胰岛素抵抗与肥胖对保留生育功能的子宫内膜癌患者的预后影响

Prognostic effects of insulin resistance and obesity on patients with fertility preserving endometrial carcinoma

目的探讨胰岛素抵抗(IR)与肥胖对保留生育功能的子宫内膜癌(EC)患者的预后影响。方法回顾性分析郑州大学第一附属医院2012年12月至2020年12月行保留生育功能治疗的53例EC患者的临床资料,应用宫腔镜联合高效孕激素治疗,每3个月行子宫内膜病理检查,分析IR与肥胖对早期EC患者保留生育功能治疗的预后影响。结果经保守治疗后,43例完全缓解,12例复发,11例成功妊娠,目前所有患者均无瘤生存。合并IR的EC患者保留生育功能治疗的完全缓解时间长于不合并IR的EC患者(Z=3.023,P=0.003)。体质量指数(BMI)是影响早期EC患者保留生育功能治疗完全缓解的独立危险因素,BMI<28 kg/m^(2)的保留生育功能治疗的EC患者更易达到完全缓解与妊娠(χ^(2)=17.570,P<0.001;χ^(2)=4.331,P=0.037)。结论IR虽不影响保留生育功能的EC患者的完全缓解、复发和妊娠,但明显延长EC患者保留生育功能治疗的完全缓解时间,肥胖的EC患者更不易达到完全缓解与妊娠。

Objective To investigate the prognostic effects of insulin resistance(IR)and obesity on patients with fertility preserving endometrial carcinoma(EC).Methods The clinical data of 53 EC patients who received fertility preservation therapy from December 2012 to December 2020 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.The EC patients were treated with hysteroscopy combined with highly effective progesterone,and endometrial pathological examination was performed every 3 months.To analyze the prognostic effects of insulin resistance and obesity on early EC patients.Results Of the EC patients treated with fertility preservation,43 had complete response,12 relapsed,and 11 had successful pregnancies.All the patients were currently tumor-free.The complete response time of EC patients with fertility preservation combined with IR was significantly longer than that of the EC patients with fertility preservation without IR(Z=3.023,P=0.003).Body mass index(BMI)was an independent risk factor for complete response of fertility preservation therapy in early EC patients.Patients with BMI<28 kg/m^(2) were more likely to achieve complete response and pregnancy(χ^(2)=17.570,P=0.000;χ^(2)=4.331,P=0.037).Conclusion IR doesn’t affect the complete response rate,recurrence rate and pregnancy rate of EC patients with fertility preservation,but significantly prolongs the complete response time of EC patients with fertility preservation.EC patients with obesity are less likely to achieve complete response and pregnancy.