Hormone receptor expression patterns in the endometrium of asymptomatic morbidly obese women before and after bariatric surgery

Peter Argenta, Charles Svendsen, Esther Elishaev, Nika Gloyeske, Melissa A. Geller, Robert P. Edwards, Faina Linkov

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective Obesity increases risk for endometrial neoplasia, but neither the pathophysiology nor the effects of weight loss on the risk are well established. We attempted to characterize the molecular profile of the endometrium of asymptomatic women with morbid obesity before and following bariatric surgery-induced weight loss. Methods 59 asymptomatic, morbidly obese women underwent endometrial sampling before bariatric surgery; 46 (78%) of these returned one year later for re-biopsy (median weight loss of 41 kg). Duplicate samples from these specimens were scored for expression of estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), and Ki-67 by two independent, blinded pathologists using an H-score [staining intensity (0-3) × (percent of tissue involved)]. Results The prevalence of hyperplasia pre-operatively was 7% overall and 10% among patients not on an anti-estrogen. ER H-scores were similar before and after surgery overall (median 190 and 196 respectively, p = 0.82), but patients with hyperplasia had higher pre-operative H-scores (median 256, p < 0.001) and experienced greater H-score drops, than those without hyperplasia (- 112 vs + 50, p = 0.028). In two patients with persistent hyperplasia at one year, ER H-scores fell to levels that were similar to those without pathology. One patient who developed hyperplasia during the study period had a rising ER H-score. Patients with hyperplasia had higher median PR H-scores pre-operatively (284 vs 188, p = 0.01), which normalized through greater drops (75 vs 0, p = 0.053). AR H-scores dropped significantly after surgery (13 vs 2, p = 0.015), but were similar between patients with and without hyperplasia (p = 0.33). Weight loss did not affect Ki-67 proliferation index. Conclusion Asymptomatic morbidly obese patients have a high prevalence of occult hyperplasia, characterized by relatively high hormone receptor expression. These profiles appear to normalize with weight loss and in advance of pathologically identifiable changes. These data suggest a potential role for screening this population as well as the possibility that weight loss may be a valid treatment strategy for risk reduction.

Original languageEnglish (US)
Pages (from-to)78-82
Number of pages5
JournalGynecologic oncology
Volume133
Issue number1
DOIs
StatePublished - Apr 2014

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Bariatric Surgery
Endometrium
Hyperplasia
Hormones
Weight Loss
Estrogen Receptors
Androgen Receptors
Progesterone Receptors
Morbid Obesity
Risk Reduction Behavior
Estrogens
Obesity
Pathology
Staining and Labeling
Biopsy

Keywords

  • Bariatric surgery
  • Endometrial cancer
  • Endometrial hyperplasia
  • Estrogen receptor (ER)
  • Obesity
  • Progesterone receptor (PR)

Cite this

Hormone receptor expression patterns in the endometrium of asymptomatic morbidly obese women before and after bariatric surgery. / Argenta, Peter; Svendsen, Charles; Elishaev, Esther; Gloyeske, Nika; Geller, Melissa A.; Edwards, Robert P.; Linkov, Faina.

In: Gynecologic oncology, Vol. 133, No. 1, 04.2014, p. 78-82.

Research output: Contribution to journalArticle

Argenta, Peter ; Svendsen, Charles ; Elishaev, Esther ; Gloyeske, Nika ; Geller, Melissa A. ; Edwards, Robert P. ; Linkov, Faina. / Hormone receptor expression patterns in the endometrium of asymptomatic morbidly obese women before and after bariatric surgery. In: Gynecologic oncology. 2014 ; Vol. 133, No. 1. pp. 78-82.
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AU - Argenta, Peter

AU - Svendsen, Charles

AU - Elishaev, Esther

AU - Gloyeske, Nika

AU - Geller, Melissa A.

AU - Edwards, Robert P.

AU - Linkov, Faina

PY - 2014/4

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N2 - Objective Obesity increases risk for endometrial neoplasia, but neither the pathophysiology nor the effects of weight loss on the risk are well established. We attempted to characterize the molecular profile of the endometrium of asymptomatic women with morbid obesity before and following bariatric surgery-induced weight loss. Methods 59 asymptomatic, morbidly obese women underwent endometrial sampling before bariatric surgery; 46 (78%) of these returned one year later for re-biopsy (median weight loss of 41 kg). Duplicate samples from these specimens were scored for expression of estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), and Ki-67 by two independent, blinded pathologists using an H-score [staining intensity (0-3) × (percent of tissue involved)]. Results The prevalence of hyperplasia pre-operatively was 7% overall and 10% among patients not on an anti-estrogen. ER H-scores were similar before and after surgery overall (median 190 and 196 respectively, p = 0.82), but patients with hyperplasia had higher pre-operative H-scores (median 256, p < 0.001) and experienced greater H-score drops, than those without hyperplasia (- 112 vs + 50, p = 0.028). In two patients with persistent hyperplasia at one year, ER H-scores fell to levels that were similar to those without pathology. One patient who developed hyperplasia during the study period had a rising ER H-score. Patients with hyperplasia had higher median PR H-scores pre-operatively (284 vs 188, p = 0.01), which normalized through greater drops (75 vs 0, p = 0.053). AR H-scores dropped significantly after surgery (13 vs 2, p = 0.015), but were similar between patients with and without hyperplasia (p = 0.33). Weight loss did not affect Ki-67 proliferation index. Conclusion Asymptomatic morbidly obese patients have a high prevalence of occult hyperplasia, characterized by relatively high hormone receptor expression. These profiles appear to normalize with weight loss and in advance of pathologically identifiable changes. These data suggest a potential role for screening this population as well as the possibility that weight loss may be a valid treatment strategy for risk reduction.

AB - Objective Obesity increases risk for endometrial neoplasia, but neither the pathophysiology nor the effects of weight loss on the risk are well established. We attempted to characterize the molecular profile of the endometrium of asymptomatic women with morbid obesity before and following bariatric surgery-induced weight loss. Methods 59 asymptomatic, morbidly obese women underwent endometrial sampling before bariatric surgery; 46 (78%) of these returned one year later for re-biopsy (median weight loss of 41 kg). Duplicate samples from these specimens were scored for expression of estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), and Ki-67 by two independent, blinded pathologists using an H-score [staining intensity (0-3) × (percent of tissue involved)]. Results The prevalence of hyperplasia pre-operatively was 7% overall and 10% among patients not on an anti-estrogen. ER H-scores were similar before and after surgery overall (median 190 and 196 respectively, p = 0.82), but patients with hyperplasia had higher pre-operative H-scores (median 256, p < 0.001) and experienced greater H-score drops, than those without hyperplasia (- 112 vs + 50, p = 0.028). In two patients with persistent hyperplasia at one year, ER H-scores fell to levels that were similar to those without pathology. One patient who developed hyperplasia during the study period had a rising ER H-score. Patients with hyperplasia had higher median PR H-scores pre-operatively (284 vs 188, p = 0.01), which normalized through greater drops (75 vs 0, p = 0.053). AR H-scores dropped significantly after surgery (13 vs 2, p = 0.015), but were similar between patients with and without hyperplasia (p = 0.33). Weight loss did not affect Ki-67 proliferation index. Conclusion Asymptomatic morbidly obese patients have a high prevalence of occult hyperplasia, characterized by relatively high hormone receptor expression. These profiles appear to normalize with weight loss and in advance of pathologically identifiable changes. These data suggest a potential role for screening this population as well as the possibility that weight loss may be a valid treatment strategy for risk reduction.

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KW - Progesterone receptor (PR)

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