Mismatch repair-deficiency specifically predicts recurrence of atypical endometrial hyperplasia and early endometrial carcinoma after conservative treatment: A multi-center study

Autor: Giovanni Scambia, Valeria Masciullo, Saveria Spadola, Antonio Travaglino, Attilio Di Spiezio Sardo, Giuseppe Bifulco, Gian Franco Zannoni, U Catena, Luigi Insabato, Luigi Della Corte, Alessia Piermattei, Fulvio Zullo, Francesco Fanfani, Antonio Raffone
Přispěvatelé: Raffone, Antonio, Catena, Ursula, Travaglino, Antonio, Masciullo, Valeria, Spadola, Saveria, DELLA CORTE, Luigi, Piermattei, Alessia, Insabato, Luigi, Franco Zannoni, Gian, Scambia, Giovanni, Zullo, Fulvio, Bifulco, Giuseppe, Fanfani, Francesco, DI SPIEZIO SARDO, Attilio
Rok vydání: 2021
Předmět:
0301 basic medicine
Adult
medicine.medical_specialty
medicine.drug_class
Endometrioid adenocarcinoma
Fertility-sparing
Hysteroscopy
Progesterone
Progestin
Progestogen
Hysteroscopy
Gastroenterology
DNA Mismatch Repair
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Statistical significance
Internal medicine
Carcinoma
Medicine
Humans
Atypical Endometrial Hyperplasia
Progesterone
Retrospective Studies
medicine.diagnostic_test
Receiver operating characteristic
business.industry
Fertility-sparing
Area under the curve
Obstetrics and Gynecology
medicine.disease
Immunohistochemistry
digestive system diseases
Endometrial Neoplasms
Progestin
stomatognathic diseases
030104 developmental biology
Settore MED/40 - GINECOLOGIA E OSTETRICIA
Oncology
Italy
030220 oncology & carcinogenesis
Relative risk
Progestogen
Endometrial Hyperplasia
Female
Neoplasm Recurrence
Local
business
Endometrioid adenocarcinoma
Carcinoma
Endometrioid
Zdroj: Gynecologic oncology. 161(3)
ISSN: 1095-6859
Popis: Objective: Deficient expression of mismatch repair proteins (MMR) has been suggested to be a predictor of resistance of atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EEC) to conservative treatment. Aims: To assess the predictive value of MMR immunohistochemistry in patients conservatively treated for AEH and EEC, and to calculate its predictive accuracy. Materials and methods: All patients with AEH or EEC conservatively treated with hysteroscopic resection plus progestins in two referral centers from January 2004 to July 2019 were retrospectively assessed. Immunohistochemistry for MMR was ad hoc performed. Study outcomes were: (i) the association of a deficient immunohistochemical expression of MMR with resistance and recurrence of AEH and EEC after conservative treatment, and (ii) the accuracy of MMR immunohistochemistry in predicting the outcome of conservative treatment. Relative risk (RR) for the associations, and sensitivity, specificity and area under the curve (AUC) on receiver operating characteristic curve for the predictive accuracy were calculated. Results: Sixty-nine women, (47 AEH and 22 EEC) were included; deficient MMR expression was observed in 8.7% of cases. Resistance to conservative treatment was more common in MMR-deficient than MMR-proficient cases (33.3% vs 15.9%; RR = 2.1), but with no statistical significance (p = 0.2508). On the other hand, recurrence was significantly more common in MMR-deficient than MMR-proficient cases (100% vs 26.4%; RR = 3.8; p < 0.0001). In predicting recurrence, a deficient immunohistochemical expression of MMR showed sensitivity = 22.2%, specificity = 100%, and AUC = 0.61. Conclusion: Deficient MMR immunohistochemical expression does not imply resistance of AEH/EEC to conservative treatment. On the other hand, MMR-deficiency appears as a highly specific predictor of recurrence of AEH/EEC after initial regression.
Databáze: OpenAIRE
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