Pathologic features associated with resolution of complex atypical hyperplasia and grade 1 endometrial adenocarcinoma after progestin therapy |
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Authors: | Camille C. Gunderson Sonia Dutta Amanda Nickles Fader Kruti P. Maniar Niloo Nasseri-Nik Robert E. Bristow Teresa P. Diaz-Montes Robert Palermo Robert J. Kurman |
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Affiliation: | 1. University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology; Oklahoma City, OK, USA;2. Johns Hopkins Hospital, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology; Baltimore, MD, USA;3. Johns Hopkins Medical Institutions/Greater Baltimore Medical Center, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology; Baltimore, MD, USA;4. Johns Hopkins Hospital, Departments of Gynecology and Obstetrics, Pathology, Division of Gynecologic Pathology and Oncology; Baltimore, MD, USA;5. University of California Irvine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology; Orange, CA, USA;6. Greater Baltimore Medical Center, Department of Pathology; Baltimore, MD, USA |
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Abstract: |
ObjectiveTo 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.MethodsWe 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.ResultsForty-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.ConclusionIn 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. |
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Keywords: | Complex atypical hyperplasia Well differentiated endometrial adenocarcinoma Progestin therapy Estrogen/progesterone receptor |
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