University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology; Oklahoma City, OK, USA.
Johns Hopkins Hospital, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology; Baltimore, MD, USA.
Gynecol Oncol. 2014 Jan;132(1):33-7. doi: 10.1016/j.ygyno.2013.11.033. Epub 2013 Dec 4.
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.
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.
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.
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.
确定孕激素治疗对复杂不典型增生（CAH）和分化良好的子宫内膜样腺癌（WDC）的反应，以及治疗前雌激素和孕激素受体状态是否预测治疗结果。
我们对在两个机构接受孕激素治疗的 CAH 或 WDC 患者进行了回顾性研究。记录了临床病理、治疗和复发数据。进行了治疗前后的病理评估。使用 SAS 9.2 进行统计分析。
共纳入 46 例患者。中位年龄为 35 岁，中位 BMI 为 36.9。37%的患者诊断为 CAH，63%的患者患有 WDC。醋酸甲地孕酮是最常用的药物（89%）；24%的患者接受了多种孕激素治疗。中位治疗时间为 6 个月（范围，1-84 个月）；36%的患者最终接受了子宫切除术，17.4%的患者在子宫标本中发现了癌症（8 例原发性子宫内膜癌，1 例原发性卵巢癌）。中位随访 35 个月（范围，2-162 个月）后，65%的患者获得完全缓解（CR），28%的患者病情持续或进展，23%的患者获得 CR 后复发。单因素分析显示，治疗后腺体细胞减少（p=0.0006）、治疗后无有丝分裂象（p=0.0008）和使用多种孕激素药物（p=0.025）与 CR 相关；然而，仅治疗后腺体细胞减少在多因素分析中具有统计学意义（p=0.007）。雌激素和孕激素受体表达与治疗反应无关。
在 CAH 或 WDC 患者中，孕激素治疗的总体反应率为 65%；治疗前雌激素/孕激素受体状态不能预测对治疗的反应。
