Fertility-sparing treatment for overweight patients with early-stage endometrial cancer or atypical endometrial hyperplasia under weight loss intervention

To evaluate various body fat indicators under weight management on the time to complete response (CR) in overweight patients undergoing fertility-sparing treatment for endometrial cancer (EC) or atypical hyperplasia (AEH). Clinical data and weight indicators of obese patients (percent body fat ≥ 30%) with AEH or early-stage EC who received fertility-sparing treatment from 2018 to 2023 were retrospectively collected from the Peking Union Medical College Hospital. Cox proportional hazards regression analysis was used for univariate and multivariate analyses. Fifty-three patients with AEH (45.28%) or EC (54.72%) were finally included. Percent body fat > 8% (p = 0.018) was identified as an independent predictor of time to CR. Patients with body fat mass loss > 15%, and percent body fat loss > 8% had a lower recurrence rate (p = 0.043 and p = 0.007, respectively). Patients with visceral fat area loss > 18%, body fat mass loss > 15%, and percent body fat loss > 8% had a slightly higher pregnancy rate. When overweight patients with AEH or EC receive fertility-sparing treatment, multiple body fat indicators, especially the loss of percent body fat, are more meaningful for evaluating the time to CR, recurrence rate, and pregnancy rate than weight loss. Registration: ChiCTR2200067099