胰岛素抵抗和体重对子宫内膜癌患者肿瘤及妊娠结局的影响

Effects of insulin resistance and body weight on tumor and pregnancy outcomes in patients with endometrial carcinoma

目的探讨胰岛素抵抗和体重对保留生育功能治疗的子宫内膜非典型增生及子宫内膜癌患者肿瘤和妊娠结局的影响。方法回顾性分析2010年1月至2022年12月就诊于北京大学人民医院行保留生育功能治疗的108例子宫内膜非典型增生及子宫内膜癌患者的临床资料,对患者治疗前体重、糖脂代谢指标及治疗中体重变化进行单因素及多因素logistic回归分析。结果多因素logistic回归分析显示,胰岛素抵抗是影响保留生育功能治疗完全缓解的独立危险因素(OR=0.156,95%CI:0.032~0.756,P=0.021);治疗期间体重增加的患者未成功妊娠的风险更大(OR=0.084,95%CI:0.015~0.461,P=0.004);体重及糖脂代谢指标预测保留生育功能治疗的子宫内膜非典型增生及子宫内膜癌患者肿瘤和妊娠结局的受试者工作曲线下面积分别为0.826和0.754。结论胰岛素抵抗是影响肿瘤完全缓解的独立危险因素,治疗中体重增加是影响妊娠的独立危险因素,在保留生育治疗过程中应对患者的体重及糖脂代谢指标进行重点监测及管理,以提高疗效。

Objective To investigate the effects of insulin resistance and body weight on tumour outcome and pregnancy outcomes in patients with endometrial atypical hyperplasia and endometrial carcinoma treated with fertility preservation.Methods The clinical data of 108 patients with atypical endometrial hyperplasia and endometrial cancer who were treated with fertility preservation at Peking University People's Hospital from January 2010 to December 2022 were retrospectively analyzed.The patients'pre-treatment weight,glycolipid metabolic index and weight change during treatment were analysed by univariate and multifactorial logistic regression.Results Multifactorial logistic regression analysis showed that insulin resistance was an independent risk factor for complete remission of fertility preservation treatment(OR=0.156,95%CI:0.032~0.756,P=0.021);patients who gained weight during treatment had a greater risk of failing to have a successful pregnancy(OR=0.084,95%CI:0.015~0.461,P=0.004);the area under the working curve for subjects whose body weight and glucolipid metabolism indices predicted tumor and pregnancy outcomes in patients with endometrial atypical hyperplasia and endometrial cancer treated with fertility preservation were 0.826 and 0.754,respectively.Conclusions Insulin resistance is an independent risk factor affecting complete tumor remission,and weight gain during treatment is an independent risk factor affecting pregnancy,so patients'weight and glycemic and lipid metabolism indexes should be monitored and managed with emphasis during fertility preservation treatment to improve the curative effect.