Prognostic significance of the immunohistochemical status of the endometrium as markers of therapy for endometrial hyperplasia

Abstract

BACKGROUND: in patients of the reproductive period with endometrial hyperplasia without atypia (EH), the issue of choosing hormonal treatment and prognosis of response to it remains relevant. AIM:to increase the effectiveness of hormonal therapy for EH in patients of reproductive age with abnormal uterine bleeding (AUB), taking into account data on receptivity and proliferative activity of the endometrium. METHODS:179 patients of the reproductive period with AUB and EH were examined. After removal of the endometrial tissue, hormonal therapy was performed for 6 months: 101 patients - dydrogesterone 20 mg/day, 78 patients - norethisterone acetate 10 mg/day. Expression of ER, PR, Ki67 in endometrial tissue was determined by immunohistochemistry (IHC) at baseline and 3 months after the end of treatment. The comparison group consisted of 18 women without gynecological pathology. RESULTS:Before treatment, the expression of ER, PR in both compartments, Ki67 in the glands is lower (p0.05) in patients with HE compared with the control group. Remission was achieved in 77 (76.24%) (dydrogesterone) and 62 (79.49%) (norethisterone acetate). Initially, ER in the glands and stroma of GE is lower (p0.05) than the comparison group; in the group of resistant patients - lower (p0.05) responders to treatment. PR in the group of resistant patients is lower (p0.05) than the comparison group and those who have achieved remission. Ki67 in the glands in the group of those who responded to treatment is lower (p0.05) than the comparison group, in the stromal - lower (p0.05) of resistant patients. After treatment in both compartments ER and PR in the group of resistant patients is lower (p0.05) than in the comparison group and those who responded to treatment. A logistic regression equation was obtained with a set of predictors: ER (glands) + PR (glands and stroma) + Ki-67 (stroma) with a potential response to therapy of 93%. CONCLUSION: it is promising to use the specified predictive model. The effectiveness of therapy will be observed in 93% of cases.