Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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(2), IR, family history, MRS, and early EC groups had a worse prognosis. CONCLUSION: 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.