title: Prognostic significance of estrogen and progesterone receptor expression in LNG-IUS (Mirena) treatment of endometrial hyperplasia: an immunohistochemical study.
abstract: We performed immunohistochemical analysis of estrogen (ERalpha) and progesterone receptors (PRA and PRB), phosphatase and tensin homolog (PTEN) and aromatase in endometrial hyperplasia treated with Mirena (levonorgestrel-releasing intrauterine system; LNG-IUS) and explored their prognostic significance. The baseline pre-treatment endometrial hyperplasia of a selected prospective cohort was analyzed [complex (n = 29) and atypical (n = 5)]. Study participants were categorized into those that showed endometrial regression (responders, n = 28) and those that showed non-regression or histological progression to atypia or malignancy (non-responders, n = 6). Immunohistochemical expression was expressed as a histological score (HS). Responders compared to non-responders showed significantly higher HSs for estrogen and progesterone receptors. Absence of estrogen and progesterone receptors predicted non-responder status with likelihood ratios of 9.33 (95% CI 2.19-39.81) and 2.92 (95% CI 1.47-5.79), respectively. Neither PTEN nor aromatase expression were associated with LNG-IUS therapy responsiveness. Responsiveness of endometrial hyperplasia to LNG-IUS therapy may be determined through analysis of baseline estrogen and progesterone receptors, but these exploratory findings require confirmation in a larger dataset.
authors.affiliation: Academic Unit of Obstetrics and Gynecology, Birmingham Women's Hospital, Birmingham, B15 2TG, UK.
authors.forename: Emelie
authors.initials: E
authors.lastname: Akesson
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Gallos
authors.forename: Raji
authors.initials: R
authors.lastname: Ganesan
authors.forename: Rajesh
authors.initials: R
authors.lastname: Varma
authors.forename: Janesh K
authors.initials: JK
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D016009:Chi-Square Distribution; D004714:Endometrial Hyperplasia / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007150:Immunohistochemistry; D016912:Levonorgestrel / Q000627:therapeutic use*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011960:Receptors, Estrogen / Q000096:biosynthesis*; D011980:Receptors, Progesterone / Q000096:biosynthesis*; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D016912:Levonorgestrel