Department of Gynaecological Oncology, Clinic for Surgery, Cancer and Women's Diseases, University Hospital of North Norway, Tromsø, Norway.
Research Group for Gynaecological Oncology, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
BJOG. 2019 Jun;126(7):936-943. doi: 10.1111/1471-0528.15579. Epub 2019 Jan 25.
After successful progestin therapy for endometrial hyperplasia (EH), the risk of relapse remains. We aimed to assess if immunohistochemical (IHC) expression of progesterone receptor isoforms, PR-A and PR-B, in endometrial glands and stroma in pre-treatment endometrial biopsies was related to relapse of EH.
Biopsy material originated from women with low-risk and medium-risk EH recruited to a recent Norwegian multicentre randomised trial. Participants (n = 153) had been treated for 6 months with three different progestin regimens.
One hundred and thirty-five of the 153 women achieved therapy response and underwent follow up for 24 months after therapy withdrawal. Fifty-five women relapsed during follow up. Pre-treatment endometrial biopsies from 94 of the 135 responding women were available for IHC staining.
Immunohistochemical staining was performed separately for PR-A and PR-B and IHC expression was evaluated in endometrial glands and stroma by a histological score (H-score) using light microscopy.
Immunohistochemical expression of PR-A and PR-B in endometrial glands and stroma in women with or without relapse of EH.
Low PR-A in endometrial glands (P = 0.013) and stroma (P < 0.001), and high PR-B in endometrial glands (P = 0.001) in pre-treatment endometrial biopsy have a statistically significant association with relapse of EH. Women with a pre-treatment ratio of PR-A:PR-B ≤ 1 have a higher risk of relapse (71%) compared with women with a ratio of PR-A:PR-B > 1 (19%; P < 0.001).
Immunohistochemical expression of PR-A and PR-B in pre-treatment endometrial biopsy proves valuable as a predictor of relapse in EH.
Pre-treatment endometrial expression of PR-A and PR-B is a valuable predictor of relapse in endometrial hyperplasia.
子宫内膜增生（EH）经孕激素治疗成功后，仍有复发的风险。本研究旨在评估孕激素受体（PR）亚型 PR-A 和 PR-B 在治疗前子宫内膜活检中的腺体和间质的免疫组化（IHC）表达与 EH 复发是否相关。
活检材料来自参加挪威多中心随机试验的低风险和中风险 EH 女性。参与者（n=153）接受了 6 个月的三种不同孕激素治疗方案。
153 名女性中，135 名达到治疗反应，并在停药后随访 24 个月。55 名女性在随访期间复发。135 名有反应的女性中，94 名的治疗前子宫内膜活检可用于 IHC 染色。
分别对 PR-A 和 PR-B 进行免疫组化染色，并通过组织学评分（H 评分）用光学显微镜评估子宫内膜腺体和间质中的 IHC 表达。
EH 复发和未复发女性治疗前子宫内膜腺体和间质中 PR-A 和 PR-B 的免疫组化表达。
治疗前子宫内膜活检中，腺体（P=0.013）和间质（P<0.001）中低 PR-A 以及腺体（P=0.001）中高 PR-B 与 EH 复发有统计学显著相关性。治疗前 PR-A：PR-B 比值≤1 的女性复发风险（71%）高于比值>1 的女性（19%；P<0.001）。
治疗前子宫内膜活检中 PR-A 和 PR-B 的 IHC 表达可作为 EH 复发的预测指标。
治疗前子宫内膜 PR-A 和 PR-B 的表达是子宫内膜增生复发的一个有价值的预测指标。
