影响子宫内膜非典型增生及早期子宫内膜癌保留生育功能患者复发的临床因素分析

Analysis of clinical factors affecting recurrence in patients with atypical endometrial hyperplasia and early endometrial carcinoma with fertility preservation

目的探讨子宫内膜非典型增生(AEH)及子宫内膜癌(EC)患者保留生育功能完全缓解后复发的相关影响因素。方法采用回顾性研究2009年1月至2023年3月在北京大学人民医院接受保留生育功能随访时间6个月以上并且完全缓解的EC及AEH患者240例。采用Kaplan-Meier生存分析及log-rank检验比较无复发生存时间,logistic回归分析及Cox生存分析评估影响复发相关因素。结果240例患者中位随访时间44.70个月(23.93个月,80.25个月),复发率为24.58%(59/240),其中EC的复发率为30.9%(34/110),AEH为19.2%(25/130)。患者中位无复发生存时间为19.58个月(10.16个月,41.53个月)。logistics回归分析显示,病理类型(P=0.014)、口服孕激素时间(P=0.024)、身体形态指数(P=0.009)、合并肥胖(P=0.005)及身体圆度指数(P=0.01)是影响完全缓解后的EC及AEH患者的复发的主要因素。K-M生存分析显示,病理类型(P=0.015)和是否接受维持治疗(P=0.020)组间的无复发生存时间比较,差异有统计学意义。多因素Cox生存回归分析显示,病理类型(P=0.017),身体形态指数(P=0.003)和肥胖(P=0.009)是影响EC及AEH患者完全缓解后复发的独立危险因素。结论EC及AEH患者在接受保留生育功能治疗完全缓解后,病理类型、身体形态指数、合并肥胖、身体圆度指数及是否接受维持治疗为影响复发的危险因素。

Objective To investigate the related factors of recurrence in patients with atypical endometrial hyperplasia(AEH)and endometrial carcinoma(EC)after complete remission with fertility preservation.Methods The retrospective study was conducted on 240 patients with EC and AEH who underwent fertility-sparing treatment and initially reached a complete response at Peking University People's Hospital from January 1,2009 to March 1,2023.All patients were followed up for more than 6 months.This study analyzed the factors affecting the recurrence of patients and compared the disease free survival(DFS)time through Kaplan-Meier survival analysis and Log-rank test.Binary logistic regression and Cox survival analysis were used to assess the recurrence.Results The median follow-up time of 240 patients was 44.70 months(23.93 months,80.25 months),and the recurrence rate was 24.58%(59/240).Among them,the recurrence rate of EC was 30.9%(34/110),and that of AEH was 19.2%(25/130).The median DFS time for patients was 19.58 months(10.16 months,41.53 months).Logistic regression analysis showed that pathological type(P=0.014),oral progesterone duration(P=0.024),a body shape index(ABSI)(P=0.009),obesity(P=0.005)and body roundness index(BRI)(P=0.01)were the most influential factors of recurrence in EC and AEH patients after complete remission(CR).K-M survival analysis showed pathological type(P=0.015)and maintenance treatment(P=0.020)showed a significantly lower DFS with statistical significance.Multivariate Cox survival regression analysis suggested that pathological type(P=0.017),ABSI(P=0.003)and obesity(P=0.009)were independent risk factors for recurrence after CR in patients with EC and AEH.Conclusions After CR of EC and AEH after receiving fertility-sparing treatment,pathological type,ABSI,obesity,BRI and maintenance treatment are the risk factors for recurrence.