Department of Obstetrics and Gynecology, Chengdu Second People's Hospital, Chengdu, China.
J BUON. 2020 May-Jun;25(3):1534-1540.
To explore the efficacy of metformin in the treatment of estrogen-dependent endometrial carcinoma (EC) complicated with type 2 diabetes mellitus (T2DM), and the influencing factors for the prognosis of such patients.
The clinical data of 68 patients histopathologically diagnosed with estrogen-dependent EC complicated with T2DM in our hospital from April 2013 to March 2016, and 132 estrogen-dependent EC patients with normal blood glucose during the same period were retrospectively analyzed. The clinical and pathological features were compared between diabetic patients and non-diabetic patients. The diabetic patients were divided into the metformin group and the non-metformin group according to whether metformin was taken. The survival curves were plotted and analyzed using the Kaplan-Meier method, and the overall survival (OS) and progression-free survival (PFS) were compared among the three groups. Moreover, the multivariate analysis was performed using the COX regression model, so as to analyze the influencing factors for the prognosis of patients with estrogen-dependent EC complicated with T2DM.
Compared with non-diabetic patients, diabetic patients had higher age of onset, a higher BMI, higher proneness to hypertension, more advanced tumor stage, a higher histological grade, deeper myometrial invasion and a higher risk of lymph node metastasis. Both OS and PFS of T2DM patients who took metformin were significantly prolonged compared with those of T2DM patients who did not take metformin (p=0.021, p=0.011). There were no statistically significant differences in the PFS and OS between diabetic patients who took metformin and non-diabetic patients (p>0.05). According to the results of Cox multivariate analysis, OS was obviously shortened in case of high age of onset, complicated T2DM, late pathological stage of tumor advanced tumor stage, high histological grade, deep myometrial invasion and positive lymph node metastasis, while PFS could was obviously shortened in case of complicated T2DM, late pathological stage of tumor advanced tumor stage, high histological grade, deep myometrial invasion and positive lymph node metastasis. Metformin evidently improved OS and PFS.
Complicated T2DM, high age of onset, advanced tumor stage, high histological grade, deep myometrial invasion and positive lymph node metastasis are factors for the poor prognosis of patients with estrogen-dependent EC, and metformin can significantly ameliorate both OS and PFS in these patients, thereby improving their prognosis.
探讨二甲双胍治疗雌激素依赖性子宫内膜癌（EC）合并 2 型糖尿病（T2DM）的疗效及影响患者预后的因素。
回顾性分析 2013 年 4 月至 2016 年 3 月我院收治的 68 例经组织病理学诊断为雌激素依赖性 EC 合并 T2DM 患者的临床资料，同期选取 132 例血糖正常的雌激素依赖性 EC 患者。比较糖尿病患者与非糖尿病患者的临床病理特征。根据是否服用二甲双胍将糖尿病患者分为二甲双胍组和非二甲双胍组。采用 Kaplan-Meier 法绘制生存曲线并进行分析，比较三组患者的总生存期（OS）和无进展生存期（PFS）。采用 COX 回归模型进行多因素分析，探讨影响雌激素依赖性 EC 合并 T2DM 患者预后的因素。
与非糖尿病患者相比，糖尿病患者发病年龄较大，BMI 较高，高血压倾向较高，肿瘤分期较晚，组织学分级较高，肌层浸润较深，淋巴结转移风险较高。服用二甲双胍的 T2DM 患者的 OS 和 PFS 明显长于未服用二甲双胍的 T2DM 患者（p=0.021，p=0.011）。服用二甲双胍的 T2DM 患者与非糖尿病患者的 PFS 和 OS 无统计学差异（p>0.05）。Cox 多因素分析结果显示，发病年龄较大、合并 T2DM、肿瘤晚期病理分期、肿瘤晚期病理分期、组织学分级较高、肌层浸润较深、淋巴结转移阳性均明显缩短 OS，而合并 T2DM、肿瘤晚期病理分期、组织学分级较高、肌层浸润较深、淋巴结转移阳性均明显缩短 PFS。二甲双胍明显改善了 OS 和 PFS。
合并 T2DM、发病年龄较大、肿瘤晚期病理分期、组织学分级较高、肌层浸润较深、淋巴结转移阳性是雌激素依赖性 EC 患者预后不良的因素，二甲双胍能显著改善此类患者的 OS 和 PFS，从而改善患者预后。
