Allred score is a promising predictor of prognosis and medroxyprogesterone acetate efficacy in patients with endometrial cancer
Allred score is a promising predictor of prognosis and medroxyprogesterone acetate efficacy in patients with endometrial cancer
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DOI：
10.1007/s00280-017-3342-5
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发表时间：
2017-07-01
影响因子：
3
通讯作者：
Tamura, Kenji
中科院分区：
文献类型：
--
作者：
Yunokawa, Mayu;Yoshida, Hiroshi;Tamura, Kenji
在转移性或复发性子宫内膜癌患者中，口服甲羟孕酮(MPA)治疗的疗效或疾病控制的预测因素仍有待阐明。本研究的目的是阐明甲孕酮在子宫内膜癌患者中的作用，寻找预测甲孕酮疗效的标志物。检测子宫内膜癌组织中雌激素受体、孕激素受体(PGR)、雄激素受体和Ki67指数的表达。用Allred评分半定量评估表达水平。我们分析了40例患者的临床因素和27例患者的分子病理因素对治疗效果的影响。40例患者总有效率为35%，其中10例(25%)持续完全或部分缓解5年以上。然而，较高的PGR ALLRED评分(p=0.050)和较低的Ki67标记指数(p=0.001)是5年以上长期完全或部分缓解的显著预测因素。中位无进展生存期为6.4(2-217)个月，5年无进展生存率为32%。多变量分析显示，PGR的Allred评分ae3(p=0.039)是唯一有意义的预测长期疾病控制的标志物。没有发生导致停用MPA的严重不良事件。这项研究表明，当PGR的Allred评分为ae3时，MPA是有效的。需要未来的前瞻性研究来证实这些发现。
Predictors of response or disease control with oral medroxyprogesterone acetate (MPA) therapy in patients with metastatic or recurrence endometrial cancer remain to be elucidated. The purpose of this study was to clarify the effect of MPA in patients with endometrial cancer and identify markers that predict MPA efficacy.We retrospectively analyzed clinical and pathological factors in patients who received MPA. Expression of estrogen receptor, progesterone receptor (PgR), androgen receptor, and Ki67 index was assessed with residual tissue samples of endometrial cancer. Expression levels were evaluated semi-quantitatively using the Allred score. Correlations between expression levels and patients' characteristics, response to MPA, and survival were assessed.We analyzed clinical factors in 40 patients and molecular pathological factors in 27 patients for MPA efficacy. The overall response rate was 35% in all 40 patients and there were 10 patients (25%) with continued complete or partial response for over 5 years. However, higher Allred score for PgR (p = 0.050) tended to be and lower Ki67 labeling index (p = 0.001) were significantly predictive factors for long-term complete or partial response over 5 years. Median progression-free survival was 6.4 (2-217) months and the 5-year progression-free survival rate was 32%. Multivariate analysis showed that Allred score ae3 for PgR (p = 0.039) was the only significant predictive marker for long-term disease control. There were no severe adverse events that resulted in discontinuation of MPA.This study suggests the utility of MPA when the Allred score for PgR is ae3. Future prospective studies are needed to confirm these findings.