In women of reproductive age with hyperplastic processes in the endometrium, therapy has shown a significant increase in the expression of estrogen and, to a greater extent, progesterone receptors in both stroma and glands. In patients with atypical endometrial hyperplasia (AEH), the ratio of estrogen and progesterone receptors in the stroma is lower than the control values, while the restoration of the receptor apparatus in the glands is more successful.
OBJECTIVE
To evaluate the effect of complex hormonal therapy on the condition of the endometrium and the risk of malignancy in its atypical hyperplasia in women of reproductive age.
MATERIAL AND METHODS
216 women of reproductive age with hyperplastic processes in the endometrium (the main group) were examined and treated. Among them, 122 patients had histologically determined endometrial hyperplasia without atypia (EH) — the 1st comparison group; 94 patients were diagnosed with atypical endometrial hyperplasia — the 2nd comparison group. The control group consisted of 24 healthy women who were enrolled in assisted reproductive technology programs due to male infertility. The distribution of patients into comparison groups was carried out in accordance with the current (binary) classification of WHO in 2014. The analysis of IHC reactions for estrogen receptors α and progesterone receptors A (PR-A) of the endometrium, ROC analysis of the predictive value of hormone receptor expression with possible recurrence of hyperplasia and oncological transformation of the endometrium. All the results obtained were summarized and processed using the MedCalc medical statistics program (version 15.2).
RESULTS
During progestin treatment, the expression of estrogen and progesterone receptors in both the stroma and endometrial glands increased significantly, the results approached those of the control group, and the dynamics of changes were more pronounced with respect to progesterone receptors. In patients of the main group, by the end of treatment, the ratio of ER-α/PR-A in the glands of the functional layer of the endometrium was almost within the limits of the control group, while in the stroma of the basal layer, due to high values of expression of PR-A and low expression of estrogen receptors, the ratio of ER-α/PR-A turned out to be statistically significantly lower than this indicator in the control group, and this difference was more pronounced in the group of patients with AEH. At the stage of diagnosis, a change in the expression of estrogen and progesterone receptors in the endometrium makes it possible to predict AEH malignancy with a sensitivity of 100% and a specificity of up to 77.25% (area AUC=0.868). After the treatment, the specificity (95.73%) increased and the sensitivity (80.0%) of the prognosis decreased (AUC area=0.788). The use of progestins in combination with antibiotics or GnRH, depending on the initial clinical parameters of the patients, is quite effective. However, changes in the expression of estrogen and progesterone receptors that persist during treatment increase the prognosis of the possibility of AEH malignancy.
CONCLUSION
During treatment, the expression of estrogen and progesterone receptors increases significantly in both the stroma and the endometrial glands. The results are approaching those of the control group. However, in patients with atypical endometrial hyperplasia, the ratio of ER-α/PR-A in the stroma is lower than these values in the control group, which is associated with the continued low expression of estrogen receptors. At the same time, in the glands of the endometrium, the restoration of the receptor apparatus is more successful.
