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van den Bosch AAS, Pijnenborg JMA, Romano A, Winkens B, van der Putten LJM, Kruitwagen RFPM, Werner HMJ. The impact of adipose tissue distribution on endometrial cancer: a systematic review. Front Oncol 2023; 13:1182479. [PMID: 37313459 PMCID: PMC10258319 DOI: 10.3389/fonc.2023.1182479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction Endometrial cancer (EC) is the most common gynecological cancer with a rising incidence, attributed to advanced life expectancy and obesity. Adipose tissue (AT) is an important endocrine organ, and its metabolic activity is affected by the different anatomical distribution or locations. AT distribution influences a number of diseases. In EC, it remains unclear whether the type of AT distribution affects development or prognosis. This systematic review aimed to determine whether AT distribution is associated with patient characteristics, disease characteristics, and patient prognosis in EC. Materials and methods A search was conducted in Medline, MEDLINE EMBASE, and Cochrane Library. We included studies that enrolled patients with EC with any histological subtype and that distinguished between the visceral and subcutaneous AT compartment. In eligible studies, correlative analyses were performed for all outcome measures and AT distribution. Results Eleven retrospective studies were included, with a wide range of measurements for the visceral and subcutaneous AT compartments. AT distribution was found to be significantly correlated to a number of relevant (disease) characteristics including obesity measures, histological subtype, lymph node metastasis, and sex steroid levels. Five studies reported on survival parameters including overall survival, progression-free survival and disease-specific survival, and they found that increased VAT volume was statistically significantly associated with a worse survival. Discussion/conclusion This review demonstrates that there are significant correlations between AT distribution and prognosis, body mass index, sex steroid levels, and disease characteristics like histology. Well-designed, prospective, and larger-scale studies are needed to pinpoint these differences more specifically and understand how it can add in prediction and even therapy in EC.
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Affiliation(s)
- Anouk A. S. van den Bosch
- Department of Obstetrics and Gynecology, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Andrea Romano
- Department of Obstetrics and Gynecology, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands
| | | | - Roy F. P. M. Kruitwagen
- Department of Obstetrics and Gynecology, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Henrica M. J. Werner
- Department of Obstetrics and Gynecology, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, Netherlands
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Dos Santos NS, Gonçalves DR, Balbinot B, Visioli F. Is GRP78 (Glucose-regulated protein 78) a prognostic biomarker in differents types of cancer? A systematic review and meta-analysis. Pathol Res Pract 2023; 242:154301. [PMID: 36610326 DOI: 10.1016/j.prp.2023.154301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
GRP78 is a chaperone with anti-apoptotic function associated with aggressive tumors. This systematic review aimed to evaluate GRP78 expression in cancer and its relation to prognosis outcomes. This review was conducted in different databases searching for human cancer studies assessing GRP78 immunohistochemical levels on tissue samples. A total of 98 manuscripts were included. In 62% of the studies, GRP78 was associated with a worse prognosis. A meta-analysis included 29 studies that detected a significantly higher expression of GRP78 in cancer tissues (RR= 2.35, 95% CI 1.75-3.15) compared to control. A meta-analysis of 3 and 5-years Overall Survival revealed an increased risk of death for tumors with high expression of GRP78 (RR=1.36, 95%CI 1.16-1,59, I2 = 57%) and (RR=1.65, 95%CI 1.22-2.21, I2 =64%), respectively. GRP78 is an important prognostic biomarker for different types of cancer and a promising therapeutic target.
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Affiliation(s)
- Natália Souza Dos Santos
- Oral Pathology Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Brazil
| | - Douglas Rodrigues Gonçalves
- Oral Pathology Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Brazil; Oral Medicine Unit, Otorhinolaryngology Service, Hospital de Clínicas de Porto Alegre, Brazil
| | - Bianca Balbinot
- Oral Pathology Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Brazil
| | - Fernanda Visioli
- Oral Pathology Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Brazil; Experimental Center Research, Hospital de Clínicas de Porto Alegre, Brazil.
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Cheng Y, Wang Z, Jia X, Zhou R, Wang J. Association Between Abdominal Adipose Tissue Distribution and Risk of Endometrial Cancer: A Case-Control Study. Clin Med Insights Oncol 2022; 16:11795549221140776. [PMCID: PMC9742701 DOI: 10.1177/11795549221140776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Obesity contributes to endometrial cancer (EC). However, it is not clear whether the distribution of adipose tissue affects the occurrence of endometrial carcinoma. This study aimed to evaluate the relationship between abdominal adipose tissue distribution and EC. Methods: We designed a case-control study with 115 women with EC and a control group. The total abdominal adipose tissue, visceral adipose tissue, and subcutaneous adipose tissue were measured by single slice computerized tomography at the level of umbilicus. Univariate and multivariate logistic regression models were used to calculate odds ratios (ORs) for the risk of EC associated with adipose tissue distribution. Furthermore, we analyzed the correlation between adipose tissue distribution and clinicopathologic features of endometrial carcinoma. Results: Multivariate analysis showed that a larger visceral adipose tissue ratio was associated with an increased risk of EC after adjusting for body mass index (BMI) and diabetes (OR = 1.046, 95% confidence interval = [1.008-1.079]). The ratio of International Federation of Obstetrics and Gynecology (FIGO) stage I and type I EC was higher in EC patients with larger visceral adipose tissue (84.5% vs 63.2%, P = .009; 91.4% vs 75.4%, P = .021). There was a higher positive ratio of progesterone receptor in EC patients with a larger subcutaneous adipose tissue area (91.2% vs 77.6%; P = .044). Conclusions: Higher visceral adipose tissue ratio, independent of BMI, was associated with an increased risk of EC. Therefore, this study demonstrated that women with normal BMI, but abnormal abdominal adipose tissue distribution, have an increased risk for EC.
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Affiliation(s)
- Yuan Cheng
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing, China
| | - Zhongyu Wang
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing, China
| | - Xiaoxuan Jia
- Department of Radiology, Peking University People’s Hospital, Beijing, China
| | - Rong Zhou
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing, China
| | - Jianliu Wang
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing, China,Jianliu Wang, Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing 100044, China.
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Buckley E, Mullen MM, Nizamuddin RA, Stein JH, Kuroki LM, Fuh KC, Hagemann AR, McCourt CK, Mutch D, Khabele D, Powell MA, Ippolito JE, Thaker PH. High visceral fat to subcutaneous fat ratios portend a poor prognosis in patients with advanced endometrial cancer. Gynecol Oncol 2022; 167:496-501. [PMID: 36180305 PMCID: PMC10836416 DOI: 10.1016/j.ygyno.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Visceral adiposity has been established as a predictor of outcomes in various cancers. We aimed to determine the association of radiographic measurements of visceral fat with clinical outcomes in patients with endometrial cancer. METHODS A retrospective review of patients with stage III-IV endometrial cancer who underwent surgery between 2004 and 2014 was performed. Visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and total adipose tissue (TAT;VAT+SAT) were assessed on preoperative computed tomography (CT) scans. Exploratory analysis was performed to establish the optimal cut-off values for VAT, SAT, and TAT to identify patients with poor prognostic body composition. Survival rates were analyzed using Kaplan-Meier analysis, log-rank tests, and cox-regression. RESULTS Eighty-three patients were included. Forty-two (51%) patients had a low VAT/SAT ratio (<0.45) and 41 (49.4%) had a high VAT/SAT ratio (>0.45). There were no significant differences in demographics between the groups. The mean VAT, SAT, and TAT were 176.3 cm2, 379.3 cm2, and 555.3 cm2 respectively. Compared to patients with low VAT/SAT ratios, patients with high VAT/SAT ratios had a shorter recurrence-free survival (median 29.6 vs 32.3 months, P = 0.01) and shorter overall survival (median 56 vs 93.7 months, P = 0.03). CONCLUSIONS Visceral fat measurements are predictive of outcomes in patients with advanced stage endometrial cancer. Specifically, VAT to SAT ratios are predictive of overall survival. Future studies should be pursued to identify potential therapeutic targets and biological mechanisms that underlie obesity's relationship with endometrial cancer.
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Affiliation(s)
- Elizabeth Buckley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
| | - Mary M Mullen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
| | - Rehan A Nizamuddin
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Jonathan H Stein
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Lindsay M Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
| | - Katherine C Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
| | - Andrea R Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
| | - Carolyn K McCourt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
| | - David Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
| | - Dineo Khabele
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
| | - Joseph E Ippolito
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America; Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, United States of America.
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America.
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Pahk K, Ryu KJ, Joung C, Kwon HW, Lee S, Park H, Kim T, Song JY, Kim S. Metabolic Activity of Visceral Adipose Tissue Is Associated with Metastatic Status of Lymph Nodes in Endometrial Cancer: A 18F-FDG PET/CT Study. Int J Environ Res Public Health 2021; 19:92. [PMID: 35010352 DOI: 10.3390/ijerph19010092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/02/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022]
Abstract
Obesity contributes to increased cancer incidence and aggressiveness in patients with endometrial cancer. Inflamed metabolic activity of visceral adipose tissue (VAT) is regarded as a key underlying mechanism of adverse consequences of obesity. The aim of this study was to investigate the association between inflammatory metabolic activity of VAT evaluated by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and metastatic status of lymph nodes (LN) in patients with endometrial cancer. In total, 161 women with newly diagnosed endometrial cancer, who received preoperative 18F-FDG PET/CT, were enrolled. VAT inflammatory metabolic activity was defined as V/S ratio and measured from the maximum standardized uptake value (SUVmax) of VAT normalized to the SUVmax of subcutaneous adipose tissue (SAT). The positive LN metastasis group exhibited a significantly higher V/S ratio than the negative LN metastasis group. Systemic inflammatory surrogate markers including high sensitivity C-reactive protein, spleen SUVmax, and bone marrow SUVmax were also higher in the LN metastasis group than in the negative LN metastasis group, showing significant correlations with V/S ratio. In multivariate logistic regression analysis, V/S ratio was independently associated with LN metastasis. V/S ratio is independently associated with the LN metastasis status in patients with endometrial cancer. This finding could be useful as a potential surrogate marker of obesity-induced VAT inflammation associated with tumor aggressiveness.
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Wada M, Yamaguchi K, Yamakage H, Inoue T, Kusakabe T, Abiko K, Takakura K, Konishi I, Satoh-Asahara N. Visceral-to-subcutaneous fat ratio is a possible prognostic factor for type 1 endometrial cancer. Int J Clin Oncol 2021; 27:434-440. [PMID: 34716844 PMCID: PMC8816789 DOI: 10.1007/s10147-021-02060-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/19/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Associations have been observed between obesity defined by the body mass index (BMI) and the incidence of endometrial cancer. However, the impact of obesity on the prognosis of endometrial cancer is not yet clear. Recently, visceral fat has been considered to have a greater impact on malignant disease in obese patients than subcutaneous fat. In this study, we investigated the association between prognostic factors of type 1 and type 2 endometrial cancer and obesity parameters. METHODS The impacts of clinical factors on the progression-free survival (PFS) and overall survival (OS) were analyzed retrospectively in 145 primary endometrial cancer patients. The factors included age, BMI, pathological findings, Federation of Gynecology and Obstetrics (FIGO) stage, status of lymph node metastasis, and the amounts of visceral and subcutaneous fat obtained from computed tomography (CT) data. RESULTS Only the visceral-to-subcutaneous fat ratio (V/S ratio) (cutoff value 0.5) corresponded to a significant difference in OS and PFS in type 1 endometrial cancer (p = 0.0080, p = 0.0053) according to the results of log-rank tests of Kaplan-Meier curves. The COX regression univariate analysis revealed that only the V/S ratio was a significant prognostic factor for PFS, but not OS (p = 0.033 and p = 0.270, respectively). CONCLUSION A V/S ratio > 0.5 is a possible factor for poor prognosis in type 1 endometrial cancer. Further research is needed to investigate the preventive and therapeutic effects of reducing visceral fat on the prognosis of this type of cancer.
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Affiliation(s)
- Michiko Wada
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto, 612-8555, Japan
| | - Ken Yamaguchi
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan.
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto, 612-8555, Japan.
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Hajime Yamakage
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Takayuki Inoue
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Toru Kusakabe
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Kaoru Abiko
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto, 612-8555, Japan
| | - Kenji Takakura
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto, 612-8555, Japan
| | - Ikuo Konishi
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto, 612-8555, Japan
| | - Noriko Satoh-Asahara
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
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An L, Zhang J, Feng D, Zhao Y, Ouyang W, Shi R, Zhou X, Yu Z, Wei S, Min J, Wang H. KIF2C Is a Novel Prognostic Biomarker and Correlated with Immune Infiltration in Endometrial Cancer. Stem Cells Int 2021; 2021:1434856. [PMID: 34650608 DOI: 10.1155/2021/1434856] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
Endometrial cancer (EC) is commonly diagnosed cancer in women, and the prognosis of advanced types of EC is extremely poor. Kinesin family member 2C (KIF2C) has been reported as an oncogene in cancers. However, its pathophysiological roles and the correlation with tumor-infiltrating lymphocytes in EC remain unclear. The mRNA and protein levels of KIF2C in EC tissues were detected by qRT-PCR, Western blot (WB), and IHC. CCK8, Transwell, and colony formation assay were applied to assess the effects of KIF2C on cell proliferation, migration, and invasion. Cell apoptosis and cell cycle were analyzed by flow cytometry. The antitumor effect was further validated in the nude mouse xenograft cancer model and humanized mouse model. KIF2C expression was higher in EC. Knockdown of KIF2C prolonged the G1 phases and inhibited EC cell proliferation, migration, and invasion in vitro. Bioinformatics analysis indicated that KIF2C is negatively correlated with the infiltration level of CD8+ T cells but positively with the poor prognosis of EC patients. The apoptosis of CD8+ T cell was inhibited after the knockdown of KIF2C and was further inhibited when it is combined with anti-PD1. Conversely, compared to the knockdown of KIF2C expression alone, the combination of anti-PD1 further promoted the apoptosis of Ishikawa and RL95-2 cells. Moreover, the knockdown of KIF2C inhibited the expression of Ki-67 and the growth of tumors in the nude mouse xenograft cancer model. Our study found that the antitumor efficacy was further evaluated by the combination of anti-PD1 and KIF2C knockdown in a humanized mouse model. This study indicated that KIF2C is a novel prognostic biomarker that determines cancer progression and also a target for the therapy of EC and correlated with tumor immune cells infiltration in EC.
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Salim S, Kartawidjajaputra F, Suwanto A. SIRT1 as a Potential Biomarker for Obesity. J Nutr Sci Vitaminol (Tokyo) 2021; 66:S324-S328. [PMID: 33612619 DOI: 10.3177/jnsv.66.s324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Asian people generally have thin figures; yet, they often suffer from hidden alarming metabolic conditions due to high visceral fat area (VFA). Therefore, it is crucial to have a biomarker to predict visceral obesity to prevent further complications. SIRT1, a NAD-dependent deacetylase gene, is responsible for upregulating lipolysis genes and is downregulated after acute high-fat meal consumption. However, the chronic exposure effect remains unknown. The purpose of this study was to assess the association between SIRT1 mRNA expression, fat intake, and visceral obesity in Indonesian population. METHODS This cross-sectional study involved 38 healthy subjects (20-30 y old, not suffering any chronic diseases or fever, not taking any medication or treatment, not smoking, not drinking alcohol frequently, not being pregnant, and not breastfeeding). Dietary patterns from 24-h food recall, physical activities fom international physical activity questionnaire (IPAQ), medical data from annual medical check-up, and body compositions were measured using InBody720 and compared with SIRT1 expression from peripheral blood mononuclear cells (PBMCs) samples. RESULTS Subjects with excessive percentage of body fat (PBF) had a significantly higher body mass index (BMI) (normal: 20.28±2.09, excessive: 23.86±3.71, p=0.023) and VFA (normal: 48.00±9.38, excessive: 79.17±16.14, p=5×1025). The SIRT1 mRNA expression was significantly higher in subjects with excessive PBF (normal: 1±0.43, excessive: 3.68±2.62, p=0.018) and positively correlated with PBF (ρ=0.376, p=0.045). CONCLUSION SIRT1 acted as a potential marker for obesity in the evaluated population.
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Affiliation(s)
- Stephen Salim
- Faculty of Biotechnology, Atma Jaya Catholic University of Indonesia
| | | | - Antonius Suwanto
- Faculty of Biotechnology, Atma Jaya Catholic University of Indonesia
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Donkers H, Fasmer KE, Mcgrane J, Pijnenborg JMA, Bekkers R, Haldorsen IS, Galaal K. Obesity and visceral fat: Survival impact in high-grade endometrial cancer. Eur J Obstet Gynecol Reprod Biol 2020; 256:425-432. [PMID: 33307325 DOI: 10.1016/j.ejogrb.2020.11.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Obesity is an important risk factor for the development of endometrial cancer (EC). Recent data showed that body fat distribution might be more relevant than Body Mass Index (BMI). High visceral fat percentage was shown to be an independent predictor for survival in EC, but mainly included grade 1-2 EC. OBJECTIVE To evaluate body fat distribution and its relation to outcome in high-grade endometrial cancer. METHODS Retrospective study in women diagnosed with high-grade EC between February 2006 and August 2017 at the Royal Cornwall Hospital who had abdominal CT-scan as part of routine diagnostic work-up. Subcutaneous abdominal fat volumes and visceral abdominal fat volumes were quantified based on CT-scan measurements, and visceral fat percentage calculated. RESULTS A total of 176 patients with high-grade EC were included. The median age was 70 years and median BMI was 29.4 kg/m2. The majority of patients had non-endometrioid endometrial cancer (NEEC; 62 %). High visceral fat percentage was associated with poor overall- and disease-specific survival (p = 0.006 and p = 0.026 respectively) in NEEC patients, but not in high-grade endometrioid EC (EEC). The most frequent obesity comorbidities hypertension and diabetes mellitus were significantly associated with high BMI and high visceral fat percentage. CONCLUSION In high-grade EC, high visceral fat percentage was an independent predictor of poor survival only in NEEC. The strong correlation between high visceral fat and obesity-related comorbidities might be reflective of an unhealthy macroenvironment.
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Affiliation(s)
- Hannah Donkers
- Royal Cornwall Hospital NHS Trust, Truro, Cornwall, United Kingdom
| | - Kristine E Fasmer
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital Bergen, Bergen, Norway; Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - John Mcgrane
- Royal Cornwall Hospital NHS Trust, Truro, Cornwall, United Kingdom
| | - Johanna M A Pijnenborg
- Department of Obstetrics & Gynecology, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruud Bekkers
- Grow School for Oncology and Developmental Biology, Maastricht University, the Netherlands; Catharina Hospital, Eindhoven, the Netherlands
| | - Ingfrid S Haldorsen
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital Bergen, Bergen, Norway; Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Khadra Galaal
- Royal Cornwall Hospital NHS Trust, Truro, Cornwall, United Kingdom.
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Smith CG, Sharma D, Smith H, Zippay S, Bastin L, Acosta-Briceno L, Lee J, Shelton B, Gorski J, Mcdowell A, Burgess B, Fredericks T, Miller R, Desimone C, Dietrich C, Gallion H, Ueland F, Pavlik E, Vannagell J, Baldwin L. Clinicopathological effects of body composition measurements for patients with endometrial cancer. Minerva Ginecol 2020; 72:430-435. [PMID: 32720803 DOI: 10.23736/s0026-4784.20.04629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Christopher G Smith
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA -
| | - Deepti Sharma
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
| | - Hagen Smith
- Department of Obstetrics and Gynecology, TriHealth Good Samaritan Hospital, Cincinnati, OH, USA
| | - Shelley Zippay
- Department of Obstetrics and Gynecology, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Liza Bastin
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | | | - James Lee
- Emergency Radiology and Abdominal Radiology, University of Kentucky, Lexington, KY, USA
| | - Brent Shelton
- Department of Biostatistics, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Justin Gorski
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
| | - Anthony Mcdowell
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
| | - Brian Burgess
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
| | - Tricia Fredericks
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rachel Miller
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
| | - Christopher Desimone
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
| | - Charles Dietrich
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
| | - Holly Gallion
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
| | - Frederick Ueland
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
| | - Edward Pavlik
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
| | - John Vannagell
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
| | - Lauren Baldwin
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY, USA
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11
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Celik E, Kizildag Yirgin I, Goksever Celik H, Engin G, Sozen H, Ak N, Saip P, Onder S, Topuz S, Salihoglu MY. Does visceral adiposity have an effect on the survival outcomes of the patients with endometrial cancer? J Obstet Gynaecol Res 2020; 47:560-569. [PMID: 33197987 DOI: 10.1111/jog.14560] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/22/2020] [Accepted: 10/16/2020] [Indexed: 01/18/2023]
Abstract
AIM Endometrial cancer is the most common cancer of the female reproductive tract in the developed countries. There are many risk factors defined for the development of endometrial cancer, including obesity. We aimed to evaluate the significance of adiposity on the survival outcomes of the patients with endometrial cancer. METHODS The patients diagnosed with endometrial cancer and underwent surgery between April 2009 and October 2017 were retrospectively reviewed. The visceral adipose tissue and subcutaneous adipose tissue volumes were measured at the level of umbilicus on single-slice magnetic resonance imaging. Visceral adiposity index was calculated. Patients were compared regarding their clinical, demographical, pathologic and survival characteristics. Patients divided into low visceral adiposity (≤0.265, group 1) and high visceral adiposity (>0.265, group 2). RESULTS A total of 186 patients were included in this retrospective study. There was no significant difference in terms of the demographical, clinical and tumor characteristics of the patients, except age, menopausal status, subcutaneous adipose tissue and visceral adipose tissue. Although no significant difference in progression-free survival and disease-specific survival was noted between groups (P = 0.181), more patients in group 2 died because of endometrial cancer as statistically significant (P = 0.024). Disease-specific survival showed a significant difference between groups according to the log-rank test. CONCLUSION Visceral adiposity tissue is a significant and reliable prognostic indicator for endometrial cancer prognosis. Women diagnosed with endometrial cancer should be informed about the deleterious effects of visceral adiposity on disease-specific survival.
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Affiliation(s)
- Engin Celik
- Department of Obstetrics and Gynecology, Health Sciences University Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Inci Kizildag Yirgin
- Department of Radiology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Hale Goksever Celik
- Department of Obstetrics and Gynecology, Health Sciences University Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Gulgun Engin
- Department of Radiology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Hamdullah Sozen
- Istanbul Faculty of Medicine, Department of Gynecologic Oncology, Istanbul University, Istanbul, Turkey
| | - Naziye Ak
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Pınar Saip
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Semen Onder
- Istanbul Faculty of Medicine, Department of Pathology, Istanbul University, Istanbul, Turkey
| | - Samet Topuz
- Istanbul Faculty of Medicine, Department of Gynecologic Oncology, Istanbul University, Istanbul, Turkey
| | - Mehmet Y Salihoglu
- Istanbul Faculty of Medicine, Department of Gynecologic Oncology, Istanbul University, Istanbul, Turkey
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12
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Hu Z, Wu J, Lai S, Xu Y, Zhan J, Li R, Liu X, Wang N, Wei X, Jiang X, Yang R. Clear cell renal cell carcinoma: the value of sex-specific abdominal visceral fat measured on CT for prediction of Fuhrman nuclear grade. Eur Radiol 2020; 30:3977-3986. [PMID: 32144457 DOI: 10.1007/s00330-020-06747-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore whether sex-specific abdominal visceral fat composition on CT can predict the Fuhrman nuclear grade of clear cell renal cell carcinoma (ccRCC). METHODS One hundred seventy-one patients (123 males and 48 females) from four hospitals (multicentre group) and 159 patients (109 males and 50 females) from the cancer imaging archive (TCIA-KIRC group) with pathologically proven ccRCC (multicentre: 124 low grade and 47 high grade; TCIA-KIRC: 79 low grade and 80 high grade) were retrospectively included. Abdominal fat was segmented into subcutaneous fat area (SFA) and visceral fat area (VFA) on CT using ImageJ. The total fat area (TFA) and relative VFA (rVFA) were then calculated. Clinical characteristics (age, sex, waist circumference and maximum tumour diameter) were also assessed. Univariate and multivariate logistic regression analyses were performed to identify the association between general or sex-specific visceral fat composition and Fuhrman grade. RESULTS Females with high-grade ccRCC from the multicentre group had a higher rVFA (42.4 vs 31.3, p = 0.001) than those with low-grade ccRCC after adjusting for age. There was no significant difference in males. The rVFA remained a stable and independent predictor for females high-grade ccRCC in both the univariate (multicentre: OR 1.205, 95% CI 1.074-1.352, p = 0.001; TCIA-KIRC: OR 1.171, 95% CI 1.016-1.349, p = 0.029) and multivariate (multicentre: OR 1.095, 95% CI 1.024-1.170, p = 0.003; TCIA-KIRC: OR 1.103, 95% CI 1.024-1.187, p = 0.010) models. CONCLUSIONS Sex-specific visceral fat composition has different values for predicting high-grade ccRCC and could be used as an independent predictor for females with high-grade ccRCC. KEY POINTS • Visceral fat measurement (rVFA) as an independent predictor for high-grade ccRCC had good predictive power in females, but not in males. • Sex-specific visceral fat composition was significantly associated with high-grade ccRCC in females only. • The rVFA could be considered one of the risk factors for high-grade ccRCC for females.
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Affiliation(s)
- Zexuan Hu
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, China
| | - Jialiang Wu
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, China
| | - Shengsheng Lai
- Department of Medical Devices, Guangdong Food and Drug Vocational College, Guangzhou, 510520, Guangdong, China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jie Zhan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Ran Li
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing, 400042, China
| | - Xilong Liu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Ningning Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, 511436, Guangdong, China
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, China.,Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Xinqing Jiang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, China.,Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Ruimeng Yang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, China. .,Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China.
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13
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Han X, Ren C, Yang T, Qiao P, Wang L, Jiang A, Meng Y, Liu Z, Du Y, Yu Z. Negative regulation of AMPKα1 by PIM2 promotes aerobic glycolysis and tumorigenesis in endometrial cancer. Oncogene 2019; 38:6537-6549. [PMID: 31358902 DOI: 10.1038/s41388-019-0898-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/09/2018] [Accepted: 04/16/2019] [Indexed: 01/07/2023]
Abstract
Endometrial cancer (EC) is one of the most common gynecologic malignancies. However, the molecular mechanisms underlying the development and progression of EC remain unclear. Here, we demonstrated that the protein proviral insertion in murine lymphomas 2 (PIM2) was necessary for maintaining EC tumorigenesis in vivo and in vitro, and could inhibit AMPKα1 kinase activity in EC cells. Specifically, we found that PIM2 bound to AMPKα1, and directly phosphorylated it on Thr467. Phosphorylation of AMPKα1 by PIM2 led to decreasing AMPKα1 kinase activity, which in turn promoted aerobic glycolysis and tumor growth. In addition, PIM2 expression positively correlated with AMPKα1 Thr467 phosphorylation in EC tissues. Further, treatment with a combination of the PIM2 inhibitor SMI-4a and the AMPKα1 activator AICAR could effectively inhibit tumor growth. Thus, our findings provide insight into the role of PIM2 and AMPKα1 in EC and suggest that combination targeting of these proteins may represent a new strategy for EC treatment.
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Affiliation(s)
- Xue Han
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, PR China
| | - Chune Ren
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, PR China
| | - Tingting Yang
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, PR China
| | - Pengyun Qiao
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, PR China
| | - Li Wang
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, PR China
| | - Aifang Jiang
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, PR China
| | - Yuhan Meng
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, PR China
| | - Zhijun Liu
- Department of Medical Microbiology, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Yu Du
- Department of Medical Microbiology, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Zhenhai Yu
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, PR China.
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14
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van Weelden WJ, Fasmer KE, Tangen IL, IntHout J, Abbink K, van Herwaarden AE, Krakstad C, Massuger LFAG, Haldorsen IS, Pijnenborg JMA. Impact of body mass index and fat distribution on sex steroid levels in endometrial carcinoma: a retrospective study. BMC Cancer 2019; 19:547. [PMID: 31174495 PMCID: PMC6555924 DOI: 10.1186/s12885-019-5770-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/29/2019] [Indexed: 12/25/2022] Open
Abstract
Background Obesity is an important cause of multiple cancer types, amongst which endometrial cancer (EC). The relation between obesity and cancer is complicated and involves alterations in insulin metabolism, response to inflammation and alterations in estradiol metabolism. Visceral obesity is assumed to play the most important role in the first two mechanisms, but its role in estradiol metabolism is unclear. Therefore, this retrospective study explores the relationship of body mass index (BMI), visceral fat volume (VAV) and subcutaneous fat volume (SAV) and serum levels of sex steroids and lipids in patients with endometrial cancer. Methods Thirty-nine postmenopausal EC patients with available BMI, blood serum and Computed Tomography (CT) scans were included. Serum was analyzed for estradiol, dehydroepiandrosterone sulfate (DHEAS), androstenedione, testosterone, cholesterol, triglycerides and high (HDL), low (LDL) and non-high density (NHDL) lipoprotein. VAV and SAV were quantified on abdominal CT scan images. Findings were interpreted using pearson correlation coefficient and linear regression with commonality analysis. Results Serum estradiol is moderately correlated with BMI (r = 0.62) and VAV (r = 0.58) and strongly correlated with SAV (r = 0.74) (p < 0.001 for all). SAV contributes more to estradiol levels than VAV (10.3% for SAV, 1.4% for VAV, 35.9% for SAV and VAV, p = 0.01). Other sex steroids and lipids have weak and moderate correlations with VAV or SAV. Conclusions This study shows that serum estradiol is correlated with BMI and other fat-distribution measures in postmenopausal endometrial cancer patients. Subcutaneous fat tissue contributes more to the estradiol levels indicating that subcutaneous fat might be relevant in endometrial cancer carcinogenesis. Electronic supplementary material The online version of this article (10.1186/s12885-019-5770-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Willem Jan van Weelden
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein 10, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Kristine Eldevik Fasmer
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital Bergen, Bergen, Norway.,Department of Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild L Tangen
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.,Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Joanna IntHout
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karin Abbink
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein 10, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | | | - Camilla Krakstad
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.,Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Leon F A G Massuger
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein 10, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Ingfrid S Haldorsen
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital Bergen, Bergen, Norway.,Department of Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein 10, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
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15
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Aşıcıoğlu O, Gungorduk K, Ozdemir A, Güngördük Ö, Gokçü M, Yaşar L, Sancı M. A novel preoperative scoring system based on 18-FDG PET-CT for predicting lymph node metastases in patients with high-risk endometrial cancer. J OBSTET GYNAECOL 2018; 39:105-109. [PMID: 30187784 DOI: 10.1080/01443615.2018.1467884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to develop a model predicting the probability of pelvic-paraaortic node metastases in high-risk endometrial cancer patients. This trial included 41 high-risk endometrial cancer patients. All of the patients underwent an 18-FDG PET-CT followed by surgical staging, including a pelvic and paraaortic lymphadenectomy. We developed a useful scoring system combining weighted risk factors derived from a regression model: (3 × presence PET-CT involvement) + (3 × PET-CT maximum standardised uptake value ≥20) + (2 × diabetes comorbidity) + (1 × age ≥60 years) + (1 × body mass index ≥30). The area under the curve of the resulting score was 0.848. There was 75% sensitivity, 89% specificity and a 75% positive predictive value and 89% negative predictive value when a score of 6 was used as the cut-off. Our novel preoperative scoring system is an accurate method for the preoperative evaluation of lymph node metastases, and thus will aid gynaecological oncologists in selecting EC patients who may benefit from a lymphadenectomy. Impact statement What is already known on this subject? Endometrial cancer (EC) is a common gynaecological malignancy. Surgical staging is currently the standard treatment and the gold standard for evaluating lymph node metastases (LNm) is a surgical assessment (Chan et al. 2006 ). Three previous randomised clinical studies failed to find a clear therapeutic role for the lymphadenectomy; thus, the utility of this surgical procedure in high-risk early-stage EC remains under debate (Benedetti Panici et al. 2008 ; Kitchener et al. 2009 ; Signorelli et al. 2015 ). Non-invasive techniques that accurately identify lymph node metastases would reduce costs and complications. What do the results of this study add? Our developed novel scoring system that is based on positron emission tomography-computer tomography (PET-CT) with 2-deoxy-2-(18F) flouro-2-D-glucose (FDG) may facilitate the identification of patients at an increased risk of LNm. What are the implications of these finding for clinical practice and/or further research? This study shows that our novel preoperative scoring system provides an accurate method for the preoperative evaluation of LNm, and thus could guide gynaecologic oncologists in selecting the high-risk endometrial cancer patients who may benefit from a systematic lymphadenectomy. Further larger, prospective studies are needed to confirm the accuracy and the feasibility of our scoring system.
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Affiliation(s)
- Osman Aşıcıoğlu
- a Department of Gynecologic Oncology , Kanuni Sultan Suleyman Education and Research Hospital , Istanbul , Turkey
| | - Kemal Gungorduk
- b Department of Gynecologic Oncology , Mugla Sıtkı Kocman University Education and Research Hospital , Mugla , Turkey
| | - Aykut Ozdemir
- c Department of Gynecologic Oncology , Dr Sadi Konuk Education and Research Hospital , Istanbul , Turkey
| | - Özgü Güngördük
- b Department of Gynecologic Oncology , Mugla Sıtkı Kocman University Education and Research Hospital , Mugla , Turkey
| | - Mehmet Gokçü
- d Department of Gynecologic Oncology , Tepecik Education and Research Hospital , Izmir , Turkey
| | - Levent Yaşar
- c Department of Gynecologic Oncology , Dr Sadi Konuk Education and Research Hospital , Istanbul , Turkey
| | - Muzaffer Sancı
- d Department of Gynecologic Oncology , Tepecik Education and Research Hospital , Izmir , Turkey
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16
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Rzechonek A, Błasiak P, Pniewski G, Cierpikowski P, Mościbrodzka M, Ornat M, Grzegrzółka J, Brzecka A. Influence of Obesity on the Course of Malignant Neoplastic Disease in Patients After Pulmonary Metastasectomy. ACTA ACUST UNITED AC 2017; 32:197-202. [PMID: 29275320 DOI: 10.21873/invivo.11225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM The aim of the study was to determine whether increased body mass index (BMI) in patients operated on for lung metastases influences the course of the disease. MATERIALS AND METHODS The retrospective data of 97 patients previously operated on for different malignancies were analyzed. There were 40 obese patients (BMI >30 kg/m2, mean 33.9±4.5) and 57 non-obese patients (BMI 25.8±2.7 kg/m2, p<0.001). Disease-free interval (DFI), the overall survival (OS) and survival after pulmonary metastasectomy were analyzed. RESULTS DFI and OS were longer in obese than in non-obese patients (82.1±83.5 months vs. 43.0±44.4, p<0.01 and 110.7±81.3 months vs. 69.9±52.9 p<0.005, respectively). Survival after pulmonary metastasectomy was 27.2±25.6 months and was longer in obese and overweight patients than in normal weight patients (20.2±18.4 months vs. 29.4±26.5, p<0.05). CONCLUSION Being obese or overweight is a favorable prognostic factor in patients after surgical resection of lung metastases of different malignancies.
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Affiliation(s)
- Adam Rzechonek
- Department and Clinic of Thoracic Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Błasiak
- Department and Clinic of Thoracic Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Pniewski
- Department of Thoracic Surgery, Lower Silesian Centre for Lung Diseases, Wroclaw, Poland
| | - Piotr Cierpikowski
- Department and Clinic of Thoracic Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Mościbrodzka
- Institute of Economic Sciences, Department of Statistics and Operational Research, University of Wroclaw, Wroclaw, Poland
| | - Maciej Ornat
- Department of Histology and Embryology, Wroclaw Medical University, Wroclaw, Poland
| | - Jędrzej Grzegrzółka
- Department of Histology and Embryology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Brzecka
- Department and Clinic of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
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17
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Ferron G, De Santiago J, Querleu D, Martinez A, Angeles MA, Boulet B, Guyon F, Zapardiel I. Left Lateral Endosurgical Extraperitoneal Total Hysterectomy with Para-Aortic and Pelvic Lymphadenectomy: A Novel Approach for the Obese Patient with Endometrial Cancer. J Minim Invasive Gynecol 2018; 25:730-6. [PMID: 29229578 DOI: 10.1016/j.jmig.2017.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/24/2017] [Accepted: 11/28/2017] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To describe the left lateral extraperitoneal approach to perform complete para-aortic and pelvic lymphadenectomy and transverse total hysterectomy from left to right as a novel approach to treat obese patients with endometrial cancer. Laparoscopic management of obese patients represents a challenge for the gynecologic surgeon. The extraperitoneal approach is technically easier in the obese patient because it naturally creates a bowel-free operative field. DESIGN A prospective pilot bicentric and descriptive study (Canadian Task Force classification III) evaluating the feasibility and reproducibility of the transverse total hysterectomy and complete lymphadenectomy through left endoscopic extraperitoneal approach in obese patients with endometrial cancer. SETTING A comprehensive cancer center in Toulouse and a teaching university hospital in Madrid. PATIENTS Sixteen consecutive overweight or obese patients (body mass index > 25 kg/m2) with high-risk endometrial cancer. INTERVENTIONS Currently, the left extraperitoneal approach is routinely used to perform complete para-aortic and pelvic lymphadenectomy. It provides direct access to the left ureter and uterine pedicle. This access can be extended to the right side when performing a transverse extrafascial hysterectomy from left to right. The procedure starts from the left extraperitoneal space, where the left uterine artery is sectioned and the vesicovaginal and rectovaginal septa are developed, without opening the peritoneum. Colpotomy is performed from the left to the right side. Once the right ureter is identified, the right uterine artery can be safely transected. Alternatively, the right uterine artery can be sealed and sectioned during the right pelvic lymphadenectomy. At the end of the procedure the peritoneum is opened to complete the surgery. MEASUREMENTS AND MAIN RESULTS Between May 2015 and February 2016, 16 consecutive obese patients were successfully treated using this technique. Median patient age was 62 years (range, 44-78), and median body mass index was 32.5 kg/m2 (range, 26-42). In 3 cases the right uterine artery was sealed during the right pelvic lymphadenectomy, in 11 cases after completing vaginal opening, and in 2 cases after peritoneal opening. The median operative time was 137.5 minutes (range, 66-260). The median blood loss was 85 mL (range, 0-260), and no blood transfusion was required in any of our 16 patients. No significant complications occurred. CONCLUSION The full extraperitoneal approach represents an interesting alternative strategy for the surgical treatment of obese patients with high-risk endometrial cancer.
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18
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Okamura A, Watanabe M, Yamashita K, Yuda M, Hayami M, Imamura Y, Mine S. Implication of visceral obesity in patients with esophageal squamous cell carcinoma. Langenbecks Arch Surg 2018; 403:245-53. [PMID: 29196841 DOI: 10.1007/s00423-017-1643-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/24/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Visceral obesity is considered to be associated not only with chronic systemic inflammation but also with aggressive cancer behavior. However, the implication of visceral obesity in patients with esophageal squamous cell carcinoma (ESCC) is unclear. METHODS Computed tomography volumetry was performed in 364 patients who underwent esophagectomy for ESCC. We calculated the ratio of the visceral fat area to the subcutaneous fat area (VS ratio), which is a valuable parameter of visceral obesity. Then, the clinicopathological characteristics were compared between patients with low VS ratio and those with high VS ratio. RESULTS Overall and disease-specific survivals of patients with high VS ratio were significantly worse than those with low VS ratio (P < 0.001 in both). Patients with high VS ratio had considerably more advanced pN factor, higher prevalence of lymphatic invasion, and more number of metastatic lymph nodes than those with low VS ratio (P = 0.044, < 0.001, and 0.006, respectively). Among patients who received preoperative treatment, high VS ratio correlated with poor response to preoperative treatment (P = 0.040). CONCLUSIONS Visceral obesity was associated with lymphatic invasiveness and poor response to preoperative treatment in patients with ESCC, which may negatively influence their prognosis.
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gao Y, Dai X, Chen L, Lee AC, Tong M, Wise M, Chen Q. Body Mass Index Is Positively Associated with Endometrial Cancer in Chinese Women, Especially Prior to Menopause. J Cancer 2016; 7:1169-73. [PMID: 27326261 PMCID: PMC4911885 DOI: 10.7150/jca.15037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/26/2016] [Indexed: 12/24/2022] Open
Abstract
Objective: Obesity is a well-known risk factor for developing endometrial cancer. However, the incidence and survival rate of endometrial cancer are associated with ethnicity and geographical area. In addition, whether menopausal status is associated with developing endometrial cancer in obese women and whether obesity is associated with subtypes of endometrial cancer have not been fully investigated. Here, we investigated the effect of BMI on developing endometrial cancer in Chinese women taking into account menopausal status and cancer subtypes. Methods: Data on 1,127 women with endometrial cancer including body mass index (BMI), age at diagnosis, parity, menopausal status and cancer subtype were collected from the largest obstetrics & gynaecology hospital in China and analysed. Results: After adjusting for age and parity, the odds for developing endometrial cancer in overweight or obese perimenopausal women was significantly higher than that in women with normal weight (OR=2.6 with 95%CI:1.9-3.5, and OR=3.5 with 95%CI: 2.2-5.4, respectively). The odds of developing endometrial cancer in overweight postmenopausal women were significantly higher than that in women who were normal weight (OR=2.4 with 95%CI: 1.8-3.1), however this was not the case for obese postmenopausal women. We further found that BMI, menopausal status, age and parity were not associated with subtypes of endometrial cancer. Conclusion: Our data demonstrate that obesity is positively associated with the incidence of developing endometrial cancer in Chinese women, with more significant effects in perimenopausal women.
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Affiliation(s)
- Yifei Gao
- 1. The Hospital of Obstetrics & Gynaecology, Fudan University, China
| | - Xujing Dai
- 1. The Hospital of Obstetrics & Gynaecology, Fudan University, China
| | - Limei Chen
- 1. The Hospital of Obstetrics & Gynaecology, Fudan University, China
| | - Arier C Lee
- 2. Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, New Zealand
| | - Mancy Tong
- 3. Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Michelle Wise
- 3. Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Qi Chen
- 1. The Hospital of Obstetrics & Gynaecology, Fudan University, China; 3. Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
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