子宫内膜癌或不典型子宫内膜增生患者保留生育治疗期间焦虑与抑郁的纵向轨迹
该前瞻性随机试验纳入187例18-40岁接受保留生育治疗的G1-2子宫内膜癌或不典型子宫内膜增生患者，每12周用医院焦虑抑郁量表评估心理状态。线性混合效应模型显示焦虑评分每3个月显著下降0.162分（P=0.003），抑郁保持稳定；焦虑改善与较早完全缓解相关，建议常规心理筛查。
要点
- 保留生育治疗期间焦虑评分每3个月显著下降0.162分（P=0.003），抑郁保持稳定。
- 达到完全缓解的157例患者中，62.5%轻度焦虑者恢复至正常范围（P=0.002）。
- 3或6个月内完全缓解者焦虑显著改善，≥9个月者无显著改善（P=0.733）。
核心结论
- 保留生育治疗期间焦虑逐渐减轻而抑郁保持稳定，焦虑改善可能与较早完全缓解相关，建议常规心理筛查并关注延迟缓解患者。
研究设计与样本
- 前瞻性随机试验，纳入2023至2025年187例18-40岁接受保留生育治疗的G1-2子宫内膜癌或不典型子宫内膜增生患者，中位随访5个月（IQR 3-7）。
- 治疗为GnRHa联合芳香化酶抑制剂或口服孕激素，每12周用医院焦虑抑郁量表评估，采用线性混合效应模型分析纵向轨迹并按完全缓解时间（3、6或≥9个月）分层。
主要发现
- 线性混合效应模型显示焦虑评分每3个月下降0.162分（P=0.003），抑郁评分无显著变化（P>0.05）。
- 从基线至完全缓解（n=157），焦虑严重程度显著改善（P=0.002），62.5%的轻度焦虑患者恢复至正常范围，抑郁无显著变化（P=0.556）。
- 3或6个月内达到完全缓解者焦虑显著降低（均P<0.05），需≥9个月者焦虑无显著改善（P=0.733）。
- 无临床或人口学变量与心理结局独立相关。
临床怎么用
- 对接受保留生育治疗的子宫内膜癌或不典型子宫内膜增生患者应常规进行心理筛查。
- 尤其关注完全缓解延迟（≥9个月）患者的焦虑状况。
局限性
- 完全缓解后的长期心理轨迹有待进一步研究。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
INTRODUCTION: Fertility-sparing treatment (FST) is vital for young women with endometrial cancer (EC) or atypical endometrial hyperplasia (AEH). While oncologic outcomes are well reported, longitudinal psychological trajectories during FST remain unclear. This study aimed to evaluate changes and determinants of anxiety and depression during FST. METHODS: In this prospective randomized trial, patients aged 18-40 years with G1-2 EC or AEH undergoing FST between 2023 and 2025 were enrolled. Treatment consisted of GnRHa plus aromatase inhibitors or oral progestins. Psychological status was assessed every 12 weeks using the Hospital Anxiety and Depression Scale. Longitudinal trajectories were analyzed using linear mixed-effects models and stratified by time to complete remission (CR: 3, 6, or ≥ 9 months). RESULTS: A total of 187 patients were included, with a median follow-up of 5 months (IQR 3-7). Anxiety scores declined significantly over time in the linear mixed-effects model (-0.162 points per 3 months, P = 0.003), whereas depression remained stable (P > 0.05). From baseline to CR (n = 157), anxiety severity significantly improved (P = 0.002), with 62.5% of patients with mild anxiety returning to normal range; no significant change in depression was observed (P = 0.556). Anxiety reduction was observed in patients achieving CR within 3 or 6 months (both P < 0.05) and not in those requiring ≥9 months (P = 0.733). No clinical or demographic variables were independently associated with psychological outcomes. CONCLUSION: During FST, anxiety decreases progressively while depression remains stable. Anxiety improvement appears to be associated with earlier CR, suggesting a potential time-dependent pattern. Routine psychological screening is warranted, particularly for patients with delayed remission. Longer-term psychological trajectories after CR require further study.
引用
- Cao Y, Liu Q, Zhou H, et al. Longitudinal trajectories of anxiety and depression in patients with endometrial cancer or atypical endometrial hyperplasia undergoing fertility-sparing treatment. Gynecol Oncol. 2026. PMID: 42139817. doi:10.1016/j.ygyno.2026.05.010
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。