Insulin resistance and overweight prolonged fertility-sparing treatment duration in endometrial atypical hyperplasia patients.
- Author:
Bingyi YANG
1
;
Liying XIE
;
Hongwei ZHANG
;
Qin ZHU
;
Yan DU
;
Xuezhen LUO
;
Xiaojun CHEN
Author Information
- Publication Type:Original Article
- Keywords: Endometrial Hyperplasia; Conservative Treatment; Overweight; Insulin Resistance
- MeSH: Endometrial Hyperplasia; Endometrial Neoplasms; Female; Humans; Hyperplasia*; Hysterectomy; Hysteroscopy; Insulin Resistance*; Insulin*; Overweight*; Retrospective Studies; Therapeutic Uses; Treatment Failure
- From:Journal of Gynecologic Oncology 2018;29(3):e35-
- CountryRepublic of Korea
- Language:English
- Abstract: 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/m2) 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.
