肥胖、糖尿病和种族在 I 型和 II 型子宫内膜癌中的复杂三联征：患病率和预后意义。
The complex triad of obesity, diabetes and race in Type I and II endometrial cancers: prevalence and prognostic significance.
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, USA; University of North Carolina Lineberger Comprehensive Cancer Center, USA.
Department of Obstetrics and Gynecology, Duke University Medical Center, USA.
出版信息
Gynecol Oncol. 2014 Apr;133(1):28-32. doi: 10.1016/j.ygyno.2014.01.032.
BACKGROUND
We examined the distribution of obesity, diabetes, and race in Type I and Type II endometrial cancers (EC) and their associations with clinical outcomes.
METHODS
A multi-institutional retrospective analysis of Type I and II EC cases from January 2005 to December 2010 was conducted. Type I (endometrioid), Type II (serous and clear cell), low grade (LG) (grade 1 and 2 endometrioid), and high grade (HG) (grade 3 endometrioid, serous, clear cell) cohorts were compared. Univariate and multivariate analyses were used to determine time-to-recurrence (TTR), recurrence-free survival (RFS), and overall survival (OS).
RESULTS
Type I EC patients were more frequently obese than Type II (66% versus 51%, p<0.0001) and had similar rates of diabetes (25% versus 23%, p=0.69). African-Americans (AA) had higher median BMI than Caucasians in both Type I (p<0.001) and II (p<0.001) ECs, and were twice as likely to have diabetes (p<0.001). In Type I EC, DM was associated with worse RFS and OS in unadjusted and adjusted models (RFS HR 1.38, 95%CI 1.01-1.89; OS HR 1.86, 95%CI 1.30-2.67), but not with TTR. BMI was associated with improved TTR in the adjusted analysis for Type I EC (HR 0.98, 95%CI 0.95-1.0), but not with RFS or OS. There was no association between DM or BMI and outcomes in Type II or HG EC. AA race was not associated with RFS or OS on adjusted analyses in any group.
CONCLUSIONS
Obesity and diabetes are highly prevalent in Type I and II ECs, especially in AA. DM was associated with worse RFS and OS in Type I EC. Neither DM nor BMI was associated with outcomes in Type II or HG EC.
背景
我们研究了 I 型和 II 型子宫内膜癌（EC）中肥胖、糖尿病和种族的分布及其与临床结局的关系。
方法
对 2005 年 1 月至 2010 年 12 月期间的 I 型和 II 型 EC 病例进行了多机构回顾性分析。比较了 I 型（子宫内膜样）、II 型（浆液性和透明细胞）、低级别（LG）（1 级和 2 级子宫内膜样）和高级别（HG）（3 级子宫内膜样、浆液性、透明细胞）队列。使用单变量和多变量分析来确定无复发生存时间（TTR）、无复发生存率（RFS）和总生存率（OS）。
结果
I 型 EC 患者比 II 型患者更常肥胖（66%比 51%，p<0.0001），且糖尿病发生率相似（25%比 23%，p=0.69）。非裔美国人（AA）在 I 型（p<0.001）和 II 型（p<0.001）EC 中的中位 BMI 均高于白种人，且患糖尿病的可能性是白种人的两倍（p<0.001）。在 I 型 EC 中，DM 在未经调整和调整模型中与较差的 RFS 和 OS 相关（RFS HR 1.38，95%CI 1.01-1.89；OS HR 1.86，95%CI 1.30-2.67），但与 TTR 无关。在 I 型 EC 的调整分析中，BMI 与 TTR 改善相关（HR 0.98，95%CI 0.95-1.0），但与 RFS 或 OS 无关。DM 或 BMI 与 II 型或 HG EC 的结果之间没有关联。在任何组中，AA 种族在调整后的分析中均与 RFS 或 OS 无关。
结论
肥胖和糖尿病在 I 型和 II 型 EC 中非常普遍，尤其是在 AA 中。DM 与 I 型 EC 的 RFS 和 OS 较差相关。DM 或 BMI 与 II 型或 HG EC 的结果均无关联。
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