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 |
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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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