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Kokts-Porietis RL, Elmrayed S, Brenner DR, Friedenreich CM. Obesity and mortality among endometrial cancer survivors: A systematic review and meta-analysis. Obes Rev 2021; 22:e13337. [PMID: 34476900 DOI: 10.1111/obr.13337] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 01/16/2023]
Abstract
Excess body fat is a major risk factor for endometrial cancer incidence, but its impact on recurrence and survival remains unclear. The aim of this systematic review and meta-analysis was to assess the association between excess body fat with recurrence, cancer-specific, and all-cause mortality among endometrial cancer survivors. We searched MEDLINE and EMBASE databases up to July 2021. Risk of bias was assessed with the Ottawa Newcastle Scale. Random effects models estimated pooled hazard ratios for the main associations between body mass index (BMI) and survival outcomes and stratified by endometrial cancer type. Potential heterogeneity and publication bias were evaluated with sensitivity analyses, funnel plots, and Egger's test. Forty-six studies were included, of which 45 estimated body fat with BMI and six used direct waist circumference measures or CT/MRI scans. Higher BMI (≥30 kg/m2 ) was associated with increased all-cause mortality (HR = 1.34, 95%CI = 1.12-1.59) and recurrence (HR = 1.28, 95%CI = 1.06-1.56). In sub-group analysis, associations between higher BMI and all-cause mortality were observed for both Types I and II survivors, while recurrence associations were only significant among Type I cases. Obesity at endometrial cancer diagnosis was associated with increased cancer recurrence and all-cause mortality among endometrial cancer survivors but not endometrial cancer-specific mortality.
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Affiliation(s)
- Renée L Kokts-Porietis
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Seham Elmrayed
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christine M Friedenreich
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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2
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Andleeb A, Fatima K, Nasreen S, Sofi M, Qadri S. Endometrial carcinoma: A single institute experience. JOURNAL OF RADIATION AND CANCER RESEARCH 2021. [DOI: 10.4103/jrcr.jrcr_19_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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3
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Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:1210-1222. [PMID: 30083701 PMCID: PMC6142981 DOI: 10.1001/jamainternmed.2018.2820] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE As the worldwide burden of endometrial cancer continues to rise, interest is growing in the evaluation of early detection and prevention strategies among women at increased risk. Focusing efforts on women with postmenopausal bleeding (PMB), a common symptom of endometrial cancer, may be a useful strategy; however, PMB is not specific for endometrial cancer and is often caused by benign conditions. OBJECTIVE To provide a reference of the prevalence of PMB in endometrial cancers and the risk of endometrial cancer in women with PMB. DATA SOURCES For this systematic review and meta-analysis, PubMed and Embase were searched for English-language studies published January 1, 1977, through January 31, 2017. STUDY SELECTION Observational studies reporting the prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB in unselected populations were selected. DATA EXTRACTION AND SYNTHESIS Two independent reviewers evaluated study quality and risk of bias using items from the Newcastle-Ottawa Quality Assessment Scale and the Quality Assessment of Diagnostic Accuracy Studies tool. Studies that included highly selected populations, lacked detailed inclusion criteria, and/or included 25 or fewer women were excluded. MAIN OUTCOMES AND MEASURES The pooled prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB. RESULTS A total of 129 unique studies, including 34 432 unique patients with PMB and 6358 with endometrial cancer (40 790 women), were analyzed. The pooled prevalence of PMB among women with endometrial cancer was 91% (95% CI, 87%-93%), irrespective of tumor stage. The pooled risk of endometrial cancer among women with PMB was 9% (95% CI, 8%-11%), with estimates varying by use of hormone therapy (range, 7% [95% CI, 6%-9%] to 12% [95% CI, 9%-15%]; P < .001 for heterogeneity) and geographic region (range, 5% [95% CI, 3%-11%] in North America to 13% [95% CI, 9%-19%] in Western Europe; P = .09 for heterogeneity). CONCLUSIONS AND RELEVANCE Early detection strategies focused on women with PMB have the potential to capture as many as 90% of endometrial cancers; however, most women with PMB will not be diagnosed with endometrial cancer. These results can aid in the assessment of the potential clinical value of new early detection markers and clinical management strategies for endometrial cancer and will help to inform clinical and epidemiologic risk prediction models to support decision making.
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Affiliation(s)
- Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Beverly J Long
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Arena Del Mar Morillo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Miranda C, Barkley J, Smith B. Intrauterine photoacoustic and ultrasound imaging probe. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-9. [PMID: 29701020 DOI: 10.1117/1.jbo.23.4.046008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
Intrauterine photoacoustic and ultrasound imaging are probe-based imaging modalities with translational potential for use in detecting endometrial diseases. This deep-tissue imaging probe design allows for the retrofitting of commercially available endometrial sampling curettes. The imaging probe presented here has a 2.92-mm diameter and approximate length of 26 cm, which allows for entry into the human endometrial cavity, making it possible to use photoacoustic imaging and high-resolution ultrasound to characterize the uterus. We demonstrate the imaging probes' ability to provide structural information of an excised pig uterus using ultrasound imaging and detect photoacoustic signals at a radial depth of 1 cm.
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Affiliation(s)
| | - Joel Barkley
- Maricopa Integrated Health Systems, United States
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5
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Mauland KK, Eng Ø, Ytre-Hauge S, Tangen IL, Berg A, Salvesen HB, Salvesen ØO, Krakstad C, Trovik J, Hoivik EA, Werner HMJ, Mellgren G, Haldorsen IS. High visceral fat percentage is associated with poor outcome in endometrial cancer. Oncotarget 2017; 8:105184-105195. [PMID: 29285243 PMCID: PMC5739630 DOI: 10.18632/oncotarget.21917] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/03/2017] [Indexed: 11/25/2022] Open
Abstract
Despite evidence of increased endometrial cancer (EC) risk in obese women, the impact of obesity on clinical and histological phenotype is poorly understood. This study explored abdominal fat volumes and fat distribution quantified by computed tomography (CT), in relation to tumor characteristics and outcome. 227 EC patients with preoperative abdominal CT scans were included. Total abdominal fat volume (TAV), subcutaneous abdominal fat volume (SAV) and visceral abdominal fat volume (VAV) were quantified, and visceral fat percentage calculated (VAV%=[VAV/TAV]x100). Waist circumference (WC) and liver density (LD) were measured, and body mass index (BMI) calculated. Data for estrogen, progesterone and androgen receptor (ERα/PR/AR) expression by immunohistochemistry were available for 149 tumors, and global gene expression data for 105 tumors. High BMI, TAV, SAV, VAV and WC, and low LD, were associated with low grade endometrioid tumors and PR and AR positivity (all p≤0.03). High VAV% was associated with high age (p<0.001), aneuploidy (p=0.01) and independently predicted reduced disease-specific survival (HR 1.05, 95% CI 1.00-1.11, p=0.041). Tumors from patients with low VAV% showed enrichment of gene sets related to immune activation and inflammation. In conclusion, high VAV% independently predicts reduced EC survival. Tumors arising in patients with low VAV% show enrichment of immune and inflammation related gene sets, suggesting that the global metabolic setting may be important for tumor immune response.
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Affiliation(s)
- Karen Klepsland Mauland
- Centre for Cancer Biomarkers, CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Øyvin Eng
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Sigmund Ytre-Hauge
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Ingvild L Tangen
- Centre for Cancer Biomarkers, CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Anna Berg
- Centre for Cancer Biomarkers, CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Helga B Salvesen
- Centre for Cancer Biomarkers, CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Øyvind O Salvesen
- Unit for Applied Clinical Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Camilla Krakstad
- Centre for Cancer Biomarkers, CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Centre for Cancer Biomarkers, CCBIO, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Centre for Cancer Biomarkers, CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Erling A Hoivik
- Centre for Cancer Biomarkers, CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Henrica Maria Johanna Werner
- Centre for Cancer Biomarkers, CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Mellgren
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway.,KG Jebsen Centre for Diabetes Research, Department of Clinical Science (K2), University of Bergen, Bergen, Norway
| | - Ingfrid S Haldorsen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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6
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Secord AA, Hasselblad V, Von Gruenigen VE, Gehrig PA, Modesitt SC, Bae-Jump V, Havrilesky LJ. Body mass index and mortality in endometrial cancer: A systematic review and meta-analysis. Gynecol Oncol 2015; 140:184-90. [PMID: 26524722 DOI: 10.1016/j.ygyno.2015.10.020] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/22/2015] [Accepted: 10/28/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the association between body mass index (BMI) and mortality in women with endometrial cancer. METHODS A systematic review was performed utilizing a Medline search with Mesh keywords 'endometrial neoplasms' and ('body mass index' or 'obesity') and ('survival analysis' or 'mortality' or 'survivor' or 'survival') for studies published prior to June 2013. Inclusion criteria included studies that assessed associations between BMI and survival in endometrial cancer patients. Two investigators independently reviewed the title and abstract and full-text of articles for inclusion or exclusion decision; discordant decisions were adjudicated by a third reviewer. A random-effects model was constructed that was comparable to the standard random-effects models used in the meta-analysis of odds ratios. The model was fitted using SAS PROC NLMIXED. RESULTS 1451 studies were identified and reviewed in duplicate, 18 met inclusion criteria. A random-effects meta-analysis demonstrated significantly higher odds of mortality with increasing BMI in endometrial cancer patients. Specifically the odds ratios were 1.01, 1.17, 1.26, and 1.66 for BMI categories of 25-29.9, 30-34.9, 35-39.9, and 40+, respectively. The odds ratio for all-cause mortality in endometrial cancer patients with a BMI≥40 compared to those with a BMI<25 was 1.66 (CI: 1.10-2.51, p=0.02). A single dose-response model indicated that a 10% increase in BMI resulted in a 9.2% increase in the odds of all-cause mortality (p=0.007). CONCLUSION Increased BMI is significantly associated with increased all-cause mortality in women with endometrial cancer, with the highest risk for those with a BMI≥40.
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Affiliation(s)
- Angeles Alvarez Secord
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Vic Hasselblad
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Vivian E Von Gruenigen
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Summa Health System, Akron, OH, USA
| | - Paola A Gehrig
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of North Carolina in Chapel Hill, Chapel Hill, NC, USA
| | - Susan C Modesitt
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Victoria Bae-Jump
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of North Carolina in Chapel Hill, Chapel Hill, NC, USA
| | - Laura J Havrilesky
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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7
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Association Between Obesity and Clinical Outcomes in Gynecologic Cancer. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0131-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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8
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Felix AS, Scott McMeekin D, Mutch D, Walker JL, Creasman WT, Cohn DE, Ali S, Moore RG, Downs LS, Ioffe OB, Park KJ, Sherman ME, Brinton LA. Associations between etiologic factors and mortality after endometrial cancer diagnosis: the NRG Oncology/Gynecologic Oncology Group 210 trial. Gynecol Oncol 2015; 139:70-6. [PMID: 26341710 DOI: 10.1016/j.ygyno.2015.08.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/25/2015] [Accepted: 08/26/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have analyzed relationships between risk factors for endometrial cancer, especially with regard to aggressive (non-endometrioid) histologic subtypes, and prognosis. We examined these relationships in the prospective NRG Oncology/Gynecologic Oncology Group 210 trial. METHODS Prior to surgery, participants completed a questionnaire assessing risk factors for gynecologic cancers. Pathology data were derived from clinical reports and central review. We used the Fine and Gray subdistribution hazards model to estimate subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations between etiologic factors and cause-specific subhazards in the presence of competing risks. These models were stratified by tumor subtype and adjusted for stage and socioeconomic status indicators. RESULTS Median follow-up was 60months after enrollment (range: 1day-118months). Among 4609 participants, a total of 854 deaths occurred, of which, 582 deaths were attributed to endometrial carcinoma. Among low-grade endometrioid cases, endometrial carcinoma-specific subhazards were significantly associated with age at diagnosis (HR=1.04, 95% CI=1.01-1.06 per year, P-trend) and BMI (class II obesity vs. normal BMI: HR=2.29, 95% CI=1.06-4.98, P-trend=0.01). Among high-grade endometrioid cases, endometrial carcinoma-specific subhazards were associated with age at diagnosis (HR=1.05, 95% CI=1.02-1.07 per year, P-trend<0.001). Among non-endometrioid cases, endometrial carcinoma-specific subhazards were associated with parity relative to nulliparity among serous (HR=0.55, 95% CI=0.36-0.82) and carcinosarcoma cases (HR=2.01, 95% CI=1.00-4.05). DISCUSSION Several endometrial carcinoma risk factors are associated with prognosis, which occurs in a tumor-subtype specific context. If confirmed, these results would suggest that factors beyond histopathologic features and stage are related to prognosis. ClinicalTrials.gov Identifier: NCT00340808.
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Affiliation(s)
- Ashley S Felix
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - D Scott McMeekin
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - David Mutch
- Washington University School of Medicine, St. Louis, MO, USA
| | - Joan L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - William T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Shamshad Ali
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Richard G Moore
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI, USA
| | - Levi S Downs
- Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Olga B Ioffe
- Anatomical Pathology, University of Maryland, College Park, MD, USA
| | - Kay J Park
- Surgical Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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9
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Park JY, Cho JH, Min JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Impact of body mass index on the prognosis of Korean women with endometrioid adenocarcinoma of the uterus: A cohort study. Obstet Gynecol Sci 2014; 57:115-20. [PMID: 24678484 PMCID: PMC3965694 DOI: 10.5468/ogs.2014.57.2.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/15/2013] [Accepted: 10/03/2013] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To analyze how pretreatment body mass index relates to known endometrial cancer prognostic factors and how it impacts the disease-free survival and cause-specific survival of Korean women with endometrial cancer. METHODS The patients were divided into the non-obese (<25 kg/m(2)) and obese groups (≥25 kg/m(2)) according to their pretreatment body mass index. The 25 kg/m(2) body mass index cut-off was based on the World Health Organization criteria for Asian people. The two groups were compared in terms of their clinicopathological characteristics and survival outcomes. RESULTS A total of 213 consecutive patients with endometrioid adenocarcinoma of the uterus met the eligibility criteria of this study and were included in the analysis. Of these patients, 105 patients had a body mass index less than 25 kg/m(2) (non-obese group) and 108 patients had a body mass index equal to or more than 25 kg/m(2) (obese group). The two groups did not differ in terms of age, menopause, parity, height, FIGO (International Federation of Obstetrics and Gynecology) stage, tumor grade, tumor size, myometrial invasion, lymphovascular space invasion, cytology, and lymph node metastasis. Body mass index was not a significant factor for disease-free and cause-specific survival in univariate analysis, and after adjusting for all prognostic factors that were significant in univariate analysis, it did not associate significantly with disease-free and cause-specific survival. CONCLUSION In Korean women with endometrioid adenocarcinoma of the uterus, a high pretreatment body mass index did not associate with other prognostic factors and had little impact on the disease-free survival and cause-specific survival of these women.
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Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae-Hyun Cho
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin-Young Min
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong-Hyeok Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo-Hyun Nam
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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10
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Noer MC, Sperling C, Christensen IJ, Nielsen MLS, Lidegaard O, Høgdall C. Comorbidity is an independent prognostic factor in women with uterine corpus cancer: a nationwide cohort study. Acta Obstet Gynecol Scand 2014; 93:325-34. [PMID: 24443826 DOI: 10.1111/aogs.12338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 01/12/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether comorbidity independently affects overall survival in women with uterine corpus cancer. DESIGN Cohort study. SETTING Denmark. STUDY POPULATION A total of 4244 patients registered in the Danish Gynecologic Cancer database with uterine corpus cancer from 1 January 2005 until 13 October 2011. METHODS All patients included in the study were assigned a comorbidity score according to the Charlson Comorbidity Index. Multivariate survival analyses were performed to investigate the prognostic impact of comorbidity adjusting for known prognostic factors. As performance status might capture the prognostic impact of comorbidity and because information on the variable grade was missing in some special histological subtypes, we included different models in the multivariate analyses with and without PS and grade, respectively. MAIN OUTCOME MEASURES Overall survival. RESULTS Univariate survival analysis showed a significant (p < 0.001) negative association between increasing level of comorbidity and overall survival. Multivariate analyses adjusting for other prognostic factors showed that comorbidity is a significant independent prognostic factor with hazard ratios ranging from 1.27 to 1.42 in mild, 1.69 to 1.74 in moderate, and 1.72 to 2.48 in severe comorbidity. Performance status was independently associated to overall survival and was found to slightly reduce the prognostic impact of comorbidity. CONCLUSION Comorbidity is an independent prognostic factor in uterine corpus cancer and increasing levels of comorbidity are associated with shorter survival.
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Affiliation(s)
- Mette C Noer
- Gynecologic Clinic, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
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11
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Arem H, Chlebowski R, Stefanick ML, Anderson G, Wactawski-Wende J, Sims S, Gunter MJ, Irwin ML. Body mass index, physical activity, and survival after endometrial cancer diagnosis: results from the Women's Health Initiative. Gynecol Oncol 2013; 128:181-6. [PMID: 23127972 PMCID: PMC3552067 DOI: 10.1016/j.ygyno.2012.10.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/24/2012] [Accepted: 10/29/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE While low physical activity and high body mass index (BMI) have been associated with higher endometrial cancer incidence, no previous studies have evaluated the association between physical activity and survival after endometrial cancer diagnosis, and studies on BMI and survival have not been performed in a prospective cohort. METHODS We examined pre-diagnosis BMI and moderate- to vigorous-intensity physical activity in relation to overall and disease-specific survival among 983 postmenopausal women who were diagnosed with endometrial cancer in the Women's Health Initiative Observational Study and Clinical Trials. RESULTS Over a median 5.2 (max 14.1) years from diagnosis to death or end of follow-up, 163 total deaths were observed, 66 of which were due to endometrial cancer. We observed a higher all-cause mortality hazard ratio (HR) = 1.85 (95% CI 1.19-2.88) comparing women with a BMI ≥ 35 kg/m(2) to women with BMI< 25 kg/m(2). For endometrial cancer-specific mortality the HR = 2.23 (95% CI 1.09-4.54) comparing extreme BMI categories. To examine histologic subtypes we analyzed type I endometrial tumors separately and found an HR = 1.20 (95% CI 1.07-1.35) associated with all-cause mortality for each 5-unit change in BMI. Moderate- to vigorous-intensity physical activity was not associated with all-cause or endometrial cancer-specific mortality. CONCLUSIONS Pre-diagnosis BMI, but not physical activity, was associated with survival among women with endometrial cancer. Future studies should investigate mechanisms and timing of BMI onset to better understand the burden of disease attributable to BMI.
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Affiliation(s)
- Hannah Arem
- Yale School of Public Health, 60 College St, New Haven, CT
| | - Rowan Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Marcia L. Stefanick
- Stanford Prevention Research Center, School of Medicine, Stanford University, California
| | - Garnet Anderson
- Division of Public Health Sciences, WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jean Wactawski-Wende
- Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, NY
| | - Stacy Sims
- Stanford Prevention Research Center, School of Medicine, Stanford University, California
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12
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Arem H, Park Y, Pelser C, Ballard-Barbash R, Irwin ML, Hollenbeck A, Gierach GL, Brinton LA, Pfeiffer RM, Matthews CE. Prediagnosis body mass index, physical activity, and mortality in endometrial cancer patients. J Natl Cancer Inst 2013; 105:342-9. [PMID: 23297041 DOI: 10.1093/jnci/djs530] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Higher body mass index (BMI) and inactivity have been associated with a higher risk of developing endometrial cancer, but the impact on endometrial cancer survival is unclear. Methods Among incident endometrial cancer case subjects in the National Institutes of Health-AARP Diet and Health Study, we examined associations of prediagnosis BMI (n = 1400) and physical activity (n = 875) with overall and disease-specific 5- and 10-year mortality. Using Cox proportional hazards regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for tumor characteristics, treatment, and other risk factors. All statistical tests were two-sided. Results Compared with women with a BMI in the range of 18.5 to less than 25kg/m(2), the hazard ratios for 5-year all-cause mortality were 1.74 (95% CI = 1.13 to 2.66) for BMI in the range of 25 to less than 30kg/m(2), 1.84 (95% CI = 1.17 to 2.88) for BMI in the range of 30 to less than 35kg/m(2), and 2.35 (95% CI = 1.48 to 3.73) for BMI greater than or equal to 35kg/m(2) (P trend < .001). Higher BMI was also statistically significantly associated with poorer endometrial cancer-specific but not cardiovascular disease 5-year mortality. Hazard ratio estimates for 10-year all-cause and endometrial cancer-specific mortality as related to BMI were similar to 5-year hazard ratio estimates, whereas 10-year cardiovascular disease mortality became statistically significant (HR = 4.08; 95% CI = 1.56 to 10.71 comparing extreme BMI groups). More physical activity was related to lower all-cause 5-year mortality (HR = 0.57, 95% CI = 0.33 to 0.98 for >7 hours/week vs never/rarely), but the association was attenuated after adjustment for BMI (HR = 0.64, 95% CI = 0.37 to 1.12). No association was observed between physical activity and disease-specific mortality. Conclusions Our findings suggest that higher prediagnosis BMI increases risk of overall and disease-specific mortality among women diagnosed with endometrial cancer, whereas physical activity lowers risk. Intervention studies of the effect of these modifiable lifestyle factors on mortality are needed.
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Affiliation(s)
- Hannah Arem
- MHS, 6120 Executive Blvd, EPS 3029, Rockville, MD 20852, USA.
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Abstract
Although it is known that obesity increases the risk of endometrial cancer and is linked to higher mortality rates in the general population, the association between obesity and mortality among endometrial cancer survivors is unclear. We performed a medline search using exploded Mesh keywords 'endometrial neoplasms/' and ('body mass index/' or 'obesity/') and ('survival analysis/' or 'mortality/' or (survivor* or survival*).mp.). We also inspected bibliographies of relevant papers to identify related publications. Our search criteria yielded 74 studies, 12 of which met inclusion criteria. Four of the included studies reported a statistically or marginally significant association between obesity and higher all cause mortality among endometrial cancer survivors after multivariate adjustment. The suggestive association between body mass index and higher all cause mortality among women with endometrial cancer was comparable to the magnitude of association reported in prospective studies of healthy women. Of the five studies that examined progression-free survival and the two studies reporting on disease-specific mortality, none reported an association with obesity. Future studies are needed to understand disease-specific mortality, the importance of obesity-onset timing and whether mechanisms of obesity-related mortality in this population of women differ from those of the general population.
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Affiliation(s)
- H Arem
- Department of Chronic Disease Epidemiology, Yale University, School of Public Health, New Haven, CT 06520, USA.
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Laser Literature Watch. Photomed Laser Surg 2006; 24:222-48. [PMID: 16706704 DOI: 10.1089/pho.2006.24.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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