Correlation between hormone receptor expression and polyp morphology,pathological type and clinical symptoms in infertility patients with endometrial polyps

Liu Fei; Zhang Jingzhe; Cheng Cun

doi:10.3969/j.issn.1672-8521.2025.04.007

Abstract：Objective:To investigate the correlation between hormone receptor expression and polyp morphology,pathological type and clinical symptoms in infertility patients with endometrial polyps(EP).Methods:A total of 91 infertility patients with EP treated in Nanyang Central Hospital from October 2020 to June 2023 were selected as the study objects.The expression levels of estrogen receptor(ER)and progesterone receptor(PR)were compared across different polyp morphological characteristics,pathological types,and clinical features(including symptoms,comorbidities,and age).Furthermore,risk factors influencing ER and PR expression in these patients were analyzed.Results:Among the 91 infertile patients with EP,the ER positivity rate was 74.73%(68/91)and PR positivity rate was 56.04%(51/91).In EP tissues,low ER expression was observed in 36 cases(39.56%),while high expression was found in 55 cases(60.44%),with the difference being statistically significant(χ²=7.934,P=0.004).For PR,low expression was observed in 60 cases(65.93%)and high expression in 31 cases(34.07%),with low expression being significantly more common than high expression(χ²=18.483,P＜0.001).There were differences in the polyp morphological features,pathological types,and clinical symptoms of EP among patients with different expression levels of ER and PR:long diameter≥2 cm,multiple polyps,and polyps located at the uterine fundus showed higher rates of high ER and PR expression compared to those with the long diameter＜2 cm,single polyps,or polyps located near the tubal orifice(ER:long diameter χ²=21.555,P＜0.001;number χ²=13.001,P＜0.001;location χ²=17.258,P＜0.001)(PR:long diameter χ²=5.154,P＜0.001;number χ²=10.513,P＜0.001;location χ²=8.057,P=0.004).The proportion of patients with simple functional polyps in those with high expression of ER and PR was significantly higher than that in those with low expression of each receptor(χ²=4.376,5.579,P＜0.05),and the proportion of patients with simple hyperplastic polyps in those with high expression of ER and PR was significantly higher than that in the low expression group of each receptor(χ²=4.234,5.909,P＜0.05).The proportion of patients with both functional and hyperplastic polyps in those with high expression of ER and PR was significantly lower than that in the low expression groups of each receptor,and the difference was statistically significant(χ²=17.343,23.123,P＜0.001).The proportion of patients with abnormal uterine bleeding,intermenstrual/postcoital bleeding,and hot flashes among those with high expression of ER and PR is higher than that of patients without the above symptoms(ER:abnormal uterine bleeding χ²=15.357,P＜0.001;intermenstrual/postcoital bleeding χ²=5.131,P=0.023;hot flashes χ²=12.551,P＜0.001)(PR:abnormal uterine bleeding χ²=20.353,P＜0.001;intermenstrual/postcoital bleeding χ²=7.893,P=0.004;hot flashes χ²=4.919,P=0.026).Patients without diabetes,hypertension,or age＜40 years exhibited a lower proportion among those with high ER and PR expression compared to those with diabetes,hypertension,or aged≥40 years(ER:diabetes χ²=7.115,P=0.007;hypertension χ²=5.519,P=0.018;age χ²=20.411,P＜0.001)(PR:diabetes χ²=22.802,P＜0.001;hypertension χ²=6.003,P=0.014;age χ²=19.408,P＜0.001).Multivariate logistic regression analysis identified the following as independent risk factors for high ER and PR expression in infertile patients with EP(P＜0.05):diabetes(OR:1.823,1.857),hypertension(OR:1.554,1.495),age≥40 years old(OR:1.849,1.812),polyp length diameter≥2 cm(OR:1.866,1.762),multiple polyp(OR:1.697,1.615),polyp location at the uterine fundus(OR:2.016,1.923),functional polyps(OR:2.147,2.097),hyperplastic polyp(OR:2.134,2.264),abnormal uterine bleeding(OR:1.487,1.521),intermenstrual or postcoital bleeding(OR:1.487,1.521),presence of hot flashes(OR:2.147,2.097).Conclusions:The expression of ER and PR in infertile patients with EP is associated with polyp morphology,pathological type,and clinical symptoms,which provides a new perspective for in-depth understanding of the pathogenesis of infertility with EP and the development of personalized treatment strategies.