Predictors of progestin therapy response in endometrial hyperplasia: An immunohistochemical study

Abstract

Background: Women with endometrial hyperplasia have an elevated risk of endometrial carcinoma .The first line of treatment of endometrial hyperplasia in premenopausal women is progestin treatment with variable response. Objectives: To evaluate the predictive value of immunohistochemical (IHC) biomarkers in progestin treatment for cases having endometrial hyperplasia.Methods: A prospective trial was conducted among 50 premenopausal women with menometrorrhagia. Histopathological evaluation confirmed endometrial hyperplasia in pre-treatment endometrial biopsy [without atypia (n=43) and atypia (n=7)]. All patients treated with oral progestin for 3-6 months. Endometrial immunohistochemical examination for progesterone receptors, Bel-2 and p53 were analyzed in basal blocks.Results: Study participants were classified into two groups, Group One showed endometrial response (n = 38) and Group Two showed non-response or histological progression (n=12). Immunohistochemical expression was expressed as a histopathological immunoreactive score (IRS). Immunoreactive score for progesterone receptors were significant higher in responders. Absence of progesterone receptors and presence of p53 predicted non-responder status.Conclusions: Progesterone receptor expression may be a predictive biomarker of progestin response and p53 expression may be a predictive biomarker of progestin resistance.