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Janesh K. Gupta - One of the best experts on this subject based on the ideXlab platform.

  • prediction of regression and relapse of Endometrial Hyperplasia with conservative therapy
    Obstetrics & Gynecology, 2013
    Co-Authors: Ioannis D. Gallos, Raji Ganesan, Janesh K. Gupta
    Abstract:

    OBJECTIVE: To identify predictors and to estimate their prognostic accuracy for regression and relapse of Endometrial Hyperplasia treated with levonorgestrel-releasing intrauterine system or oral progestogens. METHODS: This was a cohort study of women treated with levonorgestrel-releasing intrauterine system or oral progestogens for complex Hyperplasia or atypical complex Hyperplasia for women wishing to preserve their fertility or those who were unfit for surgery. Hazard ratios (HRs) with the Cox proportional hazards model and Kaplan-Meier survival estimates for independent predictors were calculated. RESULTS: Regression was evaluated in 344 women over a 12-year period, with a median follow-up of 58.8 months (interquartile range 38.4–96.4, range 12–148.2) for levonorgestrel-releasing intrauterine system compared with 95.1 months (interquartile range 41.6–124.6, range 13.2–162) for oral progestogens. In women treated with levonorgestrel-releasing intrauterine system for complex Hyperplasia, we found that 221 women regressed (96.5%, 221/229) and body mass index (BMI) 35 or higher was associated with failure to regress (HR 5.51, 95% confidence interval [CI] 1.05–28.87; P5.043). Relapse was evaluated in 219 women over a 9-year period, with median follow-up of 67 months (interquartile range 50.4–103.5, range 14.5–146.4) for levonorgestrel-releasing intrauterine system and 96.8 months (interquartile range 62.3–122, range 6–151.5) for oral progestogens. In women treated with levonorgestrel-releasing intrauterine system for complex Hyperplasia, we found that 18 women experienced relapse (12.7%, 18/142) and BMI 35 or higher was found to be a strong independent predictor of relapsed Endometrial Hyperplasia (HR 18.93, 95% CI 3.93–91.15; P,.001). Only 3.3% of women with complex Hyperplasia treated with levonorgestrel-releasing intrauterine system and with BMI less than 35 experienced relapse during long-term followup compared with 32.6% of women with BMI 35 or higher. CONCLUSION: Body mass index 35 or higher is strongly associated with failure to regress and relapse of complex Hyperplasia treated with levonorgestrel-releasing intrauterine system.

  • relapse of Endometrial Hyperplasia after conservative treatment a cohort study with long term follow up
    Human Reproduction, 2013
    Co-Authors: Ioannis D. Gallos, Manjeet Shehmar, Preeti Krishan, Raji Ganesan, Janesh K. Gupta
    Abstract:

    STUDY QUESTION What is the risk of relapse for women with Endometrial Hyperplasia treated with levonorgestrel-releasing intrauterine system (LNG-IUS) or oral progestogens? SUMMARY ANSWER Relapse of complex Endometrial Hyperplasia after initial regression occurs often and it occurs less often in women treated with LNG-IUS than with oral progestogens. WHAT IS KNOWN ALREADY The LNG-IUS and oral progestogens are used to treat women with Endometrial Hyperplasia and achieve regression. There is uncertainty over whether further surveillance for these women is necessary as the risk for relapse is unknown. STUDY DESIGN, SIZE, DURATION A cohort study of 219 women with complex non-atypical or atypical Endometrial Hyperplasia who were treated and achieved initial regression with LNG-IUS (n = 153) or oral progestogens (n = 66) from August 1998 until December 2007 and followed up for >5 years. The mean length of follow-up was 74.7 ± SD 31.8 months for the LNG-IUS versus 87.6 ± SD 42.2 months for the oral progestogen group. PARTICIPANTS/MATERIALS, SETTING, METHODS We evaluated the proportion of women who relapsed or had hysterectomy after initial regression with LNG-IUS compared with oral progestogens by logistic regression and adjusting for confounding. The time from regression to relapse was explored through a survival analysis. MAIN RESULTS AND THE ROLE OF CHANCE Relapse of Hyperplasia occurred in 13.7% (21/153) of women treated with LNG-IUS compared with 30.3% (20/66) of women treated with oral progestogens [adjusted odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.17-0.7, P = 0.005]. Relapse rates over long-term follow-up were lower for complex non-atypical Hyperplasia compared with atypical Hyperplasia for both LNG-IUS (12.7%, 18/142 versus 27.3%, 3/11, respectively; P ≤ 0.001) and oral progestogens (28.3%, 17/60 versus 50%, 3/6, respectively; P ≤ 0.001). The survival analysis indicates that relapse occurred less often with LNG-IUS at 12, 24, 36, 48, 60 and >60 months of follow-up (hazard ratio 0.37, 95% CI: 0.2-0.7, P = 0.0013). There were no events of relapse after 48 months from regression with oral progestogens, but 5 women treated with LNG-IUS relapsed after 60 months when treatment was discontinued. Hysterectomy rates were lower in the LNG-IUS than oral progestogen group during follow-up (19.6%, 30/153 versus 31.8%, 21/66, respectively, OR = 0.52, 95% CI: 0.27-1, P = 0.05). Endometrial cancer was diagnosed in 2 (11.8%) women who had hysterectomy (n = 17) because of relapse. LIMITATIONS, REASONS FOR CAUTION We are unable to accurately estimate the cancer risk in women who relapse during follow-up as only 17 out of 41 who relapsed underwent hysterectomy. WIDER IMPLICATIONS OF THE FINDINGS Relapse of Endometrial Hyperplasia after initial regression occurs often and long-term follow-up is advised. STUDY FUNDING/COMPETING INTEREST(S) Ioannis D. Gallos and this study were funded through a grant from Wellbeing of Women (ELS022). No competing interests.

  • Oral progestogens vs levonorgestrel-releasing intrauterine system for Endometrial Hyperplasia: a systematic review and metaanalysis
    American Journal of Obstetrics and Gynecology, 2010
    Co-Authors: Ioannis D. Gallos, Manjeet Shehmar, Shakila Thangaratinam, Thalis K. Papapostolou, Arri Coomarasamy, Janesh K. Gupta
    Abstract:

    Objective To conduct a systematic review and metaanalysis of studies evaluating the regression rate of Endometrial Hyperplasia with oral progestogens and levonorgestrel-releasing intrauterine system. Study Design Searches were conducted on Medline, Embase, Cochrane Library, and Web of Science, and reference lists of relevant articles were examined. The methodologic index for nonrandomized studies was used for quality assessment. Metaanalysis was performed with random effects model. Results There were 24 observational studies (1001 women), of low methodologic quality, evaluating the outcome of regression of Endometrial Hyperplasia with oral progestogens or levonorgestrel-releasing intrauterine system. Metaanalysis showed that oral progestogens achieved a lower pooled regression rate compared with levonorgestrel-releasing intrauterine system for complex (pooled rate, 66% vs 92%; P P = .03). There was no statistical difference in simple Hyperplasia (pooled rate, 89% vs 96%; P = .41). Conclusion Oral progestogens appear to induce a lower disease regression rate than Levonorgestrel-releasing intrauterine system in the treatment of Endometrial Hyperplasia.

  • the effectiveness of a levonorgestrel releasing intrauterine system lng ius in the treatment of Endometrial Hyperplasia a long term follow up study
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 2008
    Co-Authors: Rajesh Varma, Justin T Clark, Raji Ganesan, Hemi Soneja, Kalsang Bhatia, Terence P Rollason, Janesh K. Gupta
    Abstract:

    Abstract Objectives Medical treatment of non-atypical Endometrial Hyperplasia with oral progestogens has limited efficacy and poor compliance. A levonorgestrel-releasing intrauterine system (LNG-IUS) has been shown to successfully treat Hyperplasia in small-sized studies. Our aim was to examine the effectiveness of LNG-IUS in a larger study with long-term follow up. Study design Prospective observational study of 105 women diagnosed with Endometrial Hyperplasia and treated with LNG-IUS between 1999 and 2004 at a University Teaching hospital. Baseline characteristics and outpatient Endometrial Pipelle sampling were undertaken at 3 and 6 months post LNG-IUS insertion and 6-monthly intervals thereafter in all cases. Outcome included histological data derived from both Pipelle and uterine histologies at 1 and 2 years LNG-IUS therapy. Results LNG-IUS achieved Endometrial regression in 90% (94/105) of cases by 2 years, with a significant proportion (96%, 90/94) achieving this within 1 year. Regression occurred in 88/96 (92%) of non-atypical and 6/9 (67%) of atypical Hyperplasias, and in all 22 cases of Endometrial Hyperplasia associated with HRT. Regression rates did not differ between histological types of Hyperplasia. Twenty-three women (22%) underwent hysterectomy of which 13 were indicated and 10 were performed at patient request despite regressed endometrium. Two cases of cancer (one uterine and one ovarian) were identified. Conclusion LNG-IUS is highly effective in treating Endometrial Hyperplasia. Beneficial effects are observed by the majority within 1 year. Treatment can be reliably monitored through regular 6-montly outpatient Endometrial Pipelle surveillance. LNG-IUS treatment of non-atypical Hyperplasias is likely to reduce the number of hysterectomies performed in this subgroup.

  • the management of Endometrial Hyperplasia an evaluation of current practice
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 2006
    Co-Authors: Justin T Clark, Deepa Neelakantan, Janesh K. Gupta
    Abstract:

    Abstract Objective To identify current management practices and evaluate subsequent outcomes of treatment for women diagnosed with Endometrial Hyperplasia. Study design All women with a histological diagnosis of Endometrial Hyperplasia at the Birmingham Women's Hospital were identified between October 1998 and September 2000. A retrospective case note review was performed for each woman using a standardised data abstraction sheet. Baseline characteristics including clinical presentation and treatment strategy were obtained. Results of subsequent Endometrial tissue examinations were used to assess histological response to treatment and the need and indication for hysterectomy was used to assess clinical response. Results There were 351 women diagnosed with Endometrial Hyperplasia during the study period of which 84% presented with symptoms of abnormal uterine bleeding and 54% were postmenopausal. Complex Endometrial Hyperplasia was the most common diagnosis accounting for 60% of all cases. Eighty percent of women with atypical Endometrial Hyperplasia were treated by hysterectomy compared with 30% without evidence of cytological atypia (relative hysterectomy rate of 2.6, 95% CI 2.0–3.3). Hysterectomy was avoided in 138/172 (80%, 95% CI 74–86%) women managed conservatively during the study period. Overall 35/108 (36%, 95% CI 27–46%) of women managed conservatively had persistent or progressive disease identified (mean follow up 36 months). 20/143 (14%) women initially diagnosed with Endometrial Hyperplasia who subsequently underwent hysterectomy were found to have Endometrial cancer, the majority of whom had been diagnosed with atypical disease (14/20, 70%). Conclusion(s) The majority of women with atypical Endometrial Hyperplasia were managed by hysterectomy and the substantial risk of diagnostic under-call supports this approach to treatment. In contrast, there is no consensus regarding the initial management of women with Endometrial Hyperplasia without cytological atypia.

Ioannis D. Gallos - One of the best experts on this subject based on the ideXlab platform.

  • prediction of regression and relapse of Endometrial Hyperplasia with conservative therapy
    Obstetrics & Gynecology, 2013
    Co-Authors: Ioannis D. Gallos, Raji Ganesan, Janesh K. Gupta
    Abstract:

    OBJECTIVE: To identify predictors and to estimate their prognostic accuracy for regression and relapse of Endometrial Hyperplasia treated with levonorgestrel-releasing intrauterine system or oral progestogens. METHODS: This was a cohort study of women treated with levonorgestrel-releasing intrauterine system or oral progestogens for complex Hyperplasia or atypical complex Hyperplasia for women wishing to preserve their fertility or those who were unfit for surgery. Hazard ratios (HRs) with the Cox proportional hazards model and Kaplan-Meier survival estimates for independent predictors were calculated. RESULTS: Regression was evaluated in 344 women over a 12-year period, with a median follow-up of 58.8 months (interquartile range 38.4–96.4, range 12–148.2) for levonorgestrel-releasing intrauterine system compared with 95.1 months (interquartile range 41.6–124.6, range 13.2–162) for oral progestogens. In women treated with levonorgestrel-releasing intrauterine system for complex Hyperplasia, we found that 221 women regressed (96.5%, 221/229) and body mass index (BMI) 35 or higher was associated with failure to regress (HR 5.51, 95% confidence interval [CI] 1.05–28.87; P5.043). Relapse was evaluated in 219 women over a 9-year period, with median follow-up of 67 months (interquartile range 50.4–103.5, range 14.5–146.4) for levonorgestrel-releasing intrauterine system and 96.8 months (interquartile range 62.3–122, range 6–151.5) for oral progestogens. In women treated with levonorgestrel-releasing intrauterine system for complex Hyperplasia, we found that 18 women experienced relapse (12.7%, 18/142) and BMI 35 or higher was found to be a strong independent predictor of relapsed Endometrial Hyperplasia (HR 18.93, 95% CI 3.93–91.15; P,.001). Only 3.3% of women with complex Hyperplasia treated with levonorgestrel-releasing intrauterine system and with BMI less than 35 experienced relapse during long-term followup compared with 32.6% of women with BMI 35 or higher. CONCLUSION: Body mass index 35 or higher is strongly associated with failure to regress and relapse of complex Hyperplasia treated with levonorgestrel-releasing intrauterine system.

  • relapse of Endometrial Hyperplasia after conservative treatment a cohort study with long term follow up
    Human Reproduction, 2013
    Co-Authors: Ioannis D. Gallos, Manjeet Shehmar, Preeti Krishan, Raji Ganesan, Janesh K. Gupta
    Abstract:

    STUDY QUESTION What is the risk of relapse for women with Endometrial Hyperplasia treated with levonorgestrel-releasing intrauterine system (LNG-IUS) or oral progestogens? SUMMARY ANSWER Relapse of complex Endometrial Hyperplasia after initial regression occurs often and it occurs less often in women treated with LNG-IUS than with oral progestogens. WHAT IS KNOWN ALREADY The LNG-IUS and oral progestogens are used to treat women with Endometrial Hyperplasia and achieve regression. There is uncertainty over whether further surveillance for these women is necessary as the risk for relapse is unknown. STUDY DESIGN, SIZE, DURATION A cohort study of 219 women with complex non-atypical or atypical Endometrial Hyperplasia who were treated and achieved initial regression with LNG-IUS (n = 153) or oral progestogens (n = 66) from August 1998 until December 2007 and followed up for >5 years. The mean length of follow-up was 74.7 ± SD 31.8 months for the LNG-IUS versus 87.6 ± SD 42.2 months for the oral progestogen group. PARTICIPANTS/MATERIALS, SETTING, METHODS We evaluated the proportion of women who relapsed or had hysterectomy after initial regression with LNG-IUS compared with oral progestogens by logistic regression and adjusting for confounding. The time from regression to relapse was explored through a survival analysis. MAIN RESULTS AND THE ROLE OF CHANCE Relapse of Hyperplasia occurred in 13.7% (21/153) of women treated with LNG-IUS compared with 30.3% (20/66) of women treated with oral progestogens [adjusted odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.17-0.7, P = 0.005]. Relapse rates over long-term follow-up were lower for complex non-atypical Hyperplasia compared with atypical Hyperplasia for both LNG-IUS (12.7%, 18/142 versus 27.3%, 3/11, respectively; P ≤ 0.001) and oral progestogens (28.3%, 17/60 versus 50%, 3/6, respectively; P ≤ 0.001). The survival analysis indicates that relapse occurred less often with LNG-IUS at 12, 24, 36, 48, 60 and >60 months of follow-up (hazard ratio 0.37, 95% CI: 0.2-0.7, P = 0.0013). There were no events of relapse after 48 months from regression with oral progestogens, but 5 women treated with LNG-IUS relapsed after 60 months when treatment was discontinued. Hysterectomy rates were lower in the LNG-IUS than oral progestogen group during follow-up (19.6%, 30/153 versus 31.8%, 21/66, respectively, OR = 0.52, 95% CI: 0.27-1, P = 0.05). Endometrial cancer was diagnosed in 2 (11.8%) women who had hysterectomy (n = 17) because of relapse. LIMITATIONS, REASONS FOR CAUTION We are unable to accurately estimate the cancer risk in women who relapse during follow-up as only 17 out of 41 who relapsed underwent hysterectomy. WIDER IMPLICATIONS OF THE FINDINGS Relapse of Endometrial Hyperplasia after initial regression occurs often and long-term follow-up is advised. STUDY FUNDING/COMPETING INTEREST(S) Ioannis D. Gallos and this study were funded through a grant from Wellbeing of Women (ELS022). No competing interests.

  • Oral progestogens vs levonorgestrel-releasing intrauterine system for Endometrial Hyperplasia: a systematic review and metaanalysis
    American Journal of Obstetrics and Gynecology, 2010
    Co-Authors: Ioannis D. Gallos, Manjeet Shehmar, Shakila Thangaratinam, Thalis K. Papapostolou, Arri Coomarasamy, Janesh K. Gupta
    Abstract:

    Objective To conduct a systematic review and metaanalysis of studies evaluating the regression rate of Endometrial Hyperplasia with oral progestogens and levonorgestrel-releasing intrauterine system. Study Design Searches were conducted on Medline, Embase, Cochrane Library, and Web of Science, and reference lists of relevant articles were examined. The methodologic index for nonrandomized studies was used for quality assessment. Metaanalysis was performed with random effects model. Results There were 24 observational studies (1001 women), of low methodologic quality, evaluating the outcome of regression of Endometrial Hyperplasia with oral progestogens or levonorgestrel-releasing intrauterine system. Metaanalysis showed that oral progestogens achieved a lower pooled regression rate compared with levonorgestrel-releasing intrauterine system for complex (pooled rate, 66% vs 92%; P P = .03). There was no statistical difference in simple Hyperplasia (pooled rate, 89% vs 96%; P = .41). Conclusion Oral progestogens appear to induce a lower disease regression rate than Levonorgestrel-releasing intrauterine system in the treatment of Endometrial Hyperplasia.

Kyu Wan Lee - One of the best experts on this subject based on the ideXlab platform.

  • bag 1 expression in normal endometrium Endometrial Hyperplasia and Endometrial cancer
    Acta Obstetricia et Gynecologica Scandinavica, 2008
    Co-Authors: Jae Yun Song, Ji Won Kim, Jae Kwan Lee, Nak Woo Lee, Bom Woo Yeom, Sun Haeng Kim, Kyu Wan Lee
    Abstract:

    Background. BAG-1 (Bcl-2-associated athanogene 1) is a BCL-2 binding anti-apoptotic protein that may play a role in carcinogenesis. The purpose of this study is to compare the expression rate of BAG-1 in normal endometrium, Endometrial Hyperplasia and Endometrial cancer, and further to determine a correlation between BAG-1 expression and clinicopathological parameters, and overall survival. Methods. Tissue samples from 43 patients who were diagnosed with Endometrial cancer, tissue samples from 20 patients with Endometrial Hyperplasia and tissue samples from 20 normal patients were included in the study. Immunohistochemical analyses were performed using a polyclonal anti-BAG-1 antibody from paraffin-embedded blocks. Results. Cytoplasmic BAG-1 expression of the normal endometrium, Endometrial Hyperplasia and Endometrial cancer samples was 4/20 (20%), 3/20 (15%) and 27/43 (62%), respectively. Nuclear BAG-1 expression was 17/20 (85%), 12/20 (60%) and 16/43 (37%), respectively. Cytoplasmic BAG-1 expression cor...

  • comparison of cyclooxygenase 2 and p53 expression in normal endometrium Endometrial Hyperplasia and Endometrial cancer
    Journal of Gynecologic Oncology, 2006
    Co-Authors: Sang Wook Yoo, Jae Yun Song, Nak Woo Lee, Ok Kyong Kim, Soon Cheol Hong, Kyu Wan Lee
    Abstract:

    Objective：The purpose of this study is to compare the expression rate of cyclooxygenase-2 (COX-2), p53 in Endometrial Hyperplasia, Endometrial cancer and normal endometrium and to correlate COX-2 with the clinicopathological factors and p53 in Endometrial cancer. Methods：Immunohistochemical stain of COX-2, p53 was performed on samples from a series of 19 cases of normal proliferative endometrium, 20 cases of complex Endometrial Hyperplasia and 19 cases of Endometrial cancer. And then we analyzed the expression of COX-2 correlated the findings with clinicopathological factors and p53. Expression of COX-2 was scored according to the proportion of positive-staining cells: negative, no staining; 1+, ＜10%; 2+, 10-50%; 3+, ＞50. For p53 overexpression, when there were at least 10% of tumor cells stained, it was considered as positive. Results：Overexpression of COX-2 (2+) was seen in 5 (26.3%) of the Endometrial cancers, 6 (30%) of the complex Endometrial Hyperplasia, and 4 (21.1%) of the normal endometria. The expression rates of COX-2 in Endometrial cancer, Hyperplasia and normal endometrium were not different statistically significant (p=0.93). COX-2 was not correlated with clinicopathological factors but correlated with p53 significantly (p=0.021). Conclusion：In this study, the immunohistochemical analysis showed no difference statistically in COX-2 expression between Endometrial cancer and Hyperplasia compared to normal endometria. COX-2 was significantly correlated with p53. This finding may represent that tumor suppressor p53 upregulates COX-2 expression.

  • expression of cd44 variant 6 v6 in Endometrial cancer Endometrial Hyperplasia and normal endometrium
    Obstetrics & gynecology science, 2002
    Co-Authors: Jae Yun Song, Hyun Tae Park, Nack Woo Lee, Young Tae Kim, In Sun Kim, Kyu Wan Lee
    Abstract:

    목적 : 정상 자궁내막과, 자궁내막증식증 (Endometrial Hyperplasia), 그리고 자궁내막암 (Endometrial cancer)에 있어서 CD44 V6의 표현의 차이와 CD44 V6의 자궁내막암의 예후예측인자로서의 여부에 대하여 알아보고자 한다. 연구 방법 : 1991년부터 2001년까지 본원에서 진단된 총 76명의 환자를 대상으로 자궁내막증식증 (Endometrial Hyperplasia) 15예, 자궁내막암 24예 그리고 정상내막 37예를 대상으로 하였으며 면역양성반응과 면역강도를 종합하여 면역활성도 (immunoreactivity)를 평가하였다. 결과 : 정상조직이나 자궁내막증식증에 비해서 자궁내막암의 경우 통계학적으로 유의한 양성 소견을 나타내었다. (P＜0.05) 면역활성도를 자궁근층의 침범이 나타나기 이전의 Ia와 침범이 나타나는 Ib 이상으로 나누어 보면 통계학적 유의성을 나타내지는 못하였다. 조직분화도에 따른 면역활성도는 grade 1에서 유의한 증가를 나타내었다. 결론 : CD44 V6의 표현은 자궁내막암의 조기진단에 이용될 수 있으며 자궁내막암의 예후예측인자로서도 이용될 수 있으리라 사료된다.

John P. Curtin - One of the best experts on this subject based on the ideXlab platform.

Stephanie V Blank - One of the best experts on this subject based on the ideXlab platform.

  • lymph node dissection in the surgical management of atypical Endometrial Hyperplasia
    American Journal of Obstetrics and Gynecology, 2010
    Co-Authors: Jill Suzanne Whyte, John P. Curtin, Elizabeth P Gurney, Stephanie V Blank
    Abstract:

    Objective The aim of this study was to evaluate the effect of lymph node dissection in patients with atypical Endometrial Hyperplasia. Study Design Patients undergoing surgical management of atypical Endometrial Hyperplasia during the study period were retrospectively identified. Clinical and pathologic information was analyzed. Results Eighty-eight patients comprised our cohort. Median age was 54 years (range, 37–85 years). Sixty-seven patients had lymph node dissection at the time of surgery for atypical Endometrial Hyperplasia, whereas 21 did not. Twenty-five of 88 (28.4%) had Endometrial carcinoma on final uterine pathology. Stages were as follows: 4 IA, 15 IB, 3 IC, 2 IIB, and 1 IIIC. Surgical outcomes were not statistically significant between staged and unstaged groups. Information from lymph node dissection influenced management decisions in 7 of the 25 (28%) cancer patients. Conclusion Lymph node dissection did not adversely affect surgical outcomes in patients with atypical Endometrial Hyperplasia. Because many of these patients have concurrent Endometrial cancer, we recommend consideration of lymph node dissection in atypical Endometrial Hyperplasia patients undergoing definitive surgical treatment.