ALGORITHM FOR TREATMENT OF EXTERNAL GENITAL ENDOMETRIOSIS USING NEW MOLECULAR MARKERS
DOI:
https://doi.org/10.11603/24116-4944.2021.2.12607Keywords:
external genital endometriosis, endometriosis treatment algorithm, let-7 microRNA, mir-9 microRNA, Fast Real-time PCR, cancer antigen-125Abstract
The aim of the study – to increase the effectiveness of complex treatment of external genital endometriosis by creating an algorithm taking into account the characteristics of cellular and molecular markers.
Materials and Methods. The whole study included four main stages: a literature review, a retrospective study of the effectiveness of drug therapy of endometriosis, a prospective study to determine the expression of microRNA let-7 and mir-9 in the serum of women with external genital endometriosis (hereinafter EGE) with the control group, development and verification of the effectiveness of a new algorithm taking into account let-7 microRNA and ovarian reserve markers (AMH, AFC). The main prospective part examined the serum samples of 88 women of reproductive age (21–45 years): the control group of women who had no data on endometriosis, who underwent laparoscopic intervention on another occasion, and the group of endometriosis, which was divided into two subgroups according to the classification of ASRM stages I–II and III–IV. The last step was to create a new algorithm based on existing ones using cell-molecular markers and check its effectiveness (algorithm efficiency test group, n = 32).
Results and Discussion. The performed analysis according to Mann-Whitney showed a significant difference in the parameters of micro-RNA let-7 between the groups of patients with endometriosis and patients from the control group. Based on the data obtained, the ROC analysis demonstrated the advantages of let-7 micro-RNA (sensitivity, specificity, predictive value of positive and negative results) compared to micro-RNA mir-9 and cancer antigen Ca-125. The median value of micro-RNA let-7 was 4.43 (0.88; 17.77), mir-9 0.11 (0.04; 0.56) (p>0.05), in study group 1 mean let-7 value (8.43±2.41); in group 2 – (3.96±1.28) (95 % CI), therefore, the microRNA expression index let-7 “4” was selected for use in the new algorithm.
When evaluating the effectiveness of the algorithm, the level of anti-Müllerian hormone before treatment in the algorithm testing group was (1.03±0.22) and after (0.98±0.19) (p=0.35), the number of antral follicles was (9.84±1.83) and (8.97±1.65), respectively (р=0.24). Thus, in the patients who went through the new algorithm, it was possible to preserve the indicators of the ovarian reserve and obtain an effect in reducing the pain syndrome. The time to the start of treatment decreased by 4 times in the algorithm group due to the use of a new additional biomarker (p=0.001).
Conclusions. The new algorithm with the inclusion of a non-invasive biomarker of external genital endometriosis makes it possible to improve the diagnosis of this disease and to choose an effective method of treatment at the initial stages of the disease, to preserve the ovarian reserve in women with external genital endometriosis due to a differentiated approach to treatment. Micro-RNA let-7 has better indicators of sensitivity, specificity, positive and negative predictive values than the cancer antigen CA-125.
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