Effects of dyslipidemia on fertility-sparing treatment outcomes in endometrial atypical hyperplasia and endometrial cancer: a large cohort study

This study aimed to investigate the impact of dyslipidemia on outcomes of fertility-preserving treatment in patients with endometrioid endometrial cancer (EEC) or endometrial atypical hyperplasia (EAH). A total of 406 patients, including 118 EEC and 288 EAH, who received fertility-sparing treatment between January 2017 and December 2020 were included and divided into a dyslipidemia group (n = 282) and a non-dyslipidemia group (n = 124). The 16-/32-week complete response (CR) rate, pregnancy outcome, and recurrence were compared between patients with and without dyslipidemia. Furthermore, we explored the effect of different indicators of dyslipidemia, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL), on the therapeutic effects of fertility-preserving treatment. A total of 282 (69.5%) patients were diagnosed with dyslipidemia, and 38 patients were diagnosed with mixed dyslipidemia. The 16-/32-week CR rate, pregnant rate, live birth rate, and recurrence did not have significant differences between patients with and without dyslipidemia. Patients with mixed dyslipidemia had a lower 32-week CR rate (42.1% vs.65.5%, P = 0.004) and a longer treatment duration to achieve CR (33.4 weeks vs. 27.0 weeks, P = 0.039, HR: 0.73, 95%CI: 0.53–0.98) than those without mixed dyslipidemia. Multivariate logistic regression analyses demonstrated that mixed dyslipidemia was significantly associated with a lower 32-week CR rate (OR: 0.322, 95% CI: 0.134–0.775, P = 0.011). Patients with both overweight and mixed dyslipidemia had the lowest 32-week CR rate (12/31, 38.5%, P = 0.007) and longest median treatment duration to CR (34.0 weeks, 95%CI: 25.7–42.3 weeks, P = 0.025). Mixed dyslipidemia was an independent risk factor for fertility-preserving treatment outcomes in EAH or EEC patients, as this group had a lower 32-week CR rate and a longer treatment duration to achieve CR than those without mixed dyslipidemia.