Weight Loss Improves Pregnancy and Livebirth Outcomes in Young Women with Early-Stage Endometrial Cancer and Atypical Hyperplasia
Yanfang Zhang, Dan Li, Qi Yan, Xueru Song, Wenyan Tian, Yingmei Wang, Fei Teng, Likun Wei, Jinghua Wang, Huiying Zhang, Fengxia Xue
Abstract
Purpose: To evaluate the effects of body weight loss on reproductive outcomes in young women with early-stage endometrial cancer (EC) and atypical hyperplasia (AH) who underwent fertility-sparing therapy. Patients and Methods: Patients with well-differentiated EC (n=8, FIGO stage Ia) and AH (n=36) who achieved complete regression after fertility-sparing therapy were retrospectively reviewed. Patients were divided into a weight loss group (n=25) and a non-weight loss group (n=19). Subgroup analysis according to body mass index and relative weight loss were performed to investigate the effect of weight loss on pregnancy and live birth outcomes. Univariate and multivariate logistic regression analyses were undertaken to determine pregnancy-associated factors. Results: Mean body weight and body mass index at pre-progestin treatment and at fertility treatment initiation were 70.63± 12.03 and 67.08± 8.18 kg, respectively, 27.06± 4.44 and 25.73± 3.15 kg/m 2 , respectively. Twenty-five patients (56.82%) lost weight, the median absolute weight loss was 5.00 kg (1.00– 34.50), and the median relative weight loss was 6.70% (1.00– 36.00%) over a median of 12 months (5.00– 97.00). A favorable pregnancy rate (65.91%) and live birth rate (50.00%) were achieved. The pregnancy and live birth rates were meaningfully higher in the weight loss group than in the non-weight loss group (88.00% vs 36.84%, P =0.000; 64.00% vs 31.58%, P =0.033); weight loss ≥ 5% significantly increased pregnancy and live birth rate in patients with BMI ≥ 25 kg/m 2 . The risk ratio of weight loss ≥ 5% in multivariate logistic analysis for pregnancy was 10.448 (1.102, 99.056, P =0.041). Conclusion: Weight loss could positively affect pregnancy rate and improve live birth rate in overweight and obese women with early-stage EC and AH during/after fertility-sparing therapy. Weight loss ≥ 5% increased pregnancy and livebirth rates significantly in overweight and obese women. Keywords: weight loss, reproductive outcomes, fertility-sparing therapy, endometrial cancer, atypical hyperplasia