Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2021 Dec 16;12:780769. doi: 10.3389/fendo.2021.780769. eCollection 2021.
To explore the effects of metabolic syndrome (MetS) on the prognosis of endometrial cancer (EC) and to identify key components of MetS associated with EC.
A total of 506 patients surgically diagnosed with EC were analyzed in this study. These patients were diagnosed with EC in the Department of Obstetrics and Gynecology at the People's Hospital of Peking University between 2010 and 2016. The follow-up time was cut off at December 2019. MetS was characterized based on standards provided by the Chinese Diabetes Society in 2004.
Among the 506 EC patients analyzed, 153 patients were diagnosed with MetS. MetS patients were more likely to be older and postmenopausal. MetS was positively related to tumor grade, stage, LNM, LVSI, and MI. The univariate analysis showed that MetS was closely related to the OS (HR = 2.14; P = 0.032) and RFS (HR = 1.80; P = 0.045) of EC patients. K-M analysis also indicated that EC patients with MetS had shorter OS and RFS than EC patients without MetS. More specifically, patients that had ≥3 components showed a worse outcome compared with patients only having 0 or 1-2 components (P <0.05). In the multivariate-adjust model, after adjusting for age, histotype, tumor grade, and stage, HDL-C was found to be associated with increased risk of death related to EC (HR = 2.2, P = 0.034). However, MetS did not significantly correlate with this. ROC analysis revealed that the area under the ROC curve of combined factors (HDL-C + grade + stage) was better than traditional stage or grade at 1-, 3-, and 5-year survival rates. From this, a nomogram based on HDL-C, grade, and stage was constructed to predict survival of EC patients. Calibration curve analysis and decision curve analysis (DCA) showed the nomogram we constructed could better predict the survival of EC patients.
MetS is closely related to poor prognosis in EC patients. The prevalence of individual MetS components increase with worse outcomes in EC patients. A nomogram based on HDL-C, grade, and stage has good ability to predict survival of EC patients.
探讨代谢综合征（MetS）对子宫内膜癌（EC）预后的影响，并确定与 EC 相关的 MetS 的关键成分。
本研究共分析了 506 例经手术诊断为 EC 的患者。这些患者于 2010 年至 2016 年在北京大学人民医院妇产科被诊断为 EC。随访时间截止到 2019 年 12 月。MetS 按照中国糖尿病学会 2004 年提供的标准进行诊断。
在分析的 506 例 EC 患者中，有 153 例被诊断为 MetS。MetS 患者更有可能年龄较大且处于绝经后状态。MetS 与肿瘤分级、分期、淋巴结转移、脉管间隙浸润和肌层浸润显著相关。单因素分析表明，MetS 与 EC 患者的总生存期（HR=2.14；P=0.032）和无复发生存期（HR=1.80；P=0.045）密切相关。K-M 分析还表明，患有 MetS 的 EC 患者的总生存期和无复发生存期均短于未患有 MetS 的 EC 患者。具体而言，与仅患有 0 或 1-2 个成分的患者相比，患有≥3 个成分的患者预后更差（P<0.05）。在多变量调整模型中，在校正年龄、组织学类型、肿瘤分级和分期后，发现 HDL-C 与与 EC 相关的死亡风险增加相关（HR=2.2，P=0.034）。然而，MetS 与这并没有显著相关性。ROC 分析显示，联合因素（HDL-C+分级+分期）的 ROC 曲线下面积优于传统分期或分级在 1、3 和 5 年生存率上。由此，基于 HDL-C、分级和分期构建了一个列线图来预测 EC 患者的生存情况。校准曲线分析和决策曲线分析（DCA）表明，我们构建的列线图可以更好地预测 EC 患者的生存情况。
MetS 与 EC 患者的不良预后密切相关。个别 MetS 成分的患病率随着 EC 患者结局的恶化而增加。基于 HDL-C、分级和分期的列线图具有良好的预测 EC 患者生存能力。
