Clinical-anamnestic and ELISA predictors of recurrence of endometrial hyperplastic processes in combination with uterine fibroids
Authors: Krut Yu. Ya. , Zemlyana N. A. 
Published: July 2021

Endometrium hyperplastic processes (EHP) are characterized by high prevalence, high risk of malignancy and frequent recurrence.The objective: identify risk factors for recurrence in EHP in combination with uterine fibroids based on the study of clinical and anamnestic data and markers of oncogenesis.Materials and methods. The study examined 81 women with endometrial hyperplastic processes (34 women with simple endometrial hyperplasia without atypia and 47 women with complex endometrial hyperplasia without atypia), who were treated in the at the gynecological department of the “City Clinical Hospital No. 7” in Zaporizhia. Patients were divided into groups based on the presence of uterine fibroids (38 women without fibroids and 43 women with uterine fibroids). Patients underwent ultrasound examination on the MyLab50 device (Esaote, Italy) and video hysteroscopy (Karl Storz, Germany). Morphological examination was performed in the pathology department of the University Clinic of ZSMU. The level of markers of oncogenesis VEGF-A, Ki-67, APRIL, survinin and pPTEN in the serum was determined by ELISA assay using Elabscience reagents (USA). Statistical data processing was performed using statistical programs “Statistica 6.0 for Windows” (StatSoft Inc., № AXXR712D833214FAN5).Results. In the EHP group without uterine fibroids, recurrences were observed in 8 patients (21.5%) during the year. In women with EHP in combination with uterine fibroids during the year recurrences were observed in 13 patients (30.3%). In patients with EHP without concomitant uterine fibroids, reliable predictors of recurrence were the presence of adenomyosis (RR=4.58; CI=0.89–23.72; p<0.05), obesity (RR=7.0; CI=1,18–41,53; p<0,05), arterial hypertension (AH) (RR=6,0; CI=1,02–35,27; p<0,05), pathology of thyroid glands (RR=5,47; CI=1.04–28.89; p<0.05) and mammary gland pathology (RR=6.0; CI=1.02–35.27; p<0.05). In the presence of uterine fibroids, the reliable predictors of recurrence of EHP were the presence of adenomyosis (RR=4.50; CI=1.11–18.27; p<0.05), chronic endometritis (RR=4.40; CI=1.11–17.84; p<0.05), obesity (RR=7.39; CI=1.73–31.52; p<0.05), hypertension (RR=4.40; CI=1.11–17.48; p<0.05) and pathology of the mammary glands (RR=5.25; CI=1.28–21.57; p<0.05). Significant predictors of recurrence in women with EHP without uterine fibroids were elevated levels VEGF-A above 126 pg/ml (RR=12.0; CI=1.91–75.06; p<0.05), APRIL level greater than 36 pg/ml (RR=9.85; CI=1,61–60.24; p<0.05) and survinin more than 103 pg/ml (RR=15.0; CI=2.32–96.96; p<0.05). In patients with EHP in combination with uterine fibroids, a significant association with recurrence was associated with an increase in VEGF-A above 126.96 pg/ml (RR=10.95; CI=2.34–5.60; p<0.05) and APRIL levels greater than 41.36 pg/ml (RR=9.17; CI=1.99–42.04; p<0.05).Conclusions. With EHP without uterine fibroids during the year recurrences were observed in 21.5% of women, in the presence of uterine fibroids recurrences are found in 30.3% of women. The risks of recurrence of EHP in patients without uterine fibroids are increased in the presence of adenomyosis, hypertension, pathology of the mammary glands and thyroid gland. In women with uterine fibroids, the risk of recurrence of EHP is associated with the presence of adenomyosis, chronic endometritis, hypertension and breast pathology. Molecular-biological predictors of EHP recurrence in women without uterine fibroids were an increase in VEGF-A above 126 pg/ml, APRIL levels above 36 pg/ml and survinin above 103 pg/ml. The presence of uterine fibroids at the level of VEGF-A predictors above 126.96 pg/ml and the level of APRIL above 41.36 pg/ml is associated with an increased risk of recurrence of EHP.