Progesterone receptor B over progesterone receptor A prevents recurrence in bilateral endometriomas

Aslan, Ozgur; Yildiz, Sukru; Kaya, Cihan; Altinay, Serdar; Aydiner, Ilke Esin; Karabulut, Esra; Ekin, Murat; Yasar, Levent

doi:10.1590/1806-9282.20240485

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 70 (9) • 2024 • https://doi.org/10.1590/1806-9282.20240485 copy

Progesterone receptor B over progesterone receptor A prevents recurrence in bilateral endometriomas

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Endometriosis is a disease in which stromal cells and endometrial glands extend outside of the uterine cavity. Nevertheless, treatment failure and recurrence cause difficulties in management. This study aimed to evaluate the receptor-level components of bilateral endometriomas in the recurrence state.

METHODS:

Our retrospective cohort study was conducted with patients who underwent surgery for bilateral endometriomas between 2015 and 2021. In total, 113 patients were allocated. A total of 76 patients did not meet the eligibility criteria, and the data of 37 patients were evaluated. Medical treatments, recurrences, and postoperative follow-up data were collected. In archived tissue samples, measurements of progesterone receptor A and progesterone receptor B, histoscores and immunoreactivity scores, and their ratios were calculated in the group that received no postoperative medical treatment. Criteria for recurrence were a repeat operation and/or the detection of a new endometrioma>2 cm at the follow-up examination.

RESULTS:

No recurrence was observed in 73.0% (n=27) of the cases, whereas recurrence was observed in 27.0% (n=10) of the participants. Patients without recurrence had significantly higher progesterone receptor B histoscore/progesterone receptor A histoscore and progesterone receptor B immunoreactivity score/progesterone receptor A immunoreactivity score results (p=0.01). Nevertheless, when the histoscores and immunoreactivity scores for both receptors were contrasted separately, there was no appreciable difference between them.

CONCLUSION:

The dominance of progesterone receptor B over progesterone receptor A was inversely proportional to the recurrence status in bilateral endometriomas. Furthermore, our study revealed that assessing receptor levels alone did not result in a significant difference in recurrence.

KEYWORDS:
Endometriosis; Laparoscopy; Progesterone; Recurrence

		Recurrence		p
		Absent (n=27)	Present (n=10)	p
Age	Med±Sd	37.78±8.11	41.40±3.50	^a a Mann-Whitney U test. 0.353
BMI (kg/m²)	Med±Sd	25.26±2.88	23.41±3.60	^a a Mann-Whitney U test. 0.353
Parity (n)	Median (min–max)	2 (0–4)	1.5 (0–3)	^a a Mann-Whitney U test. 0.533
Ca-125	Med±Sd	83.75±67.04	74.33±57.54	^a a Mann-Whitney U test. 0.984
Cyst size (cm)	Med±Sd	6.47±3.81	5.01±1.79	^a a Mann-Whitney U test. 0.538
PRA H Score	Med±Sd	192.78±46.54	213.50±60.37	^a a Mann-Whitney U test. 0.271
PRB H Score	Med±Sd	141.67±35.16	105.00±60.59	^a a Mann-Whitney U test. 0.130
PRB H/PRA H	Med±Sd	0.75±0.16	0.45±0.24	^a a Mann-Whitney U test. 0.001^ p<0.01. Comparisons could not be made due to the lack of observation.
PRA IRS	Med±Sd	0.59±3.91	8.40±3.37	^a a Mann-Whitney U test. 0.098
PRB IRS	Med±Sd	3.56±3.05	2.90±3.03	^a a Mann-Whitney U test. 0.408
PRB IRS/PRA IRS	Med±Sd	0.63±0.29	0.28±0.23	^a a Mann-Whitney U test. 0.001^ p<0.01. Comparisons could not be made due to the lack of observation.
Hysterectomy	Absent	22 (81.5)	7 (70.0)	^b b Fisher exact test. 0.655
Hysterectomy	Present	5 (18.5)	3 (30.0)	^b b Fisher exact test. 0.655
Douglas obliteration	Absent	13 (48.1)	3 (30.0)	^b b Fisher exact test. 0.461
Douglas obliteration	Present	14 (51.9)	7 (70.0)	^b b Fisher exact test. 0.461
Preoperative treatment	No treatment	23 (85.2)	10 (100.0)	^c c Fisher-Freeman-Halton test. 0.668
	Progesterone	3 (11.1)	0
	GnRHa	1 (3.7)	0

	Cutoff	Sensitivity/specificity	ppv	npv	auc	95%CI	p
PRBH/PRA H Ratio	≤0.588	80.0/85.2	66.7	92.0	0.926	0.8445–1.000	0.001^* * p<0.01. ppv: positive predictive value, npv: negative predictive value, auc: area under curve. For the cutoff value of the PRB H/PRA H level of 0.588, sensitivity 80%, and specificity 85.2%; the positive predictive value is 66.7%, the negative predictive value is 92%, and the accuracy is 83.8%. The area under the ROC curve obtained was 92.6% with a standard deviation of 4.2%. For the cutoff value of PRB IRS/PRA IRS level of 0.333, sensitivity 80%, and specificity 74.1%, the positive predictive value is 53.3%, the negative predictive value is 90.9%, and the accuracy is 75.7%. The area under the ROC curve obtained was 83.7% with a standard deviation of 7.7%.
PRBIRS/PRAIRS Ratio	≤0.333	80.0/74.1	53.3	90.9	0.837	0.685–0.989	0.002^* * p<0.01. ppv: positive predictive value, npv: negative predictive value, auc: area under curve. For the cutoff value of the PRB H/PRA H level of 0.588, sensitivity 80%, and specificity 85.2%; the positive predictive value is 66.7%, the negative predictive value is 92%, and the accuracy is 83.8%. The area under the ROC curve obtained was 92.6% with a standard deviation of 4.2%. For the cutoff value of PRB IRS/PRA IRS level of 0.333, sensitivity 80%, and specificity 74.1%, the positive predictive value is 53.3%, the negative predictive value is 90.9%, and the accuracy is 75.7%. The area under the ROC curve obtained was 83.7% with a standard deviation of 7.7%.

	p	ODDS	95%CI
	p	ODDS	Lower	Upper
Age (year)	0.329	1.086	0.920	1.282
Endometrioma size (cm)	0.358	0.775	0.450	1.334
PRB H/PRA H≤0.588	0.018^* * p<0.05. The PRB H score/PRA H score was found to be 17.669 (95% confidence interval [CI]: 1.62–192.56) times associated with endometriosis recurrence.	17.669	1.621	192.560
PRB IRS/PRA IRS≤0.333	0.251	3.826	0.388	37.731

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[1] *Corresponding author:
ozgraslan92@gmail.com