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Predictive Accuracy of Progesterone Receptor B in Young Women with Atypical Endometrial Hyperplasia and Early
Antonio Raffone1, Antonio Travaglino1, Francesco Maria Zullo1
1Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences, and Dentistry (Drs. Raffone, Miranda, F. Zullo, and Bifulco); Department of Public Health (Dr. Sardo), Anatomic Pathology Unit; Department of Advanced Biomedical Sciences (Drs. Travaglino, Gencarelli, and Insabato), University of Naples Federico II, Obstetrics and Gynecology Unit; Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli (Drs. F.M. Zullo and Franciscis); Pathology Unit, Monaldi Hospital (Dr. Micheli), Naples, Italy.
Study Objective:
The immunohistochemical expression of isoform B of the progesterone receptor (PRB) has shown promising results in predicting the response of atypical endometrial hyperplasia (AEH) and early endometrial cancer (EEC) to conservative treatment. We aimed to calculate the accuracy of PRB as a predictive marker of conservative treatment outcome in AEH or EEC.
Design:
Retrospective cohort study.
Setting:
University of Naples Federico II, Naples, Italy.
Patients:
Thirty-six consecutive premenopausal women <45 years of age with AEH (n = 29) or EEC (n = 7) conservatively treated from January 2007 to June 2018 were retrospectively assessed.
Interventions:
All patients had been treated with hysteroscopic resection plus levonorgestrel-releasing intrauterine device insertion and followed for at least 1 year. The immunohistochemical expression of PRB was separately assessed in the glands and stroma of the lesion and dichotomized as "weak" or "normal."
Measurement And Main Results:
The treatment outcomes considered were (1) treatment failure (i.e., a combined outcome including no regression or recurrence); (2) no regression; and (3) recurrence. The predictive accuracy of PRB immunohistochemistry was assessed by calculating sensitivity (SE), specificity (SP), and area under the receiver operating characteristic curve (AUC). A weak glandular PRB expression showed SE = 70%, SP = 77%, and AUC = 0.74 for treatment failure; SE = 66.7%, SP = 70%, and AUC = 0.68 for no regression; and SE = 75%, SP = 68.8%, and AUC = 0.72 for recurrence. A weak stromal PRB expression showed SE = 100%, SP = 53.8%, and AUC = 0.77 for treatment failure; SE = 100%, SP = 46.7%, and AUC = 0.73 for no regression; and SE = 100%, SP = 43.8%, and AUC = 0.72 for recurrence.
Conclusion:
A weak stromal PRB expression is a highly sensitive predictive marker of both no response and recurrence of AEH and EEC conservatively treated.
