Yunokawa Mayu, Yoshida Hiroshi, Watanabe Reiko, Noguchi Emi, Shimomura Akihiko, Shimoi Tatsunori, Yonemori Kan, Shimizu Chikako, Fujiwara Yasuhiro, Tamura Kenji
Department of Breast and Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Pathology Division, Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan.
Cancer Chemother Pharmacol. 2017 Jul;80(1):127-134. doi: 10.1007/s00280-017-3342-5. Epub 2017 May 24.
Predictors of response or disease control with oral medroxyprogesterone acetate (MPA) therapy in patients with metastatic or recurrence endometrial cancer remain to be elucidated. The purpose of this study was to clarify the effect of MPA in patients with endometrial cancer and identify markers that predict MPA efficacy.
We retrospectively analyzed clinical and pathological factors in patients who received MPA. Expression of estrogen receptor, progesterone receptor (PgR), androgen receptor, and Ki67 index was assessed with residual tissue samples of endometrial cancer. Expression levels were evaluated semi-quantitatively using the Allred score. Correlations between expression levels and patients' characteristics, response to MPA, and survival were assessed.
We analyzed clinical factors in 40 patients and molecular pathological factors in 27 patients for MPA efficacy. The overall response rate was 35% in all 40 patients and there were 10 patients (25%) with continued complete or partial response for over 5 years. However, higher Allred score for PgR (p = 0.050) tended to be and lower Ki67 labeling index (p = 0.001) were significantly predictive factors for long-term complete or partial response over 5 years. Median progression-free survival was 6.4 (2-217) months and the 5-year progression-free survival rate was 32%. Multivariate analysis showed that Allred score ≥3 for PgR (p = 0.039) was the only significant predictive marker for long-term disease control. There were no severe adverse events that resulted in discontinuation of MPA.
This study suggests the utility of MPA when the Allred score for PgR is ≥3. Future prospective studies are needed to confirm these findings.
转移性或复发性子宫内膜癌患者口服醋酸甲羟孕酮（MPA）治疗的反应或疾病控制预测因素仍有待阐明。本研究的目的是明确MPA对子宫内膜癌患者的疗效，并确定预测MPA疗效的标志物。
我们回顾性分析了接受MPA治疗患者的临床和病理因素。采用子宫内膜癌残留组织样本评估雌激素受体、孕激素受体（PgR）、雄激素受体的表达及Ki67指数。使用Allred评分对表达水平进行半定量评估。评估表达水平与患者特征、对MPA的反应及生存之间的相关性。
我们分析了40例患者的临床因素和27例患者的分子病理因素以评估MPA疗效。所有40例患者的总缓解率为35%，有10例患者（25%）持续完全或部分缓解超过5年。然而，PgR的Allred评分较高（p = 0.050）有趋势，而较低的Ki67标记指数（p = 0.001）是5年以上长期完全或部分缓解的显著预测因素。无进展生存期的中位数为6.4（2 - 217）个月，5年无进展生存率为32%。多因素分析显示，PgR的Allred评分≥3（p = 0.039）是长期疾病控制的唯一显著预测标志物。没有导致停用MPA的严重不良事件。
本研究表明，当PgR的Allred评分≥3时，MPA具有应用价值。需要未来的前瞻性研究来证实这些发现。
