| [Background] Endometrial cancer (EnCa) is one of the most common reproductive tract tumors. Complex atypical endometrial hyperplasia (CAEH), a precursor lesion of EnCa, has a risk of approximately30%progressing to carcinoma. The standard treatment for EnCa is a total hysterectomy and bilateral salpingo-oophorectomy. Obviously, patients would lose fertility capability after that treatment, which is grievious to young nulliparous women. Fortunately, recently progestin is used in treating these young women with EACH and EnCa. Feasibility and safety of treating women who were diagnosed endometrial hyperplasia or early-stage, low grade carcinoma with high-dose progestin to allow for future fertility is proved by prior studies. However, the prior studies also showed that not all patients were cured through this therapy. There is a need to find out an accurate criteria to select patients suit to this therapy and to monitor the efficacy.[Object] To investigate the efficacy of progestin therapy in complex atypical endometrial hyperplasia (EACH) and early-stage endometrial cancer (EnCa). To detect the expression pattern of SPAG9in EACH and EnCa and to evaluate the diagnostic value in judging the efficacy of progestin therapy.[Methods] SPAG9gene expression levels were compared between pre and post MPA-treated endometria by immunohistochemistry on27women presenting with diagnostic curettage pre and post-progestin-treating. The27women’s pre-therapeutic endometrial biopsies were diagnosed as complex atypical endometrial hyperplasia (CAEH,19/27) and early-stage endometrial cancer (EnCa,8/27).According to change of the pathological results between pre-and post-progestin-treating, the patients are classified into therapeutic efficient group (21/27) and inefficient group (6/27),and the expression pattern of SPAG9are compared in every group inspectively. The therapeutic effect is also compare between CAEH and EnCa together with the expression of SPAG9.[Results](1)The CAEH group had a significant higher therapic efficacy and a lower SPAG9expression level than the EnCa group;(2)SPAG9expression was significantly declined in the endometria that was response to progestin. The non-responsive endomentria had a trend towards higher SPAG9expression after MPA treatment but without statistical significance.[Conclusion] Decline of SPAG9may be associated with the efficacy of progestin treatment in CAEH and EnCa. It may help to distinguish CAEH from EnCa and serve as a new biomarker for gynecologists to determine when to quit oral progestin therapy and thus avoid unexpected disease progression. |
