Correlation Of Metabolic Syndrome,Ki-67 With Clinicopathological Characteristics And Prognosis Of Endometrioid Adenocarcinoma

Objective:To investigate the relationship between metabolic syndrome,Ki-67 expression intensity and clinicopathological characteristics,prognosis of patients with endometrioid adenocarcinoma and related factors affecting prognosis.Methods:Patients who underwent surgery in the Department of Obstetrics and Gynecology of the First Affiliated Hospital from January 2017 to January 2020 with postoperative pathology suggestive of endometrioid adenocarcinoma were selected and divided into different groups according to the diagnostic criteria of metabolic syndrome and Ki-67 expression intensity,and all included patients were followed up from the date of surgery to record their recurrence survival,and cancer recurrence was studied as the primary outcome.To retrospectively analyze the clinicopathologic-al indexes and prognosis of each group,and to investigate the effects of metabolic syndrome and Ki-67 on the clinicopathological characteristics and prognosis of patients with endometrioid adenocarcinoma and the related factors affecting prognosis.Results:1.A total of 204 patients,aged 31 to 85 years,met the inclusion criteria.There were 74 patients with combined metabolic syndrome,96 patients with Ki-67 > 40%,and 42 patients with combined metabolic syndrome and Ki-67 > 40%.The proportion of patients with endometrioid adenocarcinoma combined with metabolic syndrome was higher in patients with FIGO stage Ⅲ+Ⅳ,high-grade(G3),myelomeningocele infiltration ≥1/2,choroidal carcinoma emboli,and lymph node metastasis than in those without combined metabolic syndrome(P < 0.05).Patients with endometrioid adenocarcinoma with Ki-67 > 40% had a higher proportion of patients with FIGO stage Ⅲ+Ⅳ,high-grade(G3),myxoid infiltration ≥ 1/2,choroidal carcinoma emboli,and lymph node metastasis than those with Ki-67 ≤ 40%(P < 0.05).Patients with endometrioid adenocarcinoma with combined metabolic syndrome accounted for a greater proportion of patients with Ki-67 > 40% compared with those without combined metabolic syndrome(P < 0.05).2.The 3-year progression-free survival rate was lower in the group with combined metabolic syndrome than in the group without combined metabolic syndrome in patients with endometrioid adenocarcinoma(P < 0.05);the 3-year progression-free survival rate was lower in the group with Ki-67 > 40% than in the group with Ki-67 ≤ 40%(P < 0.05);and the 3-year progression-free survival rate was lowest in the group with combined metabolic syndrome and Ki-67 > 40%(P <0.05).Subgroup analysis based on FIGO staging showed that in FIGO stage Ⅰ+Ⅱ tumors,progression-free survival was lower in the combined metabolic syndrome group,the Ki-67 > 40% group,and the combined metabolic syndrome with Ki-67 >40% group than in their control groups(P < 0.05).Univariate COX regression analysis revealed that FIGO stage,histologic grade,myxomatous infiltration,vascular cancer thrombus,lymph node metastasis,metabolic syndrome,Ki-67 expression intensity,combined metabolic syndrome,and Ki-67 >40% were associated with an increased risk of recurrence in patients(P < 0.05).Multifactorial COX regression analysis revealed that late FIGO staging,high-grade pathology,and combined metabolic syndrome were independent risk factors for patients’ cumulative progression-free survival time(P < 0.05).3.Analysis of metabolic syndrome and the efficacy of Ki-67 in predicting recurrence: the area under the curve for combined metabolic syndrome predicting recurrence was 0.706,the area under the curve for Ki-67 > 40% predicting recurrence was 0.676,and the area under the curve for combined metabolic syndrome + Ki-67 >40% predicting recurrence was 0.769.Conclusions:1.Metabolic syndrome and Ki-67 are associated with clinicopathological features and poor prognosis in patients with endometrioid adenocarcinoma.2.Metabolic syndrome is associated with Ki-67 expression,and the combined metabolic syndrome and Ki-67 high expression predicts higher diagnostic efficacy of recurrence and can be considered as a new predictor of recurrence.