Pathologic features associated with resolution of complex atypical hyperplasia and grade 1 endometrial adenocarcinoma after progestin therapy

Gynecol Oncol. 2014 Jan;132(1):33-7. doi: 10.1016/j.ygyno.2013.11.033. Epub 2013 Dec 4.

Abstract

Objective: To determine the response of complex atypical hyperplasia (CAH) and well differentiated endometrioid adenocarcinoma of the uterus (WDC) to progestin therapy and whether pre-treatment estrogen and progesterone receptor status predicts outcome.

Methods: We performed a retrospective review encompassing women treated with progestin therapy for CAH or WDC at two institutions. Clinicopathologic, treatment, and recurrence data were recorded. Pre/post-treatment pathologic evaluation was performed. SAS 9.2 was used for statistical analyses.

Results: Forty-six patients were included. The median age was 35, and median BMI was 36.9. Thirty-seven percent were diagnosed with CAH and 63% had WDC. Megestrol acetate was the most commonly used agent (89%); 24% received multiple progestin therapies. Median treatment length was 6 months (range, 1-84); 36% of the patients underwent eventual hysterectomy, and 17.4% had carcinoma in their uterine specimens (8 primary endometrial, 1 primary ovarian). After a median follow-up of 35 months (range, 2-162), 65% experienced a complete response (CR), 28% had persistent or progressive disease, and 23% had a CR followed by recurrence. On univariate analysis, decreased post-treatment glandular cellularity (p = 0.0006), absence of post-treatment mitotic figures (p = 0.0008), and use of multiple progestin agents (p = 0.025) were associated with CR; however, only decreased glandular cellularity was significant on multivariate analysis (p = 0.007). Estrogen and progesterone receptor expression was not associated with treatment response.

Conclusion: In women with CAH or WDC, the overall response rate to progestin therapy was 65%; pre-treatment estrogen/progesterone receptor status did not predict response to treatment.

Keywords: Complex atypical hyperplasia; Estrogen/progesterone receptor; Progestin therapy; Well differentiated endometrial adenocarcinoma.

MeSH terms

  • Adult
  • Carcinoma, Endometrioid / drug therapy*
  • Carcinoma, Endometrioid / pathology
  • Endometrial Hyperplasia / drug therapy*
  • Endometrial Hyperplasia / pathology
  • Endometrial Neoplasms / drug therapy*
  • Endometrial Neoplasms / pathology
  • Female
  • Humans
  • Middle Aged
  • Progestins
  • Receptors, Estrogen / analysis
  • Receptors, Progesterone / analysis
  • Retrospective Studies

Substances

  • Progestins
  • Receptors, Estrogen
  • Receptors, Progesterone