期刊
JOURNAL OF GYNECOLOGIC ONCOLOGY
卷 29, 期 3, 页码 -出版社
KOREAN SOC GYNECOLOGY ONCOLOGY & COLPOSCOPY
DOI: 10.3802/jgo.2018.29.e35
关键词
Endometrial Hyperplasia; Conservative Treatment; Overweight; Insulin Resistance
资金
- National Natural Science Foundation of China [81370688, 81671417]
- Shanghai Science and Technology Development Medical Guide Project [17411961000]
- Talent training program from Shanghai Municipal Commission of Health and Family Planning [2017BR035]
Objective: Our previous study showed that insulin resistance (IR) was related to endometrial hyperplasia as well as endometrial cancer. But the exact impact of IR on fertility-sparing treatment in endometrial hyperplasic disease is unclear. This study investigated how IR affects fertility-sparing treatment in endometrial atypical hyperplasia (EAH) patients. Methods: The 151 EAH patients received fertility-sparing treatment were retrospectively investigated. All patients received high-dose progestin combined with hysteroscopy. Therapeutic effects were evaluated by hysteroscopy every 3 months during the treatment. Results: The median age was 33.0 years old (range, 21-54 years old). Sixty-one patients (40.4%) were insulin resistant. Three patients were excluded from the analysis because they chose hysterectomy within 3 months after initiation of progestin treatment. The 141 out of 148 (95.3%) patients achieved complete response (CR). No difference was found in cumulative CR rate between those with or without IR (90.2% vs. 95.6%, p=0.320). IR significantly affected therapeutic duration to achieve CR (8.1 +/- 0.5 months with IR vs. 6.1 +/- 0.4 months without IR, p=0.004). Overweight (body mass index [BMI]=25 kg/m(2)) was associated with higher risk of treatment failure (odds ratio=5.61; 95% confidence interval=1.11-28.35; p=0.040) and longer therapeutic duration to achieve CR (7.6 +/- 0.5 months vs. 6.3 +/- 0.4 months, p=0.019). EAH patients with both IR and overweight (IR+BMI+) had the longest therapeutic time compared with other patients (8.8 +/- 0.6 months vs. 5.6 +/- 0.7, 6.3 +/- 0.4, and 6.4 +/- 0.8 months for IR-BMI+, IR-BMI-, and IR+BMI-, respectively, p=0.006). Conclusion: IR and overweight were associated with longer therapeutic duration in EAH patients receiving progestin-based fertility-sparing treatment.
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