Marcia A Ciccone1, Stephanie A Whitman2, Charlotte L Conturie2, Niquelle Brown3, Christina E Dancz2, Begum Özel2, Koji Matsuo4,5. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA. 2. Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. 3. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA. koji.matsuo@med.usc.edu. 5. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. koji.matsuo@med.usc.edu.
Abstract
OBJECTIVE: While progestins can effectively treat women with complex atypical hyperplasia (CAH), the impact of body habitus on treatment outcome is not well studied. We examine the association between body mass index (BMI) and progestin treatment outcomes. METHODS: We conducted a retrospective cohort study of patients diagnosed with hyperplasia between 2003 and 2011. Demographics, past medical history, BMI, hormonal therapy, and histologic treatment response were abstracted. Patients with CAH who received progestin therapy were examined, and rates of regression were assessed. RESULTS: Of 623 patients identified, 117 had CAH and satisfied the inclusion criteria. Median age was 34, and nearly, two-thirds (64%) were nulliparous. Mean BMI was 40.2, and 81% were obese (BMI 30-39.9: 36%, BMI ≥ 40: 45%). 103 patients (88%) received systemic progestin therapy and 14 patients (12%) received levonorgestrel-releasing intrauterine devices (LNG-IUS). 47 patients (40%) had a complete response to progestin-based therapy. BMI had no effect on the rate of complete response. The proportions of CAH patients with complete regression after hormonal therapy were BMI < 30: 39%, 30-39.9: 40%, and ≥ 40: 36% (P = 0.73). Women treated with LNG-IUS displayed higher rates of complete regression than those receiving systemic therapy (62% versus 38%, P = 0.096), and those with class III obesity were more likely than non-obese patients to receive LNG-IUS although neither reached statistical significance (< 40: 6.7% versus ≥ 40: 17%, P = 0.09). CONCLUSION: In this morbidly obese population, response to progestin therapy was generally low; body habitus did not impact treatment outcome for CAH, but local therapy may be more effective than systemic therapy.
OBJECTIVE: While progestins can effectively treat women with complex atypical hyperplasia (CAH), the impact of body habitus on treatment outcome is not well studied. We examine the association between body mass index (BMI) and progestin treatment outcomes. METHODS: We conducted a retrospective cohort study of patients diagnosed with hyperplasia between 2003 and 2011. Demographics, past medical history, BMI, hormonal therapy, and histologic treatment response were abstracted. Patients with CAH who received progestin therapy were examined, and rates of regression were assessed. RESULTS: Of 623 patients identified, 117 had CAH and satisfied the inclusion criteria. Median age was 34, and nearly, two-thirds (64%) were nulliparous. Mean BMI was 40.2, and 81% were obese (BMI 30-39.9: 36%, BMI ≥ 40: 45%). 103 patients (88%) received systemic progestin therapy and 14 patients (12%) received levonorgestrel-releasing intrauterine devices (LNG-IUS). 47 patients (40%) had a complete response to progestin-based therapy. BMI had no effect on the rate of complete response. The proportions of CAH patients with complete regression after hormonal therapy were BMI < 30: 39%, 30-39.9: 40%, and ≥ 40: 36% (P = 0.73). Women treated with LNG-IUS displayed higher rates of complete regression than those receiving systemic therapy (62% versus 38%, P = 0.096), and those with class III obesity were more likely than non-obesepatients to receive LNG-IUS although neither reached statistical significance (< 40: 6.7% versus ≥ 40: 17%, P = 0.09). CONCLUSION: In this morbidly obese population, response to progestin therapy was generally low; body habitus did not impact treatment outcome for CAH, but local therapy may be more effective than systemic therapy.
Authors: Meira Epplein; Susan D Reed; Lynda F Voigt; Katherine M Newton; Victoria L Holt; Noel S Weiss Journal: Am J Epidemiol Date: 2008-08-05 Impact factor: 4.897
Authors: Mary Margaret Huizinga; Sara N Bleich; Mary Catherine Beach; Jeanne M Clark; Lisa A Cooper Journal: Obesity (Silver Spring) Date: 2010-02-25 Impact factor: 5.002
Authors: Rachel S Mandelbaum; Marcia A Ciccone; David J Nusbaum; Mahdi Khoshchehreh; Heena Purswani; Elise B Morocco; Meghan B Smith; Shinya Matsuzaki; Christina E Dancz; Begum Ozel; Lynda D Roman; Richard J Paulson; Koji Matsuo Journal: Am J Obstet Gynecol Date: 2020-01-21 Impact factor: 8.661
Authors: Koji Matsuo; Rachel S Mandelbaum; Marcia Ciccone; Mahdi Khoshchehreh; Heena Pursuwani; Elise B Morocco; Shinya Matsuzaki; Christina E Dancz; Begum Ozel; Richard J Paulson; Lynda Roman Journal: Int J Gynecol Cancer Date: 2020-05-05 Impact factor: 3.437