title: Endoplasmic reticulum stress in complex atypical hyperplasia as a possible predictor of occult carcinoma and progestin response.
abstract: Glucose-regulated protein (GRP)-78, the key regulator of endoplasmic reticulum (ER) stress, is associated with endometrial cancer (EC) development and progression. However, its role in the continuum from complex atypical hyperplasia (CAH) to EC is unknown and the focus of this study.
  
  
  METHODS
  252 formalin-fixed, paraffin-embedded endometrial biopsies from patients with CAH diagnosed between 2003 and 2011 were evaluated for GRP78 expression by immunohistochemistry. Expression was also evaluated in subsequent biopsies from those patients treated with progestins. Differences in GRP78 expression were assessed using standard statistical methods.
  
  
  RESULTS
  GRP78 expression was undetectable in 45(18%) patients with CAH, while 120(48%) CAH cases showed moderate/strong expression. Among women who ultimately underwent hysterectomy for CAH (n=134), 54(40%) had occult EC while 57(43%) had persistent CAH. Those with occult EC upon hysterectomy had significantly stronger GRP78 expression than those who did not have occult EC (p=0.007). Greater GRP78 expression within CAH remained independently associated with the presence of an occult EC (p=0.017). Thirty-four of 54 (63%) patients with occult EC had moderate/strong GRP78 expression compared to 36 of 80 (45%) patients with persistent CAH, benign or non-atypical hyperplastic endometrium. In those treated with progestins, samples with persistent CAH and EC were more likely to have high levels of GRP78 expression in the initial biopsies than those who responded (p=0.014).
  
  
  CONCLUSIONS
  Increased GRP78 expression in untreated CAH correlates with the presence of an occult EC. In addition, CAH specimens with greater GRP78 expression may identify patients who are less likely to respond to progestin therapy.
authors: Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, University of Southern California, Los Angeles, CA, United States.
authors: Katherine E
authors: KE
authors: Tierney
authors: Biostatistics Shared Resource, USC Norris Comprehensive Cancer Center, and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
authors: Lingyun
authors: L
authors: Ji
authors: Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, University of Southern California, Los Angeles, CA, United States.
authors: Shannon S
authors: SS
authors: Dralla
authors: Women's Cancer Program, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States.
authors: Eunjeong
authors: E
authors: Yoo
authors: Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, University of Southern California, Los Angeles, CA, United States.
authors: Annie
authors: A
authors: Yessaian
authors: Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, University of Southern California, Los Angeles, CA, United States.
authors: Huyen Q
authors: HQ
authors: Pham
authors: Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, University of Southern California, Los Angeles, CA, United States.
authors: Lynda
authors: L
authors: Roman
authors: Biostatistics Shared Resource, USC Norris Comprehensive Cancer Center, and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
authors: Richard
authors: R
authors: Sposto
authors: Department of Pathology and Gynecologic Oncology, University of Southern California, Los Angeles, CA, United States. Electronic address: pfauceglia@hotmail.com.
authors: Paulette
authors: P
authors: Mhawech-Fauceglia
authors: Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, University of Southern California, Los Angeles, CA, United States; Women's Cancer Program, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States.
authors: Yvonne G
authors: YG
authors: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018269:Carcinoma, Endometrioid / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology; D004714:Endometrial Hyperplasia / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology; D000091342:Endoplasmic Reticulum Chaperone BiP; D059865:Endoplasmic Reticulum Stress; D005260:Female; D006360:Heat-Shock Proteins / Q000378:metabolism*; D006801:Humans; D007044:Hysterectomy; D007150:Immunohistochemistry; D008875:Middle Aged; D011372:Progestins / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000091342:Endoplasmic Reticulum Chaperone BiP; C000717247:HSPA5 protein, human; D006360:Heat-Shock Proteins; D011372:Progestins
keywords: Endometrial hyperplasia; GRP78; Immunohistochemistry; Occult endometrioid adenocarcinoma; Response to therapy