Abstract
We performed immunohistochemical analysis of estrogen (ERα) 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.
Acknowledgements
We would thank John Gregory for assistance with the immunohistochemistry, Terence Rollason for reviewing initial histology and Alan White for assistance with statistical analysis. This project was funded by a research grant from Birmingham Women's Hospital Research and Development department. Ioannis D. Gallos is funded through a Wellbeing of Women Research Scholarship (ELS022). At the inception of the study, Rajesh Varma was funded by a MRC Clinical Training Fellowship.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.