[Quality of life assessment and influencing factors in patients with endometrial cancer and atypical endometrial hyperplasia undergoing fertility-sparing treatment].

Objective: To investigate the quality of life (QoL) and its influencing factors in patients with early-stage endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) undergoing fertility-sparing treatment. Methods: A total of 134 patients with EC or AEH who received fertility-sparing treatment at Peking Union Medical College Hospital between August 2023 and December 2024 were enrolled. Patients were divided into two treatment groups: those receiving gonadotropin-releasing hormone agonist (GnRHa) combined with aromatase inhibitors, and those receiving high-dose oral progestins. During treatment, diagnostic curettage or hysteroscopy was performed every 3 months, and treatment was discontinued upon assessment of complete response (CR). According to treatment duration (time to achieve CR), patients were categorized into the 3-month group (n=79), 6-month group (n=40), and ≥9-month group (n=15). The Functional Assessment of Cancer Therapy-General (FACT-G) version 4 was used to quantitatively assess QoL during treatment; questionnaires were administered every 3 months, and all 134 patients completed the survey at baseline and at 3, 6, and 9 months of treatment. Multivariate linear regression analysis was used to analyzed the influencing factors of QoL. Results: Among the 134 patients, 61 (45.5%) had AEH and 73 (54.5%) had EC; 71 patients (53.0%) received GnRHa combined with aromatase inhibitors, and 63 (47.0%) received high-dose oral progestins. QoL assessment showed that FACT-G scores gradually increased from baseline in the 3-month and 6-month groups, indicating improvement in QoL as treatment progressed; whereas the median FACT-G scores in the ≥9-month group remained below 80 throughout treatment, indicating relatively lower QoL. However, there was no statistically significant difference in FACT-G scores at CR among the 3-month, 6-month, and ≥9-month groups (median scores: 82.0, 83.0, and 76.5, respectively; H=1.575, P=0.455). Univariate analysis showed no significant differences in FACT-G scores at CR among patients with different treatment regimens, body mass index (BMI), treatment duration, pathological type, marital status, treatment history, or reproductive history (all P＞0.05). Multivariate analysis showed that FACT-G scores at CR were positively correlated with baseline FACT-G scores (B=0.634, P＜0.001) and negatively correlated with BMI (B=-4.021, P=0.035). No correlation was observed between treatment regimen and QoL. Conclusions: In fertility-sparing treatment, BMI may be a key factor affecting QoL, while long-term treatment may lead to a decline in QoL. Clinical attention should be paid to weight management and psychosocial support.