Assessment of Endometrial Carcinoma Markers and Hormone Receptors Profile before and after Bariatric Surgery: A Clinico-Pathological-Immunohistochemical Study

摘要

Background: Obesity is a major risk factor for endometrial carcinoma, and we aim to assess markers of carcinogenesis including PTEN and Ki-67 and hormone receptors profile including ER, PR and AR before and after bariatric surgery to find out its effects in reducing endometrial carcinoma risk in morbid obese females. Patients and methods: The study included 80 females with morbid obesity (BMI > 40 Kg/m2) who underwent bariatric surgery. All were sampled by Pipelle biopsy at baseline and 12 months after operation and examined histopathologically and immunohistochemically for Ki-67, PTEN, ER, PR and AR. Results: Sixty two out of 80 (62/80) females showed no pathological abnormalities;4 had polyps;7 had simple endometrial hyperplasia;4 had atypical endometrial hyperplasia and 3 had endometrial carcinoma. In total, 34 females underwent gastric bypass operation (42.5%) and 46 underwent a sleeve gastrectomy operation (57.5%). There was a statistically significant difference between baseline weight and BMI before and after surgery (p < 0.001). Of the 7 women with simple hyperplasia, resolution occurred in 5 within 7 months of surgery. Three of 4 females with atypical hyperplasia (AH) showed resolution after 9 months. Mean Ki-67 score was lower at 12 months (p < 0.001) after surgery. 43/77 (55.8%) baseline biopsies were glandular PTEN null, including 9/15 of the women with baseline endometrial abnormalities, of whom 5/15 regained glandular PTEN expression as their endometrial abnormalities resolved. There was a significant reduction in ER score after surgery (p < 0.001). PR H-scores were not significantly different post-operatively (p = 0.193). AR H-scores were higher significantly in pre-operative biopsies than post-operative ones (p < 0.001). Conclusion: Females with morbid obesity have a higher risk of harboring endometrial abnormalities even if asymptomatic. However, the endometrial pathology and the high ER and PR expression can be normalized within one year without medical treatment, signifying the role of bariatric surgery-induced weight loss in reducing the risk of endometrial neoplasia development. Also, the marked weight loss occurring after bariatric surgery induces highly significant endometrial change as resolution of atypical hyperplasia, and molecular changes as reduction of Ki-67 and restoration of PTEN that are associated with transition of endometrium from high to low risk.