title: Predictors of resolution of complex atypical hyperplasia or grade 1 endometrial adenocarcinoma in premenopausal women treated with progestin therapy.
abstract: OBJECTIVE
  To identify clinical and pathologic predictors of response to progestin treatment in premenopausal women with complex atypical hyperplasia (CAH) and Grade 1 endometrial adenocarcinoma (Grade 1 EA).
  
  
  METHODS
  Forty premenopausal patients with Grade 1 EA or CAH who underwent progestin therapy for a minimum of 8 weeks were retrospectively identified. Patient characteristics and histopathologic features of pretreatment and first follow-up endometrial specimens were evaluated as predictors of resolution, defined as absence of hyperplasia or carcinoma.
  
  
  RESULTS
  Kaplan-Meier analysis indicated 63% resolution at 18 months of follow-up. Multivariate classification analysis showed that resolution rates were higher in individuals with a low pre-treatment qualitative abnormal architecture score and a BMI <35 (Standardized Resolution Ratio (SRR)=1.48, p=0.03). The diagnosis of benign endometrium or simple hyperplasia on the first follow-up specimen was highly predictive of resolution (SRR=2.25, p=0.002). Resolution rates were lower among subjects with a high pre-treatment qualitative abnormal architecture score (SRR=0.37, p<0.03) and lowest in subjects whose first follow-up specimen showed persistent complexity, atypia, or carcinoma with adjacent stromal decidualization (SRR=0.24, p=0.002).
  
  
  CONCLUSIONS
  Clinical and pathologic parameters can predict response to progestin therapy in premenopausal women with CAH and Grade 1 EA. A low likelihood of resolution is predicted by an unfavorable pre-treatment architectural score and lack of pathological response in the first specimen, despite adjacent stromal decidualization.
authors.affiliation: Department of Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA. kpenner@mednet.ucla.edu
authors.forename: Kristine R
authors.initials: KR
authors.lastname: Penner
authors.forename: Oliver
authors.initials: O
authors.lastname: Dorigo
authors.forename: Chisa
authors.initials: C
authors.lastname: Aoyama
authors.forename: Nora
authors.initials: N
authors.lastname: Ostrzega
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Balzer
authors.forename: Jianyu
authors.initials: J
authors.lastname: Rao
authors.forename: Christine S
authors.initials: CS
authors.lastname: Walsh
authors.forename: Ilana
authors.initials: I
authors.lastname: Cass
authors.forename: Christine H
authors.initials: CH
authors.lastname: Holschneider
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology*; D000328:Adult; D015331:Cohort Studies; D004714:Endometrial Hyperplasia / Q000188:drug therapy* / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D011230:Precancerous Conditions / Q000188:drug therapy / Q000473:pathology; D017697:Premenopause; D011372:Progestins / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D011372:Progestins