Wu Yuman, Wang Jingyuan, Fan Yuan, Wang Jianliu, Li Xingchen
Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, China.
Beijing Key Laboratory of Female Pelvic Floor Disorders Diseases, Beijing, 100044, China.
BMC Cancer. 2025 Jul 1;25(1):1094. doi: 10.1186/s12885-025-14481-6.
The metabolic risk score (MRS) is correlated with the progression of endometrial cancer (EC). The purpose of this study was to evaluate the influence of MRS on the recurrence of fertility-sparing treatment for early EC and atypical endometrial hyperplasia (AEH) patients.
A retrospective study was designed with clinical data from patients admitted between January 2012 and December 2020 in our center. Univariate and multivariate Cox analyses were used to explore independent risk factors for recurrence after complete remission (CR). These factors were included in the receiver operator characteristic (ROC) curve, and decision curve analysis (DCA) was used to evaluate the predictive accuracy of recurrence. Kaplan-Meier curve, combined with the log-rank test, was conducted to estimate a patient's cumulative recurrence rate.
All 109 patients with recurrence details after fertility preservation treatment were categorized into two subgroups (recurrence or no recurrence). Age (HR = 1.04, 95% CI: 1.01-1.18, P = 0.038), BMI (HR = 0.96, 95% CI: 0.93-0.99, P = 0.013), FBG (HR = 1.43, 95% CI: 1.00-2.05, P = 0.048), MRS (HR = 1.89, 95% CI: 1.45-2.46, P < 0.01), family history (HR = 2.35, 95% CI: 1.05-5.27, P < 0.05), insulin resistance (IR, HR = 9.02, 95% CI: 3.15-25.82, P < 0.01), and histological type (HR = 3.36, 95% CI: 1.48-7.64, P < 0.01) were risk factors for recurrence. Moreover, MRS (HR = 1.69, 95% CI: 1.26-2.26, P < 0.01), IR (HR = 8.17, 95% CI: 2.52-26.52, P < 0.01), and histological type (HR = 3.58, 95% CI: 1.52-8.47, P < 0.05) were independent risk factors for recurrence, both in AEH and in EC. The addition of MRS or IR could significantly improve the predictive accuracy of recurrence. The AUC improves from 0.812 to 0.892 for the MRS model and from 0.842 to 0.892 for the IR model. Finally, categorized analysis found that the effects of MRS on recurrence are diverse in different clinical characteristics, including age, gestation, parity, PCOS, infertility history, IR, and metformin for both groups (all P < 0.05). Kaplan‒Meier curves showed that patients in the age ≥ 35 years, BMI ≥ 25 kg/m, IR, family history, MRS, and early EC groups had a worse prognosis.
MRS is a new evaluating predictor that could significantly improve the predictive accuracy for recurrence in fertility preservation treatment for AEH and early EC patients, especially when combined with IR.
代谢风险评分（MRS）与子宫内膜癌（EC）的进展相关。本研究旨在评估MRS对早期EC和非典型子宫内膜增生（AEH）患者保留生育功能治疗后复发的影响。
设计一项回顾性研究，纳入2012年1月至2020年12月在本中心住院患者的临床资料。采用单因素和多因素Cox分析探讨完全缓解（CR）后复发的独立危险因素。将这些因素纳入受试者工作特征（ROC）曲线，并采用决策曲线分析（DCA）评估复发的预测准确性。采用Kaplan-Meier曲线结合对数秩检验估计患者的累积复发率。
所有109例保留生育功能治疗后有复发细节的患者被分为两个亚组（复发或未复发）。年龄（HR = 1.04，95%CI：1.01-1.18，P = 0.038）、体重指数（BMI，HR = 0.96，95%CI：0.93-0.99，P = 0.013）、空腹血糖（FBG，HR = 1.43，95%CI：1.00-2.05，P = 0.048）、MRS（HR = 1.89，95%CI：1.45-2.46，P < 0.01）、家族史（HR = 2.35，95%CI：1.05-5.27，P < 0.05）、胰岛素抵抗（IR，HR = 9.02，95%CI：3.15-25.82，P < 0.01）和组织学类型（HR = 3.36，95%CI：1.48-7.64，P < 0.01）是复发的危险因素。此外，MRS（HR = 1.69，95%CI：1.26-2.26，P < 0.01）、IR（HR = 8.17，95%CI：2.52-26.52，P < 0.01）和组织学类型（HR = 3.58，95%CI：1.52-8.47，P < 0.05）在AEH和EC中均为复发的独立危险因素。加入MRS或IR可显著提高复发的预测准确性。MRS模型的曲线下面积（AUC）从0.812提高到0.892，IR模型的AUC从0.842提高到0.892。最后，分类分析发现MRS对复发的影响在不同临床特征中存在差异，包括年龄、妊娠、产次、多囊卵巢综合征（PCOS）、不孕史、IR以及两组的二甲双胍使用情况（均P < 0.05）。Kaplan-Meier曲线显示，年龄≥35岁、BMI≥25kg/m、IR、家族史、MRS和早期EC组患者的预后较差。
MRS是一种新的评估预测指标，可显著提高AEH和早期EC患者保留生育功能治疗后复发的预测准确性，尤其是与IR联合使用时。
