Development of a model for prediction of relaxation and progression of hormone-resistant form of endometrial hyperplasia in women of reproductive age
Background. is determined by the high prevalence of endometrial hyperplasia (EH) among women of reproductive age, which often leads to recurrences and complicates treatment. The development of effective prediction methods improves the quality of therapy and prevents disease progression. Purpose –...
Saved in:
| Main Author: | |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
V. N. Karazin Kharkiv National University
2025-02-01
|
| Series: | Journal of V. N. Karazin Kharkiv National University: Series Medicine |
| Subjects: | |
| Online Access: | https://ukrmedsci.com/index.php/visnyk/article/view/137 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850151214455455744 |
|---|---|
| author | D.A. Khaskhachykh |
| author_facet | D.A. Khaskhachykh |
| author_sort | D.A. Khaskhachykh |
| collection | DOAJ |
| description | Background. is determined by the high prevalence of endometrial hyperplasia (EH) among women of reproductive age, which often leads to recurrences and complicates treatment. The development of effective prediction methods improves the quality of therapy and prevents disease progression.
Purpose – analyze the factors influencing the effectiveness of progestin therapy in women with non-atypical EH and to develop a model for predicting the risk of resistance and recurrence. A particular emphasis is placed on evaluating the relationship between clinical indicators, immunohistochemical markers, and treatment outcomes, which provides a foundation for the individualization of therapeutic approaches.
Materials and Methods. The study is aimed at developing a model for predicting recurrence or progression of hormone-resistant endometrial hyperplasia in women of reproductive age. The work is based on the analysis of clinical, anamnestic and immunohistochemical data of patients receiving progestin therapy. A total of 495 patients with abnormal uterine bleeding (AUB) with morphologically verified pathological results confirming the presence of endometrial hyperplasia (HE) and normal endometrium were included in the study. In the study group (346 cases), GE without atypia of the hormone-sensitive form (169 cases) and hormone-resistant form of GE (48 cases) were diagnosed. The control group (149 cases) consisted of women with secretory changes of the endometrium. To build the model, the data were divided into the study (70%) and validation (30%) groups.
Statistical analysis methods used in the study included the Shapiro-Wilk test to check data distribution normality, one-way ANOVA for group comparisons, the Kruskal-Wallis test for non-normal data, Bonferroni correction, and others. For categorical variables, Pearsonʼs chi-square test or Fisherʼs exact test was applied. Immunohistochemical analysis assessed the expression of markers such as Ki-67, Caspase 3, Bcl-2, VEGF, eNOS, and others, including their changes before and after progestin therapy.
Results. A significant reduction in endometrial cell proliferative activity was observed (Ki-67 decreased from 22,6% to 8,1%; p < 0,05), along with an increase in apoptosis markers (Caspase 3 increased from 183,6 to 234,3; p < 0,05). A decrease in the expression of the anti-apoptotic marker Bcl-2 (from 122,9 to 36,2; p < 0,05) indicated reduced cellular resistance to apoptosis. Angiogenesis analysis demonstrated a reduction in VEGF (from 48,7 to 21,7; p < 0,05) and eNOS (from 19,8 to 7,4; p < 0,05), suggesting decreased vascularization of the pathological endometrium. Body mass index (BMI) >30 kg/m², the presence of metabolic syndrome, and a history of recurrences were identified as key clinical risk factors for therapy failure.
The developed recurrence prediction model is based on key variables: cellular markers (Ki-67, Caspase 3, Bcl-2, VEGF), clinical characteristics (BMI, metabolic syndrome, recurrences), and morphological parameters (endometrial thickness >15 mm). This model enables the assessment of the probability of progestin therapy effectiveness and the risk of recurrence.
Conclusions. The effectiveness of progestin therapy is determined by reduced cellular proliferative activity, activation of apoptosis, and inhibition of angiogenesis. Patients with high BMI, metabolic disorders, and a history of recurrences have a higher risk of treatment failure. The prediction model allows for the individualization of therapeutic approaches, enhancing treatment effectiveness and reducing the likelihood of recurrence.
Practical Significance. The practical significance of this study lies in the application of the model for early risk detection and therapy adjustment, contributing to improved treatment outcomes for women with EH of reproductive age. |
| format | Article |
| id | doaj-art-69fd352ecb1a4f7e8c0be992c0d8183b |
| institution | OA Journals |
| issn | 2313-6693 2313-2396 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | V. N. Karazin Kharkiv National University |
| record_format | Article |
| series | Journal of V. N. Karazin Kharkiv National University: Series Medicine |
| spelling | doaj-art-69fd352ecb1a4f7e8c0be992c0d8183b2025-08-20T02:26:20ZengV. N. Karazin Kharkiv National UniversityJournal of V. N. Karazin Kharkiv National University: Series Medicine2313-66932313-23962025-02-01331(52)3347https://doi.org/10.26565/2313-6693-2025-52-03Development of a model for prediction of relaxation and progression of hormone-resistant form of endometrial hyperplasia in women of reproductive ageD.A. Khaskhachykh0https://orcid.org/0000-0001-5097-6667Dnipro State Medical University Background. is determined by the high prevalence of endometrial hyperplasia (EH) among women of reproductive age, which often leads to recurrences and complicates treatment. The development of effective prediction methods improves the quality of therapy and prevents disease progression. Purpose – analyze the factors influencing the effectiveness of progestin therapy in women with non-atypical EH and to develop a model for predicting the risk of resistance and recurrence. A particular emphasis is placed on evaluating the relationship between clinical indicators, immunohistochemical markers, and treatment outcomes, which provides a foundation for the individualization of therapeutic approaches. Materials and Methods. The study is aimed at developing a model for predicting recurrence or progression of hormone-resistant endometrial hyperplasia in women of reproductive age. The work is based on the analysis of clinical, anamnestic and immunohistochemical data of patients receiving progestin therapy. A total of 495 patients with abnormal uterine bleeding (AUB) with morphologically verified pathological results confirming the presence of endometrial hyperplasia (HE) and normal endometrium were included in the study. In the study group (346 cases), GE without atypia of the hormone-sensitive form (169 cases) and hormone-resistant form of GE (48 cases) were diagnosed. The control group (149 cases) consisted of women with secretory changes of the endometrium. To build the model, the data were divided into the study (70%) and validation (30%) groups. Statistical analysis methods used in the study included the Shapiro-Wilk test to check data distribution normality, one-way ANOVA for group comparisons, the Kruskal-Wallis test for non-normal data, Bonferroni correction, and others. For categorical variables, Pearsonʼs chi-square test or Fisherʼs exact test was applied. Immunohistochemical analysis assessed the expression of markers such as Ki-67, Caspase 3, Bcl-2, VEGF, eNOS, and others, including their changes before and after progestin therapy. Results. A significant reduction in endometrial cell proliferative activity was observed (Ki-67 decreased from 22,6% to 8,1%; p < 0,05), along with an increase in apoptosis markers (Caspase 3 increased from 183,6 to 234,3; p < 0,05). A decrease in the expression of the anti-apoptotic marker Bcl-2 (from 122,9 to 36,2; p < 0,05) indicated reduced cellular resistance to apoptosis. Angiogenesis analysis demonstrated a reduction in VEGF (from 48,7 to 21,7; p < 0,05) and eNOS (from 19,8 to 7,4; p < 0,05), suggesting decreased vascularization of the pathological endometrium. Body mass index (BMI) >30 kg/m², the presence of metabolic syndrome, and a history of recurrences were identified as key clinical risk factors for therapy failure. The developed recurrence prediction model is based on key variables: cellular markers (Ki-67, Caspase 3, Bcl-2, VEGF), clinical characteristics (BMI, metabolic syndrome, recurrences), and morphological parameters (endometrial thickness >15 mm). This model enables the assessment of the probability of progestin therapy effectiveness and the risk of recurrence. Conclusions. The effectiveness of progestin therapy is determined by reduced cellular proliferative activity, activation of apoptosis, and inhibition of angiogenesis. Patients with high BMI, metabolic disorders, and a history of recurrences have a higher risk of treatment failure. The prediction model allows for the individualization of therapeutic approaches, enhancing treatment effectiveness and reducing the likelihood of recurrence. Practical Significance. The practical significance of this study lies in the application of the model for early risk detection and therapy adjustment, contributing to improved treatment outcomes for women with EH of reproductive age.https://ukrmedsci.com/index.php/visnyk/article/view/137endometrial hyperplasia hormone resistance progestin therapy recurrence prediction progression clinical risk factors immunohistochemical markers predictive model treatment effectiveness individualized therapy |
| spellingShingle | D.A. Khaskhachykh Development of a model for prediction of relaxation and progression of hormone-resistant form of endometrial hyperplasia in women of reproductive age Journal of V. N. Karazin Kharkiv National University: Series Medicine endometrial hyperplasia hormone resistance progestin therapy recurrence prediction progression clinical risk factors immunohistochemical markers predictive model treatment effectiveness individualized therapy |
| title | Development of a model for prediction of relaxation and progression of hormone-resistant form of endometrial hyperplasia in women of reproductive age |
| title_full | Development of a model for prediction of relaxation and progression of hormone-resistant form of endometrial hyperplasia in women of reproductive age |
| title_fullStr | Development of a model for prediction of relaxation and progression of hormone-resistant form of endometrial hyperplasia in women of reproductive age |
| title_full_unstemmed | Development of a model for prediction of relaxation and progression of hormone-resistant form of endometrial hyperplasia in women of reproductive age |
| title_short | Development of a model for prediction of relaxation and progression of hormone-resistant form of endometrial hyperplasia in women of reproductive age |
| title_sort | development of a model for prediction of relaxation and progression of hormone resistant form of endometrial hyperplasia in women of reproductive age |
| topic | endometrial hyperplasia hormone resistance progestin therapy recurrence prediction progression clinical risk factors immunohistochemical markers predictive model treatment effectiveness individualized therapy |
| url | https://ukrmedsci.com/index.php/visnyk/article/view/137 |
| work_keys_str_mv | AT dakhaskhachykh developmentofamodelforpredictionofrelaxationandprogressionofhormoneresistantformofendometrialhyperplasiainwomenofreproductiveage |