目的 探讨胰岛素抵抗(IR)和代谢综合征(MetS)与早期子宫内膜癌患者保留生育功能治疗后复发的关系。方法 回顾性分析2016-01至2019-12解放军联勤保障部队第910医院进行保留生育功能治疗的111例早期子宫内膜癌患者临床资料。根据患者治疗后3年内是否复发,分为复发组(n=38)和无复发组(n=73)。比较两组资料差异,使用COX风险比例回归模型探索影响早期子宫内膜癌患者保留生育功能治疗后复发的因素。使用Kaplan-Meier法分析不同IR、MetS特征患者的无复发生存期(RFS)特点。结果 BMI≥25 kg/m2 (OR=2.723,95% CI: 1.468~5.048,P=0.001),IR(OR=9.542, 95% CI: 1.468~5.048, P<0.001),MetS(OR=4.917,95% CI:2.610~9.260,P<0.001)和维持治疗(OR=0.381,95% CI: 0.241~0.600,P<0.001)是影响早期子宫内膜癌患者保留生育功能治疗后复发的独立危险因素。Kaplan-Meier法可见存在IR患者RFS显著劣于无IR患者(χ2=14.329,P<0.001),而是否存在MetS患者间的RFS差异无统计学意义(χ2=1.558,P=0.212)。其中IR+且MetS+组的RFS显著劣于另外IR-且MetS-组和IR+或MetS+组(χ2=24.436,P<0.001)。结论 IR和MetS均是接受保留生育功能治疗早期子宫内膜癌患者复发的危险因素,两者对患者预后和复发可能具有协同作用。
Abstract
Objective To investigate the relationship between insulin resistance (IR) and metabolic syndrome (MetS) and the recurrence of early endometrial cancer patients treated with fertility preservation therapy. Methods The clinical data of 111 patients with early endometrial carcinoma who underwent fertility preservation therapy in No.910th Hospital of PLA Joint Service Support Force from January 2016 to December 2019 were retrospectively analyzed. The patients were divided into recurrent group (n=38) and non-recurrent group (n=73) according to whether they recurred within 3 years after treatment. COX risk ratio regression model was used to explore the factors that affected the recurrence of early endometrial cancer patients treated with fertility preservation therapy, and Kaplan-Meier method was used to analyze the relapse-free survival (RFS) characteristics of patients with different IR and MetS. Results BMI≥ 25 kg/m2 (OR=2.723, 95% CI: 1.468-5.048,P=0.001),IR (OR=9.542, 95% CI: 1.468-5.048, P＜0.001),MetS (OR=4.917,95% CI:2.610-9.260, P＜0.001) and maintenance therapy (OR=0.381,95% CI: 0.241-0.600,P＜0.001) were independent risk factors for the recurrence in patients with early endometrial cancer after fertility preservation therapy. Kaplan-Meier method showed that RFS of patients with IR was significantly worse than that of the patients without IR (χ2=14.329, P＜0.001), and there was no significant difference in RFS between the patients with and without MetS (χ2=1.558,P=0.212). The RFS of IR+ and MetS+ group was significantly worse than that of IR and MetS group and IR+ or MetS+ group (χ2=24.436,P<0.001). Conclusions Both IR and MetS are risk factors for the recurrence of early endometrial cancer in patients treated with fertility preservaion therapy, and they may play a synergistic role in its prognosis and recurrence.
关键词
子宫内膜癌 /
保留生育功能 /
复发 /
胰岛素抵抗 /
代谢综合征
Key words
endometrial carcinoma /
preservance of fertility function /
recurrence /
insulin resistance /
metabolic syndrome
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