative with the recurrence of some hyperplastic diseases, we hypothesized that genetic variants of LIN28B gene were associated with postoperative recurrence risk in reproductive-age women with endometrial polyps (EP). In a hospital-based cohort of 351 reproductive female patients underwent hysteroscopic polypectomies between May 2018 and Jan 2020, we genotyped two common polymorphisms in LIN28B gene ( rs 369065 C > T and rs 314280 A > G ) and analyzed their associations with the risk of postoperative recurrence in multiple Cox regression model. When followed up to Jun 2021, carries of rs369065 TT genotype had an increased risk of polyp recurrence (adjusting hazard ratio HR = 1.883 , 95% confidence interval CI = 1.033 − 3.434 ) and had a shorter time to recurrence (median time 352 vs. 342 days, log-rank P < 0.01 ), compared to the CC/CT genotype. Further stratification analysis showed that the increased risk of rs369065 TT genotype was more evident in patients who were older than 33 years (adjusted HR = 2.597 , 95 % CI = 1.037 − 6.505 ), had a single polyp (adjusted HR = 2.545 , 95 % CI = 1.059 − 6.113 ), and had smaller polyps (<1.2 cm, adjusted HR = 2.708 , 95 % CI = 1.042 − 7.043 ). However, no significant association between rs 314280 A > G polymorphism and the risk of polyp recurrence was found. Our study suggests that rs369065 TT genotype of LIN28B gene is associated with an increased postoperative recurrence risk in EP patients, especially in those with fewer and smaller polyps. These findings implicate a precise choice of clinical counseling and decision making. Larger studies in different ethnic populations are warranted.

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Retrospective cohort study on the symptomatic recurrence pattern after hysteroscopic polypectomy

Cited by 9 publications

References 13 publications

Multivariate Analysis of Recurrence after Hysteroscopic Diagnosis and Treatment of Endometrial Polyps following IVF-ET Failure

Multivariate Analysis of Recurrence after Hysteroscopic Diagnosis and Treatment of Endometrial Polyps following IVF-ET Failure

cfDNA Methylation Profiles and T-Cell Differentiation in Women with Endometrial Polyps

LIN28B Polymorphisms Confer a Higher Postoperative Recurrence Risk in Reproductive-Age Women with Endometrial Polyps

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