影响子宫内膜癌合并2型糖尿病患者预后的危险因素及二甲双胍的保护作用

Analysis of prognostic factors in patients with endometrial carcinoma and type 2 diabetes mellitus and the protective effect of metformin

目的:探讨影响子宫内膜癌合并2型糖尿病患者预后的危险因素,以及二甲双胍对患者预后可能的保护作用。方法:回顾性分析203例子宫内膜癌患者的临床资料并进行随访,根据患者是否合并糖尿病病史及二甲双胍规律服用史,将患者分为单纯子宫内膜癌组154例、二甲双胍组23例、非二甲双胍组26例。比较三组患者的总生存期(OS)与无进展生存期(PFS),并分析相关的影响因素。结果:全组患者的OS为(43.14±1.14)月,单纯子宫内膜癌组、二甲双胍组、非二甲双胍组的OS分别为(42.94±1.37)月、(48.52±2.29)月、(37.54±2.51)月,Kaplan-Meier生存分析显示,二甲双胍组患者的总生存率最好,单纯子宫内膜癌组次之,非二甲双胍组最差。全组患者的PFS为(42.63±1.15)月,单纯子宫内膜癌组、二甲双胍组、非二甲双胍组的PFS分别为(42.51±1.15)月、(48.03±2.47)月、(36.40±1.37)月,Kaplan-Meier生存分析显示,三组患者的PFS存在显著差异(P=0.045),两两比较后发现,二甲双胍组与单纯子宫内膜癌组的PFS无明显差异,但均显著好于非二甲双胍组。Cox多因素分析显示,合并糖尿病、发病年龄≥50岁、病理分期Ⅲ期、组织学分级较高、深肌层浸润、存在淋巴结转移既是影响患者OS,也是影响患者PFS的独立性危险因素(OR>1,P<0.05),服用二甲双胍是影响OS及PFS的独立性保护因素(OR<1,P<0.05)。结论:规律服用二甲双胍可明显改善子宫内膜癌合并2型糖尿病患者的预后,尤其是总生存时间。

Objective:To investigate the risk factors of prognosis in patients with endometrial carcinoma complicated with type 2 diabetes mellitus and the protective effect of metformin on prognosis.Methods:The clinical data of 203 patients were retrospectively analyzed and followed up.The patients were divided into 154 cases of simple endometrial carcinoma group,23 cases of metformin group and 26 cases of non-metformin group.The overall survival(OS) and progression-free survival(PFS) of the three groups were compared,and the related influencing factors were analyzed.Results:The overall survival rate of metformin group was significantly better than that of endometrial carcinoma group,and that of non-metformin group was the worst.PFS was(42.63±1.15) months in all patients.There was no significant difference in PFS between metformin group and simple endometrial carcinoma group,but they were significantly better than non-metformin group.The independent risk factors of OS and PFS were diabetes mellitus,age of onset(≥50 years old),pathological stage III,higher histological grade,deep muscular infiltration and lymph node metastasis.Metformin was the independent protective factor.Conclusion:Regular administration of metformin can significantly improve the prognosis of endometrial carcinoma patients with type 2 diabetes mellitus,especially the overall survival time.