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Residual disease volume and prognosis in endometrioid precancer after progestin therapy

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机构： [1]Department of Obstetrics and Gynecology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, Henan, China [2]Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA [3]Department of Obstetrics and Gynecology, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China [4]Department of Pathology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, Henan, China [5]Department of Obstetrics and Gynecology, Mianyang Central Hospital, Sichuan, China [6]Department of Pathology, Hainan Women and Children’s Medical Center, Haikou, China [7]Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA [8]School of Medicine, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, China [9]Department of Urology, Rong Tong Medical Healthcare Group, Kaifeng Hospital, China, Kaifeng, China [10]Anatomic Pathology, National Cancer Institute, National Institute of Health, Bethesda, MD, USA [11]Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA [12]Department of Pathology, Shandong Provincial Hospital, Jinan, China

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关键词： Atypical hyperplasia/endometrioid intraepithelial neoplasia Endometrial precancer Residual disease Progestin therapy

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Progestin therapy is a conservative treatment option for atypical hyperplasia/endometrioid intraepithelial neoplasia (AEH/EIN), particularly for patients seeking fertility preservation or for whom surgery is not feasible. However, approximately 30% of patients exhibit resistance to therapy, underscoring the need for early identification of responders and non-responders. We conducted a retrospective study of 252 AEH/EIN patients who underwent progestin therapy, with serial follow-up endometrial biopsies yielding 892 samples with quantifiable residual disease (RD). The amount of RD was evaluated as a predictor of therapeutic response, with a focus on its prognostic significance. Among the 252 patients, 194 (77%) were classified as responders, while 58 (23%) were non-responders. Responders exhibited a progressive reduction in RD across follow-up biopsies, with all achieving complete decidualization by the final biopsy. In contrast, non-responders consistently demonstrated persistent RD, with more RD in initial biopsies post progestin therapy significantly correlating with non-response. An amount of RD exceeding 20% in the initial biopsy or a less than 50% reduction in subsequent biopsies strongly predicted therapeutic failure (p < 0.001). The amount of RD is a valuable predictive marker for progestin therapy outcomes in AEH/EIN patients. Incorporating RD volume assessment in pathology reports can enhance clinical decision-making, facilitating more personalized and effective treatment strategies. Early identification of non-responders may prevent prolonged ineffective therapy and enable timely alternative interventions.© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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大类 | 2 区医学

小类 | 2 区病理学

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大类 | 2 区医学

小类 | 2 区病理学

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第一作者机构： [1]Department of Obstetrics and Gynecology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, Henan, China

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通讯机构： [2]Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA [7]Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA [11]Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA

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Residual disease volume and prognosis in endometrioid precancer after progestin therapy

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