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Okunade KS, Akinmola OO, Adekanye TV, Packson A, Adelabu H, Thomas-Ogodo O, Okoro AC, Okoye C, Anorlu RI. Impact of obesity on survival outcomes of women with advanced epithelial ovarian cancer in Lagos, Nigeria: a retrospective cohort study. Ecancermedicalscience 2024; 18:1743. [PMID: 39421179 PMCID: PMC11484675 DOI: 10.3332/ecancer.2024.1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Indexed: 10/19/2024] Open
Abstract
Background Epithelial ovarian cancer (EOC) is a major contributor to cancer-related illness and death among women worldwide. Obesity, a prevalent condition in many populations, has been implicated as a risk factor for various malignancies including EOC. Objectives This study investigated the impact of obesity on survival outcomes among women with advanced EOC in Lagos, Nigeria. Methods We conducted a retrospective analysis of patient medical records from a major gynaecological cancer unit of a teaching hospital in Lagos, Southwest Nigeria, to examine the relationship between body mass index (BMI) 30 kg/m2 as a measure of obesity, and progression-free (PFS) and overall survival (OS). We used Kaplan-Meier analysis stratified by patients' BMI categories (obese versus non-obese) and compared using the Log Rank test to estimate PFS and OS. The multivariable Cox proportional hazard model was used to estimate hazard ratios (HR) of the associations between the BMI categories and survival outcomes while adjusting for all confounding clinicopathologic variables. Hypothesis tests were conducted using a two-tailed approach with a significance level of 5%. Results Our study showed no statistically significant association between obesity and PFS (adjusted HR = 0.62, 95% confidence interval = 0.36-1.06, p = 0.282). However, a significant association was observed between obesity with or without ascites and OS (adjusted HR = 3.58, 95% confidence interval 1.28-10.02, p = 0.015). Conclusion Our findings suggest that obesity negatively impacts OS in patients with EOC, thus highlighting the need to address obesity in the management of EOC by introducing comprehensive, multidisciplinary approaches incorporating weight management and personalized treatment strategies to enhance the prognosis of these patients.
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, PMB 12003, Surulere, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Surulere, Lagos, Nigeria
- Center for Clinical Trials, Research and Implementation Science, College of Medicine, University of Lagos, PMB 12003, Surulere, Lagos, Nigeria
| | - Olukayode O Akinmola
- Department of Clinical Pathology, Lagos University Teaching Hospital, PMB 12003, Surulere, Lagos Nigeria
| | - Temitope V Adekanye
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Surulere, Lagos, Nigeria
| | - Akhenamen Packson
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Surulere, Lagos, Nigeria
| | - Hameed Adelabu
- Center for Clinical Trials, Research and Implementation Science, College of Medicine, University of Lagos, PMB 12003, Surulere, Lagos, Nigeria
| | - Olufemi Thomas-Ogodo
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Surulere, Lagos, Nigeria
| | - Austin C Okoro
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Surulere, Lagos, Nigeria
| | - Chinelo Okoye
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Surulere, Lagos, Nigeria
| | - Rose I Anorlu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, PMB 12003, Surulere, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Surulere, Lagos, Nigeria
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Pavone M, Goglia M, Taliento C, Lecointre L, Bizzarri N, Fanfani F, Fagotti A, Scambia G, Marescaux J, Querleu D, Seeliger B, Akladios C. Obesity paradox: is a high body mass index positively influencing survival outcomes in gynecological cancers? A systematic review and meta-analysis. Int J Gynecol Cancer 2024; 34:1253-1262. [PMID: 38642923 DOI: 10.1136/ijgc-2023-005252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE Obesity represents an exponentially growing preventable disease leading to different health complications, particularly when associated with cancer. In recent years, however, an 'obesity paradox' has been hypothesized where obese individuals affected by cancer counterintuitively show better survival rates. The aim of this systematic review and meta-analysis is to assess whether the prognosis in gynecological malignancies is positively influenced by obesity. METHODS This study adheres to PRISMA guidelines and is registered with PROSPERO. Studies reporting the impact of a body mass index (BMI) of >30 kg/m2 compared with <30 kg/m2 in patients with gynecological cancers listed in PubMed, Google Scholar and ClinicalTrials.gov were included in the analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2) was used for quality assessment of the selected articles. RESULTS Twenty-one studies were identified for the meta-analysis, including 14 108 patients with cervical, ovarian, or endometrial cancer. There was no benefit in 5-year overall survival for obese patients compared with non-obese patients (OR 1.2, 95% CI 1.00 to 1.44, p=0.05; I2=71%). When pooling for cancer sub-groups, there were no statistically significant differences in 5-year overall survival in patients with cervical cancer and 5-year overall survival and progression-free survival in patients with ovarian cancer. For obese women diagnosed with endometrial cancer, a significant decrease of 44% in 5-year overall survival (p=0.01) was found, with no significant difference in 5-year disease-free survival (p=0.78). CONCLUSION According to the results of the present meta-analysis, a BMI of ≥30 kg/m2 does not have a positive prognostic effect on survival compared with a BMI of <30 kg/m2 in women diagnosed with gynecological cancers. The existence of the 'obesity paradox' in other fields, however, suggests the importance of further investigations with prospective studies.
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Affiliation(s)
- Matteo Pavone
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Research Institute against Digestive Cancer, IRCAD France, Strasbourg, France
| | - Marta Goglia
- Research Institute against Digestive Cancer, IRCAD France, Strasbourg, France
- Department of Medical and Surgical Science and Translational Medicine, Faculty of Medicine and Psycology, Sapienza University of Rome, Rome, Italy
| | - Cristina Taliento
- Department of Obstetrics and Gynecology, University Hospital Ferrara, Ferrara, Italy
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Lise Lecointre
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Department of Gynecology, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Jacques Marescaux
- Research Institute against Digestive Cancer, IRCAD France, Strasbourg, France
| | - Denis Querleu
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Barbara Seeliger
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Department of Digestive and Endocrine Surgery, The University Hospitals of Strasbourg, Strasbourg, France
| | - Chérif Akladios
- Department of Gynecology, Hôpitaux universitaires de Strasbourg, Strasbourg, France
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3
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Levin G, Brezinov Y, Tzur Y, Bar-Noy T, Brodeur MN, Salvador S, Lau S, Gotlieb W. Association between BMI and oncologic outcomes in epithelial ovarian cancer: a predictors-matched case-control study. Arch Gynecol Obstet 2024; 310:587-593. [PMID: 38714562 PMCID: PMC11168986 DOI: 10.1007/s00404-024-07537-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/24/2024] [Indexed: 05/10/2024]
Abstract
OBJECTIVE We aimed to study the association between obesity and survival in ovarian cancer (OC) patients, accounting for confounders as disease stage, histology, and comorbidities. METHODS Retrospective matched case-control study of consecutive patients, with epithelial OC. Obese (body mass index [BMI] ≥ 35 kg m-2) patients were matched in a 1:4 ratio with patients having lower BMIs (BMI < 35 kg m-2) based on disease stage, cytoreduction state, tumor histology and ASA score. We compared the 3-year and total recurrence-free survival and overall survival through Kaplan-Meier survival curves and Cox proportional hazards. RESULTS Overall, 153 consecutive patients were included, of whom 32 (20.9%) had a BMI ≥ 35. and 121 a BMI < 35. The median follow-up time was 39 months (interquartile range 18-67). Both study groups were similar in multiple prognostic factors, including American Society of Anesthesiologists physical status, completion of cytoreduction, histology and stage of disease (p = 0.981, p = 0.992, p = 0.740 and p = 0.984, respectively). Ninety-five (62.1%) patients underwent robotic surgery and conversion rate from robotic to laparotomy was similar in both groups 2 (6.3%) in obese group vs. 6 (5.0%) in lower BMI patients, p = 0.673. During the follow-up time, the rate of recurrence was similar in both groups; 21 (65.6%) in obese group vs. 68 (57.1%), p = 0.387 and the rate of death events was similar; 16 (50.0%) in obese group vs. 49 (40.5%), p = 0.333). The 3-year OS was higher in the obese group (log rank p = 0.042) but the 3-year RFS was similar in both groups (log rank p = 0.556). Median total OS was similar in both groups 62 months (95% confidence interval 25-98 months) in obese vs. 67 months (95% confidence interval 15-118) in the lower BMI group, log rank p = 0.822. Median RFS was similar in both groups; 61 months (95% confidence interval 47-74) in obese, vs. 54 (95% confidence interval 43-64), log rank p = 0.842. In Cox regression analysis for OS, including obesity, age, laparotomy and neoadjuvant treatment - only neoadjuvant treatment was independently associated with longer OS: odds ratio 1.82 (95% confidence interval 1.09-3.05) and longer RFS: odds ratio 2.16 (95% confidence interval 1.37-3.41). CONCLUSIONS In the present study on consecutive cases of ovarian cancer, obesity did not seem to be associated with outcome, except for an apparent improved 3-year survival that faded away thereafter.
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Affiliation(s)
- Gabriel Levin
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
| | - Yoav Brezinov
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, QC, Canada
| | - Yossi Tzur
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, QC, Canada
| | - Tomer Bar-Noy
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, QC, Canada
| | | | - Shannon Salvador
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Walter Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Cao A, Cartmel B, Li FY, Gottlieb LT, Harrigan M, Ligibel JA, Gogoi R, Schwartz PE, Irwin ML, Ferrucci LM. Effect of exercise on body composition among women with ovarian cancer. J Cancer Surviv 2023; 17:1386-1396. [PMID: 35377104 PMCID: PMC9530065 DOI: 10.1007/s11764-022-01207-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Obesity is associated with a higher risk of mortality in women with ovarian cancer. Exercise has improved body composition among cancer survivors, yet no randomized controlled trial has explored the effect of exercise on body composition in women with ovarian cancer. In this analysis, we examined the effect of a six-month aerobic exercise intervention on body composition among ovarian cancer survivors in the Women's Activity and Lifestyle Study in Connecticut (WALC). METHODS Women with ovarian cancer (N = 144) were randomized in a 1:1 ratio to 6 months of an aerobic exercise intervention or attention-control, and body composition was measured as a secondary outcome at baseline and 6 months via dual-energy X-ray absorptiometry (DEXA). Women with at least one DEXA scan were included in the analysis (N = 103). RESULTS On average, participants were 57.1 (± 8.7) years old and 1.6 (± 0.9) years since diagnosis. Women randomized to exercise maintained weight during the trial (- 0.11 kg, P = 0.82), while women in attention-control gained weight (+ 1.40 kg, P = 0.03); however, the between-group difference did not reach statistical significance (P = 0.09). We found no statistically significant differences by study arm for changes in body fat percentage, bone mineral density, or lean body mass. CONCLUSIONS Weight was maintained as a result of a 6-month aerobic exercise intervention among post-treatment ovarian cancer survivors. Future exercise and healthy eating interventions should consider additional measures (e.g., computer tomography scans, D3-creatinine) to more accurately assess changes in body composition. IMPLICATIONS FOR CANCER SURVIVORS Moderate-intensity aerobic exercise may help ovarian cancer survivors maintain weight.
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Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA.
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Fang-Yong Li
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | - Linda T Gottlieb
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | - Maura Harrigan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | | | | | - Peter E Schwartz
- Geisinger Health System, Danville, PA, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Leah M Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
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Fanale D, Brando C, Corsini LR, Cutaia S, Di Donna MC, Randazzo U, Filorizzo C, Lisanti C, Magrin L, Gurrera V, Romano R, Dimino A, Bazan Russo TD, Olive D, Vieni S, Pantuso G, Giordano A, Chiantera V, Russo A, Bazan V, Iovanna JL. Low plasma PD-L1 levels, early tumor onset and absence of peritoneal carcinomatosis improve prognosis of women with advanced high-grade serous ovarian cancer. BMC Cancer 2023; 23:437. [PMID: 37179293 PMCID: PMC10183131 DOI: 10.1186/s12885-023-10911-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The most common subtype of ovarian cancer (OC) showing immunogenic potential is represented by the high-grade serous ovarian cancer (HGSOC), which is characterized by the presence of tumor-infiltrating immune cells able to modulate immune response. Because several studies showed a close correlation between OC patient's clinical outcome and expression of programmed cell death protein-1 or its ligand (PD-1/PD-L1), the aim of our study was to investigate if plasma levels of immunomodulatory proteins may predict prognosis of advanced HGSOC women. PATIENTS AND METHODS Through specific ELISA tests, we analyzed plasma concentrations of PD-L1, PD-1, butyrophilin sub-family 3A/CD277 receptor (BTN3A1), pan-BTN3As, butyrophilin sub-family 2 member A1 (BTN2A1), and B- and T-lymphocyte attenuator (BTLA) in one hundred patients affected by advanced HGSOC, before surgery and therapy. The Kaplan-Meier method was used to generate the survival curves, while univariate and multivariate analysis were performed using Cox proportional hazard regression models. RESULTS For each analyzed circulating biomarker, advanced HGSOC women were discriminated based on long (≥ 30 months) versus short progression-free survival (PFS < 30 months). The concentration cut-offs, obtained by receiver operating characteristic (ROC) analysis, allowed to observe that poor clinical outcome and median PFS ranging between 6 and 16 months were associated with higher baseline levels of PD-L1 (> 0.42 ng/mL), PD-1 (> 2.48 ng/mL), BTN3A1 (> 4.75 ng/mL), pan-BTN3As (> 13.06 ng/mL), BTN2A1 (> 5.59 ng/mL) and BTLA (> 2.78 ng/mL). Furthermore, a lower median PFS was associated with peritoneal carcinomatosis, age at diagnosis > 60 years or Body Mass Index (BMI) > 25. A multivariate analysis also suggested that plasma concentrations of PD-L1 ≤ 0.42 ng/mL (HR: 2.23; 95% CI: 1.34 to 3.73; p = 0.002), age at diagnosis ≤ 60 years (HR: 1.70; 95% CI: 1.07 to 2.70; p = 0.024) and absence of peritoneal carcinomatosis (HR: 1.87; 95% CI: 1.23 to 2.85; p = 0.003) were significant prognostic marker for a longer PFS in advanced HGSOC patients. CONCLUSIONS The identification of high-risk HGSOC women could be improved through determination of the plasma PD-L1, PD-1, BTN3A1, pan-BTN3As, BTN2A1 and BTLA levels.
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Affiliation(s)
- Daniele Fanale
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy.
| | - Chiara Brando
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy
| | - Lidia Rita Corsini
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy
| | - Sofia Cutaia
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy
| | | | - Ugo Randazzo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy
| | - Clarissa Filorizzo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy
| | - Chiara Lisanti
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy
| | - Luigi Magrin
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy
| | - Vittorio Gurrera
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy
| | - Raffaella Romano
- Department of Gynecologic Oncology, University of Palermo, Palermo, 90127, Italy
| | - Alessandra Dimino
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy
| | | | - Daniel Olive
- Team Immunity and Cancer, Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes, Marseille, France
| | - Salvatore Vieni
- Division of General and Oncological Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, 90127, Italy
| | - Gianni Pantuso
- Division of General and Oncological Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, 90127, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, PA, Philadelphia, 19122, USA
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, 90127, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy.
- Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, PA, Philadelphia, 19122, USA.
| | - Viviana Bazan
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, 90127, Italy
| | - Juan Lucio Iovanna
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes, Parc Scientifique Et Technologique de Luminy, Marseille, 13288, France
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Kakinuma T, Kakinuma K, Shinohara T, Shimizu A, Okamoto R, Kaneko A, Takeshima N, Yanagida K, Ohwada M. Efficacy and safety of an Aron Alpha method in managing giant ovarian tumors. Gynecol Oncol Rep 2023; 46:101167. [PMID: 37033210 PMCID: PMC10073634 DOI: 10.1016/j.gore.2023.101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Background Giant malignant tumors have an increased risk of intraoperative rupture, which might lead to a worse disease condition and tumor recurrence. We performed a clinical study on patients with a giant ovarian mass who underwent laparoscopy combined with an Aron Alpha method. Methods This retrospective clinical study spanned from January 2016 to September 2022 and included 23 patients with giant ovarian tumors treated with an Aron Alpha method. Results The mean age of the subjects was 47.6 ± 17.8 years, mean tumor diameter 20.4 ± 5.8 cm, mean surgical duration 87.2 ± 33.1 min, and mean hemorrhage volume 94.1 ± 92.2 mL. No patient experienced intraoperative tumor rupture or surgery-related symptoms. Histopathology of excised samples revealed serous cyst adenoma and mucinous cystadenoma, mucinous cystadenoma of borderline malignancy and mature cystic teratoma, and endometriotic cyst adenoma in 6, 4, and 3 patients, respectively. The mean hospitalization period was 6.0 ± 1.2 days, and the hospitalization period was not extended in any subject. Conclusion The Aron Alpha method allows tumor resection without capsular rupture and is a useful, minimally invasive surgical method for resecting giant ovarian tumors in which malignancy cannot be ruled out.
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Total Polyunsaturated Fatty Acid Level in Abdominal Adipose Tissue as an Independent Predictor of Recurrence-Free Survival in Women with Ovarian Cancer. Int J Mol Sci 2023; 24:ijms24021768. [PMID: 36675280 PMCID: PMC9863501 DOI: 10.3390/ijms24021768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/01/2023] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
Prognostic factors for epithelial ovarian cancers (EOCs) are in particular clinical factors such as pathology staging at diagnosis (FIGO stages), genetic mutation, or histological phenotypes. In the present study, FIGO stage, tumor residue after surgery, and body mass index were clinical predictors of recurrence-free survival (RFS). Nonetheless, a number of studies support a lipid metabolism disorder in ovarian cancer patients. The objective of this pilot study was to explore whether fatty acid composition of adipose reflecting the qualitative dietary intake and fatty acids metabolism may be associated with RFS. Forty-six women with EOCs and six with borderline ovarian tumors between March 2017 and January 2020 were included in this prospective study at Tours university teaching hospital (central France). The patients involved in the present study are part of the METERMUS trial (clinicaltrials.gov NCT03027479). Adipose tissue specimens from four abdominal locations (superficial and deep subcutaneous, visceral (pericolic), and omental) were collected during surgery or exploratory laparoscopy. A fatty acid profile of adipose tissue triglycerides was established by gas chromatography. Fatty acids composition was compared among the four locations using nonparametric Friedman’s ANOVA test for repeated measures. Median follow-up of EOC patients was 15 months and patients’ RFS was analyzed using Kaplan−Meier survival curves and log-rank test by separating patients into two groups according to median fatty acid levels. The content of long-chain saturated fatty acids (SFAs) was increased and that of long-chain polyunsaturated fatty acids (PUFAs) decreased in deep versus superficial subcutaneous adipose tissue in EOC patients. Nevertheless, the content of total SFAs was ~28%, monounsaturated fatty acids (MUFAs) ~55%, PUFAs n-6 ~11.5%, and PUFAs n-3 about 1.3%, whatever the adipose tissue. When EOC patients were separated into two groups by median fatty acid content, total PUFAs (n-6+n-3) levels, whatever the adipose tissue, were positively and independently associated with RFS. RFS was about two times longer in EOC patients with high versus low total PUFA content (median survival: 12 vs. 27 months, p = 0.01 to <0.0001 according to the tissue). Content of total PUFAs (n-6+n-3) in abdominal adipose tissue (visceral and subcutaneous) are new prognostic factors in EOC.
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8
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Influence of interdisciplinary frailty screening on perioperative complication rates in elderly ovarian cancer patients: results of a retrospective observational study. Arch Gynecol Obstet 2022; 307:1929-1940. [PMID: 36434440 PMCID: PMC10147799 DOI: 10.1007/s00404-022-06850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose
Frailty is a frequent and underdiagnosed multidimensional age-related syndrome, involving decreased physiological performance reserves and marked vulnerability against major stressors. To standardize the preoperative frailty assessment and identify patients at risk of adverse surgical outcomes, commonly used global health assessment tools were evaluated. We aimed to assess three interdisciplinary preoperative screening assessments to investigate the influence of frailty status with in-hospital complications irrespective of surgical complexity and radicality in older women with ovarian cancer (OC).
Methods
Preoperative frailty status was examined by the G8 geriatric screening tool (G8 Score-geriatric screening), Eastern Cooperative Oncology Group performance status (ECOG PS-oncological screening), and American Society of Anesthesiologists Physical Status System (ASA PS-anesthesiologic screening). The main outcome measures were the relationship between perioperative laboratory results, intraoperative surgical parameters and the incidence of immediate postoperative in-hospital complications with the preoperative frailty status.
Results
116 consecutive women 60 years and older (BMI 24.8 ± 5.2 kg/m2) with OC, who underwent elective oncological surgery in University Medical Center Mainz between 2008 and 2019 were preoperatively classified with the selected global health assessment tools as frail or non-frail. The rate of preoperative anemia (hemoglobin ≤ 12 g/dl) and perioperative transfusions were significantly higher in the G8-frail group (65.9% vs. 34.1%; p = 0.006 and 62.7% vs. 41.8%, p = 0.031; respectively). In addition, patients preoperatively classified as G8-frail exhibited significantly more postoperative clinical in-hospital complications (27.8% vs. 12.5%, p = 0.045) independent of chronological age and BMI. In contrast, ECOG PS and ASA PS did not predict the rates of postoperative complications (all p values > 0.05). After propensity score matching, the complication rate in the G8-frail cohort was approximately 1.7 times more common than in the G8-non-frail cohort.
Conclusion
Preoperative frailty assessment with the G8 Score identified elderly women with OC recording a significantly higher rate of postoperative in-hospital complications. In G8-frail patients, preoperative anemia and perioperative transfusions were significantly more recorded, regardless of chronological age, abnormal BMI and surgical complexity. Standardized preoperative frailty assessment should be added to clinical routine care to enhance risk stratification in older cancer individuals for surgical patient-centered decision-making.
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Stelten S, Schofield C, Hartman YAW, Lopez P, Kenter GG, Newton RU, Galvão DA, Hoedjes M, Taaffe DR, van Lonkhuijzen LRCW, McIntyre C, Buffart LM. Association between Energy Balance-Related Factors and Clinical Outcomes in Patients with Ovarian Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:4567. [PMID: 36230490 PMCID: PMC9559499 DOI: 10.3390/cancers14194567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background: This systematic review and meta-analysis synthesized evidence in patients with ovarian cancer at diagnosis and/or during first-line treatment on; (i) the association of body weight, body composition, diet, exercise, sedentary behavior, or physical fitness with clinical outcomes; and (ii) the effect of exercise and/or dietary interventions. Methods: Risk of bias assessments and best-evidence syntheses were completed. Meta-analyses were performed when ≥3 papers presented point estimates and variability measures of associations or effects. Results: Body mass index (BMI) at diagnosis was not significantly associated with survival. Although the following trends were not supported by the best-evidence syntheses, the meta-analyses revealed that a higher BMI was associated with a higher risk of post-surgical complications (n = 5, HR: 1.63, 95% CI: 1.06−2.51, p = 0.030), a higher muscle mass was associated with a better progression-free survival (n = 3, HR: 1.41, 95% CI: 1.04−1.91, p = 0.030) and a higher muscle density was associated with a better overall survival (n = 3, HR: 2.12, 95% CI: 1.62−2.79, p < 0.001). Muscle measures were not significantly associated with surgical or chemotherapy-related outcomes. Conclusions: The prognostic value of baseline BMI for clinical outcomes is limited, but muscle mass and density may have more prognostic potential. High-quality studies with comprehensive reporting of results are required to improve our understanding of the prognostic value of body composition measures for clinical outcomes. Systematic review registration number: PROSPERO identifier CRD42020163058.
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Affiliation(s)
- Stephanie Stelten
- Department of Physiology, Radboud Institute of Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Christelle Schofield
- Exercise Medicine Research Institute, Edith Cowan University, Perth 6027, Australia
| | - Yvonne A. W. Hartman
- Department of Physiology, Radboud Institute of Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Pedro Lopez
- Exercise Medicine Research Institute, Edith Cowan University, Perth 6027, Australia
| | - Gemma G. Kenter
- Department of Obstetrics and Gyneacology, Center for Gynaecologic Oncology Amsterdam (CGOA), Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam (CGOA), The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Center for Gynecologic Oncology Amsterdam (CGOA), Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Robert U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth 6027, Australia
| | - Daniel A. Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth 6027, Australia
| | - Meeke Hoedjes
- Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychological and Somatic Disorders, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Dennis R. Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Perth 6027, Australia
| | - Luc R. C. W. van Lonkhuijzen
- Department of Obstetrics and Gyneacology, Center for Gynaecologic Oncology Amsterdam (CGOA), Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Carolyn McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, Perth 6027, Australia
| | - Laurien M. Buffart
- Department of Physiology, Radboud Institute of Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Exercise Medicine Research Institute, Edith Cowan University, Perth 6027, Australia
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10
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Khanlarkhani N, Azizi E, Amidi F, Khodarahmian M, Salehi E, Pazhohan A, Farhood B, Mortezae K, Goradel NH, Nashtaei MS. Metabolic risk factors of ovarian cancer: a review. JBRA Assist Reprod 2022; 26:335-347. [PMID: 34751020 PMCID: PMC9118962 DOI: 10.5935/1518-0557.20210067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/29/2021] [Indexed: 11/20/2022] Open
Abstract
Ovarian cancer continues to be the leading cause of death from gynecological cancers. Despite inconsistent results, patients with metabolic abnormalities, including obesity and diabetes mellitus (DM), have poorer outcomes, showing a correlation with ovarian cancer incidence and ovarian cancer survival. Since ovarian cancer is the most common cancer in women, and considering the increasing prevalence of obesity and DM, this paper reviews the literature regarding the relationship between the aforementioned metabolic derangements and ovarian cancer, with a focus on ovarian cancer incidence, mortality, and likely mechanisms behind them. Several systematic reviews and meta-analyses have shown that obesity is associated with a higher incidence and poorer survival in ovarian cancer. Although more studies are required to investigate the etiological relation of DM and ovarian cancer, sufficient biological evidence indicates poorer outcomes and shorter survival in DM women with ovarian cancer. A variety of pathologic factors may contribute to ovarian cancer risk, development, and survival, including altered adipokine expression, increased levels of circulating growth factors, altered levels of sex hormones, insulin resistance, hyperinsulinemia, and chronic inflammation. Thus, obesity and DM, as changeable risk factors, can be targeted for intervention to prevent ovarian cancer and improve its outcomes.
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Affiliation(s)
- Neda Khanlarkhani
- Department of Physiology and Pharmacology, Karolinska Institute, Sweden
| | - Elham Azizi
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fardin Amidi
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshad Khodarahmian
- Infertility department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Salehi
- Department of Gynecology, School of Medicine, Fertility and Infertility Research Center, Dr. Ali Shariati Hospital, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Hormozgan, Iran
| | - Azar Pazhohan
- Infertility Center, Academic Center for Education, Culture and Research, East Azarbaijan, Tabriz, Iran. / Department of Midwifery, Urmia Branch, Islamic Azad University, Urmia, Iran
| | - Bagher Farhood
- Departments of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Keywan Mortezae
- Department of Anatomy, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Nasser Hashemi Goradel
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Shabani Nashtaei
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. / Infertility Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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11
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Cai B, Li K, Li G. Impact of Obesity on Major Surgical Outcomes in Ovarian Cancer: A Meta-Analysis. Front Oncol 2022; 12:841306. [PMID: 35223523 PMCID: PMC8864285 DOI: 10.3389/fonc.2022.841306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of obesity on the surgical outcomes in patients after primary ovarian cancer surgery is unclear. We aimed at conducting a meta-analysis to evaluate the associations between obesity and major surgical outcomes in ovarian cancer patients. METHOD Embase, PubMed and Web of Science databases were searched for eligible studies. Study-specific relative risks (RR) were pooled using fixed effect model when little evidence of heterogeneity was detected, otherwise random effect model was employed. RESULTS Twelve eligible studies were identified. The pooled incidence rates of all complications were 38% (95% CI: 29%, 47%) for obese patients and 27% (95% CI: 18%, 36%) for non-obese patients. Compared with the non-obese patients, there was a significantly increased risk of all complications in obese patients after ovarian cancer surgery, with a pooled RR of 1.75 (95% CI: 1.26, 2.43). For advanced (stages III-IV) ovarian cancer, the pooled RR of all complications was 1.55 (95% CI: 1.07, 2.24). Obese patients after ovarian cancer surgery were at higher risks of wound complication (pooled RR: 7.06, 95% CI: 3.23, 15.40) and infection (pooled RR: 1.94, 95% CI: 1.47, 2.55) compared with non-obese patients. Such increased risk was not observed for other major complications, namely, venous thromboembolism, ileus and organ failure. Hospital stay days between obese patients and non-obese patients were similar (Standardized Mean Difference: -0.28, 95% CI: -0.75, 0.19). The rates of optimal debulking (pooled RR: 0.96, 95% CI: 0.90, 1.03), readmission/return to operation room (pooled RR: 1.20, 95% CI: 0.56, 2.57) and 30-day mortality (pooled RR: 0.95, 95% CI: 0.54, 1.66) were also comparable between obese patients and non-obese patients. CONCLUSION Obesity is associated with an increased risk of postoperative complications, especially wound complications and infection after primary ovarian cancer surgery. Obesity may not affect their optimal debulking rates and 30-day mortality in patients undergoing ovarian cancer surgery. Besides, to improve surgical outcomes, an advanced minimally invasive robotic approach seems to be feasible for the treatment of obese patients with ovarian cancer.
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Affiliation(s)
- Benshuo Cai
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kang Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Gang Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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12
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Pang L, Chang X. Resistin Expression in Epithelial Ovarian Cancer promotes the Proliferation and Migration of Ovarian Cancer Cells to Worsen Prognosis. J Cancer 2021; 12:6796-6804. [PMID: 34659568 PMCID: PMC8518001 DOI: 10.7150/jca.62496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Epithelial ovarian cancer (EOC) is the most common gynecological cancer in women. Resistin, an inflammatory adipocytokine, is associated with obesity, insulin resistance, and various cancer types. Materials and Methods: We investigated resistin expression in tissues and its association with the clinicopathological characteristics and prognosis of patients with EOC. The SKOV3 and CAOV3 cell lines were treated with exogenous resistin and rapamycin (resistin inhibitor), and the expression of mTOR in SKOV3 and CAOV3 cells was measured. Cell proliferation was measured using the CCK-8 assay. Western blotting analysis was performed to examine the phosphorylation of P70S6K and mTOR. Wound healing and Transwell analyses were conducted to examine the effect of resistin on the migration of SKOV3 and CAOV3 cells. Results: High resistin expression was positively correlated with the pathological grade (P = 0.017) and lymph node metastasis (P = 0.045). However, resistin expression was not correlated with age, FIGO stage, or residual tumor after initial laparotomy (P > 0.05). Cox multivariate analysis showed that resistin expression was an independent factor for determining disease-free survival, whereas lymph node metastasis, resistin expression, and age (≥55 years) were independent factors affecting overall survival. Exogenous resistin induced ovarian cancer cell proliferation, whereas rapamycin had the opposite effect. Resistin promoted the proliferation of ovarian cancer cells via the mTOR signaling pathway and was associated with phosphorylating P70S6K. Furthermore, resistin promoted the migration of ovarian cancer cells. Conclusions: Resistin may promote the occurrence of ovarian cancer and is related to the prognosis of patients. This protein may also affect the proliferation of EOC cells through the mTOR signaling pathway. Therefore, resistin shows potential as a molecular therapeutic target in ovarian cancer.
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Affiliation(s)
- Li Pang
- Department of Obstetrics and Gynecology, ShengJing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaohan Chang
- Department of Obstetrics and Gynecology, ShengJing Hospital of China Medical University, Shenyang, Liaoning, China
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13
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Choe D, Lee ES, Beeghly-Fadiel A, Wilson AJ, Whalen MM, Adunyah SE, Son DS. High-Fat Diet-Induced Obese Effects of Adipocyte-Specific CXCR2 Conditional Knockout in the Peritoneal Tumor Microenvironment of Ovarian Cancer. Cancers (Basel) 2021; 13:cancers13195033. [PMID: 34638514 PMCID: PMC8508092 DOI: 10.3390/cancers13195033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 01/11/2023] Open
Abstract
Obesity contributes to ovarian cancer (OC) progression via tumorigenic chemokines. Adipocytes and OC cells highly express CXCR2, and its ligands CXCL1/8, respectively, indicating that the CXCL1/8-CXCR2 axis is a molecular link between obesity and OC. Here, we investigated how the adipocyte-specific CXCR2 conditional knockout (cKO) affected the peritoneal tumor microenvironment of OC in a high-fat diet (HFD)-induced obese mouse model. We first generated adipocyte-specific CXCR2 cKO in mice: adipose tissues were not different in crown-like structures and adipocyte size between the wild-type (WT) and cKO mice but expressed lower levels of CCL2/6 compared to the obese WT mice. HFD-induced obese mice had a shorter survival time than lean mice. Particularly, obese WT and cKO mice developed higher tumors and ascites burdens, respectively. The ascites from the obese cKO mice showed increased vacuole clumps but decreased the floating tumor burden, tumor-attached macrophages, triglyceride, free fatty acid, CCL2, and TNF levels compared to obese WT mice. A tumor analysis revealed that obese cKO mice attenuated inflammatory areas, PCNA, and F4/80 compared to obese WT mice, indicating a reduced tumor burden, and there were positive relationships between the ascites and tumor parameters. Taken together, the adipocyte-specific CXCR2 cKO was associated with obesity-induced ascites despite a reduced tumor burden, likely altering the peritoneal tumor microenvironment of OC.
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Affiliation(s)
- Deokyeong Choe
- School of Food Science and Biotechnology, Kyungpook National University, Daegu 41566, Korea;
| | - Eun-Sook Lee
- Department of Pharmaceutical Sciences, College of Pharmacy, Florida A&M University, Tallahassee, FL 32301, USA;
| | - Alicia Beeghly-Fadiel
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA;
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA;
| | - Andrew J. Wilson
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA;
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Margaret M. Whalen
- Department of Chemistry, Tennessee State University, Nashville, TN 37209, USA;
| | - Samuel E. Adunyah
- Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, School of Medicine, Meharry Medical College, Nashville, TN 37208, USA;
| | - Deok-Soo Son
- Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, School of Medicine, Meharry Medical College, Nashville, TN 37208, USA;
- Correspondence:
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14
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Stelten S, Hoedjes M, Kenter GG, Kampman E, Huijsmans RJ, van Lonkhuijzen LR, Buffart LM. Rationale and study protocol of the Physical Activity and Dietary intervention in women with OVArian cancer (PADOVA) study: a randomised controlled trial to evaluate effectiveness of a tailored exercise and dietary intervention on body composition, physical function and fatigue in women with ovarian cancer undergoing chemotherapy. BMJ Open 2020; 10:e036854. [PMID: 33148722 PMCID: PMC7643503 DOI: 10.1136/bmjopen-2020-036854] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION As a consequence of ovarian cancer and its treatment, many women with ovarian cancer have to deal with reduced physical function, fatigue, and loss of weight and/or muscle mass, compromising quality of life. Exercise and dietary interventions can positively influence body composition, physical fitness and function, and fatigue in patients with cancer. However, there are no data from randomised controlled trials on the effectiveness of exercise and dietary interventions in patients with ovarian cancer. Due to a complex disease trajectory, a relatively poor survival and distinct disease-induced and treatment-induced side effects, it is unclear whether exercise and dietary interventions that were shown to be feasible and effective in other types of cancer produce comparable results in patients with ovarian cancer. The aim of this article is to present the design of the multicentre randomised controlled Physical Activity and Dietary intervention in OVArian cancer trial and to describe how the exercise and dietary intervention is tailored to specific comorbidities and disease-induced and treatment-induced adverse effects in patients with ovarian cancer. METHODS AND ANALYSIS Adult women with primary epithelial ovarian cancer who are scheduled to undergo first-line (neo)adjuvant chemotherapy (n=122) are randomly allocated to a combined exercise and dietary intervention or a usual care control group during chemotherapy. Primary outcomes are body composition, physical function and fatigue. Outcome measures will be assessed before the start of chemotherapy, 3 weeks after completion of chemotherapy and 12 weeks later. The exercise and dietary intervention was tailored to ovarian cancer-specific comorbidities and adverse effects of ovarian cancer and its treatment following the i3-S strategy. ETHICS AND DISSEMINATION This study has been approved by the medical ethical committee of the Amsterdam UMC (reference: 018). Results of the study will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER Netherlands Trial Registry (NTR6300).
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Affiliation(s)
- Stephanie Stelten
- Epidemiology and Biostatistics, Amsterdam Public Health research institute, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Physiology, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Meeke Hoedjes
- Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | - Gemma G Kenter
- Obstetrics and Gynaecology, Cancer Center Amsterdam, Center for Gynaecologic Oncology Amsterdam (CGOA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Obstetrics and Gynaecology, Amsterdam UMC, Univ(ersity) of Amsterdam, Amsterdam, Netherlands
- Gynaecology, Center for Gynaecologic Oncology Amsterdam (CGOA), The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Ellen Kampman
- Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Rosalie J Huijsmans
- Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Luc Rcw van Lonkhuijzen
- Obstetrics and Gynaecology, Amsterdam UMC, Univ(ersity) of Amsterdam, Amsterdam, Netherlands
| | - L M Buffart
- Epidemiology and Biostatistics, Amsterdam Public Health research institute, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Physiology, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, The Netherlands
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15
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Associations between metabolic syndrome and gynecologic cancer. Obstet Gynecol Sci 2020; 63:215-224. [PMID: 32489965 PMCID: PMC7231948 DOI: 10.5468/ogs.2020.63.3.215] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/01/2020] [Accepted: 01/16/2020] [Indexed: 12/21/2022] Open
Abstract
Metabolic syndrome (MetS) is a group of risk factors that causes cardiovascular and diabetic morbidity and mortality, which is diagnosed by central obesity, dyslipidemia, hyperglycemia, and hypertension. Increasing epidemiological data and experimental results indicate that the presence of MetS increases the incidence of common malignancies and related mortality. Epidemiological studies have previously reported an association of endometrial cancer occurrence with MetS. Aromatization of androstenedione to estrogen, insulin resistance, and diabetes can cause increased levels of free estrogen, and the detrimental effect of elevated estrogen as a carcinogen is well studied in endometrial cancer. Medications used to manage MetS such as metformin and statins are suggested to reduce endometrial cancer risk and improve survival. Some large population-based epidemiological studies have suggested that the MetS is related to an increased risk of cervical carcinoma. MetS may contribute to viral-host interactions, which lead to persistent human papilloma virus (HPV) infection, although limited epidemiological data are available. Specific effects of obesity and diabetes on the occurrence of ovarian cancer have been suggested. However, the direct correlation between MetS and ovarian cancer is still lacking. Previous retrospective studies reported that the use of metformin, statins, and beta-blockers could be associated with cancer prevention or better prognosis. Proper diagnosis and management of the MetS should be a part of the strategies undertaken to prevent and treat gynecologic cancer. So far, only limited data is available on this subject, and further clinical and fundamental research is required to further clarify the effect of these therapies on gynecologic cancer treatment.
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16
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Wu CJ, Sundararajan V, Sheu BC, Huang RYJ, Wei LH. Activation of STAT3 and STAT5 Signaling in Epithelial Ovarian Cancer Progression: Mechanism and Therapeutic Opportunity. Cancers (Basel) 2019; 12:cancers12010024. [PMID: 31861720 PMCID: PMC7017004 DOI: 10.3390/cancers12010024] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022] Open
Abstract
Epithelial ovarian cancer (EOC) is the most lethal of all gynecologic malignancies. Despite advances in surgical and chemotherapeutic options, most patients with advanced EOC have a relapse within three years of diagnosis. Unfortunately, recurrent disease is generally not curable. Recent advances in maintenance therapy with anti-angiogenic agents or Poly ADP-ribose polymerase (PARP) inhibitors provided a substantial benefit concerning progression-free survival among certain women with advanced EOC. However, effective treatment options remain limited in most recurrent cases. Therefore, validated novel molecular therapeutic targets remain urgently needed in the management of EOC. Signal transducer and activator of transcription-3 (STAT3) and STAT5 are aberrantly activated through tyrosine phosphorylation in a wide variety of cancer types, including EOC. Extrinsic tumor microenvironmental factors in EOC, such as inflammatory cytokines, growth factors, hormones, and oxidative stress, can activate STAT3 and STAT5 through different mechanisms. Persistently activated STAT3 and, to some extent, STAT5 increase EOC tumor cell proliferation, survival, self-renewal, angiogenesis, metastasis, and chemoresistance while suppressing anti-tumor immunity. By doing so, the STAT3 and STAT5 activation in EOC controls properties of both tumor cells and their microenvironment, driving multiple distinct functions during EOC progression. Clinically, increasing evidence indicates that the activation of the STAT3/STAT5 pathway has significant correlation with reduced survival of recurrent EOC, suggesting the importance of STAT3/STAT5 as potential therapeutic targets for cancer therapy. This review summarizes the distinct role of STAT3 and STAT5 activities in the progression of EOC and discusses the emerging therapies specifically targeting STAT3 and STAT5 signaling in this disease setting.
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Affiliation(s)
- Chin-Jui Wu
- Department of Obstetrics & Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10002, Taiwan; (C.-J.W.); (B.-C.S.)
| | - Vignesh Sundararajan
- Cancer Science Institute of Singapore, National University of Singapore, Center for Translational Medicine, Singapore 117599, Singapore;
| | - Bor-Ching Sheu
- Department of Obstetrics & Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10002, Taiwan; (C.-J.W.); (B.-C.S.)
| | - Ruby Yun-Ju Huang
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore 119077, Singapore;
- School of Medicine, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Lin-Hung Wei
- Department of Obstetrics & Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10002, Taiwan; (C.-J.W.); (B.-C.S.)
- Correspondence: ; Tel.: +886-2-2312-3456 (ext. 71570); Fax: +886-2-2311-4965
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17
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Abstract
Ovarian cancer (OvCa), while accounting for only 3% of all women’s cancer, is the fifth leading cause of cancer death among women. One of the most significant obstacles to successful OvCa treatment is chemoresistance. The current lack of understanding of the driving mechanisms underlying chemoresistance hinders the development of effective therapeutics against this obstacle. Adipocytes are key components of the OvCa microenvironment and have been shown to be involved in OvCa cell proliferation, however, little is known about their impact on OvCa chemoresistance. In the current study, we found that adipocytes, of both subcutaneous and visceral origin, secrete factors that enhance the resistance of OvCa cells against chemotherapeutic drugs by activating the Akt pathway. Importantly, we have demonstrated that secreted lipids mediate adipocyte-induced chemoresistance. Through a comprehensive lipidomic analysis, we have identified this chemo-protective lipid mediator as arachidonic acid (AA). AA acts on OvCa cells directly, not through its downstream derivatives such as prostaglandins, to activate Akt and inhibit cisplatin-induced apoptosis. Taken together, our study has identified adipocytes and their secreted AA as important mediators of OvCa chemoresistance. Strategies that block the production of AA from adipocytes or block its anti-apoptotic function may potentially inhibit chemoresistance in OvCa patients.
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18
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Naffouje SA, Tulla KA, Khalaf Z, Salti GI. The impact of BMI extremes on disease-free survival and overall survival following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Gastrointest Oncol 2019; 10:194-202. [PMID: 31032085 DOI: 10.21037/jgo.2018.12.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are increasingly being offered to patients with peritoneal carcinomatosis (PC). On the other hand, the prevalence of obesity is also increasing and expected to reach unprecedented rates in the upcoming decades. Therefore, managing patients on either extreme of the body mass index (BMI) range is anticipated to become a routine challenge and it becomes imperative to understand the impact of BMI, as a spectrum, on the long-term outcomes of CRS and HIPEC. We aim to study the short and long-term outcomes of CRS and HIPEC in patients on both extremes of the BMI spectrum. Methods Patients with PC who underwent CRS and HIPEC over 10 years for ovarian, colorectal, and pseudomyxoma peritonei (PMP), and whose BMI was recorded were retrospectively included. Patients were divided based on their weight strata. The primary outcomes were disease-free survival (DFS) and overall survival (OS). Results A total of 126 patients were included. Fifty-seven point one percent were females and mean age was 59.31±1.57 years. No difference was noted between the groups in regards to demographics, perioperative characteristics, and immediate postoperative outcomes. Underweight group had a trend toward a higher peritoneal cancer index and lower rates of complete cytoreduction. Optimum BMI for OS and DFS was in the obesity range in colorectal PC, in the overweight range in ovarian PC, and in borderline obesity in PMP. Regression analysis identified underweight as an independent risk factor for shorter DFS, whereas underweight and morbid obesity were risk factors for shorter OS, after adjustment for other factors such as incomplete cytoreduction, tumor histology, and grade. Conclusions OS and DFS vary across the BMI strata. Ovarian PC demonstrates earlier recurrence and shorter survival, whereas colorectal PC demonstrates the "obesity paradox" as patients move into the realm of obesity. BMI extremes, low or high, generally carry a poor prognosis for OS.
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Affiliation(s)
- Samer A Naffouje
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Kiara A Tulla
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Zaynab Khalaf
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - George I Salti
- Division of Surgical Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.,Department of Surgical Oncology, Edward Hospital Cancer Center, Naperville, IL, USA
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19
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Impact of Advanced Age on Survival in Patients Undergoing Resection of Hepatocellular Carcinoma. Ann Surg 2019; 269:692-699. [DOI: 10.1097/sla.0000000000002526] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Ignacio RMC, Lee ES, Wilson AJ, Beeghly-Fadiel A, Whalen MM, Son DS. Obesity-Induced Peritoneal Dissemination of Ovarian Cancer and Dominant Recruitment of Macrophages in Ascites. Immune Netw 2018; 18:e47. [PMID: 30619633 PMCID: PMC6312889 DOI: 10.4110/in.2018.18.e47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/03/2018] [Accepted: 12/09/2018] [Indexed: 02/07/2023] Open
Abstract
One-fifth of cancer deaths are associated with obesity. Because the molecular mechanisms by which obesity affects the progression of ovarian cancer (OC) are poorly understood, we investigated if obesity could promote the progression of OC cells using the postmenopausal ob/ob mouse model and peritoneal dissemination of mouse ID8 OC cells. Compared to lean mice, obese mice had earlier OC occurrence, greater metastasis throughout the peritoneal cavity, a trend toward shorter survival, and higher circulating glucose and proinflammatory chemokine CXCL1 levels. Ascites in obese mice had higher levels of macrophages (Mφ) and chemokines including CCL2, CXCL12, CXCL13, G-CSF and M-CSF. Omental tumor tissues in obese mice had more adipocytes than lean mice. Our data suggest that obesity may accelerate the peritoneal dissemination of OC through higher production of pro-inflammatory chemokines and Mφ recruitment.
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Affiliation(s)
- Rosa Mistica C Ignacio
- Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville, TN 37208, USA
| | - Eun-Sook Lee
- Department of Pharmaceutical Sciences, College of Pharmacy, Florida A&M University, Tallahassee, FL 32301, USA
| | - Andrew J Wilson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Alicia Beeghly-Fadiel
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Margaret M Whalen
- Department of Chemistry, Tennessee State University, Nashville, TN 37209, USA
| | - Deok-Soo Son
- Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville, TN 37208, USA
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21
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Assessing Information Needs Regarding Metabolic Syndrome Among Gynecological Cancer Survivors: A Concurrent Mixed Method. Cancer Nurs 2018; 42:E48-E60. [PMID: 29734256 DOI: 10.1097/ncc.0000000000000598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cancer survivors have an increased risk of non-cancer-related deaths, particularly metabolic syndrome (MetS). OBJECTIVE We aimed to assess knowledge deficits regarding metabolism-related diseases among gynecological cancer survivors and the preferred source of health information. METHODS Using a mixed methods approach, 70 participants responded to a structured modified version of the MetS questionnaire. We conducted 28 semistructured interviews of gynecological cancer survivors with MetS. Responses were independently coded by 2 researchers, including MetS knowledge, behaviors for self-management, and preferred learning methods. RESULTS Metabolic syndrome was diagnosed in 17% of the participants. More than 50% of the participants wanted to learn about MetS and requested a consultation with healthcare providers, 70% reported that they had heard of MetS, and 61.4% reported that they had MetS-related knowledge (correct answer rate by MetS-related component, ~50%). The level of MetS-related knowledge was poor in both the quantitative and qualitative data. Most of the participants defined MetS-related self-management health behaviors as regular eating and exercise in their own words. Participants mostly wanted exercise management (29% of the participants), followed by dietary life management (27.4%), stress management (17.4%), weight management (13.7%), definition and diagnostic methods of MetS (9.1%), and smoking and drinking management (3.3%). Participants wished to use a handbook in small groups or receive counseling by healthcare providers. CONCLUSION We observed poor awareness and knowledge level and the need for information regarding MetS among gynecological cancer survivors. IMPLICATIONS FOR PRACTICE An educational handbook or counseling could effectively improve self-management of health-related behaviors.
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22
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Son JH, Chang K, Kong TW, Paek J, Chang SJ, Ryu HS. A study of clinicopathologic factors as indicators for early prediction of suboptimal debulking surgery after neoadjuvant chemotherapy in advanced ovarian cancer. J Obstet Gynaecol Res 2018; 44:1294-1301. [DOI: 10.1111/jog.13653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/03/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Joo-Hyuk Son
- Division of Gynecologic Oncology; Ajou University School of Medicine; Suwon Korea
| | - Kyoungjin Chang
- Department of Obstetrics and Gynecology; Ajou University School of Medicine; Suwon Korea
| | - Tae-Wook Kong
- Division of Gynecologic Oncology; Ajou University School of Medicine; Suwon Korea
| | - Jiheum Paek
- Division of Gynecologic Oncology; Ajou University School of Medicine; Suwon Korea
| | - Suk-Joon Chang
- Division of Gynecologic Oncology; Ajou University School of Medicine; Suwon Korea
| | - Hee-Sug Ryu
- Division of Gynecologic Oncology; Ajou University School of Medicine; Suwon Korea
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23
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Guo H, Zhong Y, Jackson AL, Clark LH, Kilgore J, Zhang L, Han J, Sheng X, Gilliam TP, Gehrig PA, Zhou C, Bae-Jump VL. Everolimus exhibits anti-tumorigenic activity in obesity-induced ovarian cancer. Oncotarget 2018; 7:20338-56. [PMID: 26959121 PMCID: PMC4991459 DOI: 10.18632/oncotarget.7934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/24/2016] [Indexed: 01/21/2023] Open
Abstract
Everolimus inhibits mTOR kinase activity and its downstream targets by acting on mTORC1 and has anti-tumorigenic activity in ovarian cancer. Clinical and epidemiologic data find that obesity is associated with worse outcomes in ovarian cancer. In addition, obesity leads to hyperactivation of the mTOR pathway in epithelial tissues, suggesting that mTOR inhibitors may be a logical choice for treatment in obesity-driven cancers. However, it remains unclear if obesity impacts the effect of everolimus on tumor growth in ovarian cancer. The present study was aimed at evaluating the effects of everolimus on cytotoxicity, cell metabolism, apoptosis, cell cycle, cell stress and invasion in human ovarian cancer cells. A genetically engineered mouse model of serous ovarian cancer fed a high fat diet or low fat diet allowed further investigation into the inter-relationship between everolimus and obesity in vivo. Everolimus significantly inhibited cellular proliferation, induced cell cycle G1 arrest and apoptosis, reduced invasion and caused cellular stress via inhibition of mTOR pathways in vitro. Hypoglycemic conditions enhanced the sensitivity of cells to everolimus through the disruption of glycolysis. Moreover, everolimus was found to inhibit ovarian tumor growth in both obese and lean mice. This reduction coincided with a decrease in expression of Ki-67 and phosphorylated-S6, as well as an increase in cleaved caspase 3 and phosphorylated-AKT. Metabolite profiling revealed that everolimus was able to alter tumor metabolism through different metabolic pathways in the obese and lean mice. Our findings support that everolimus may be a promising therapeutic agent for obesity-driven ovarian cancers.
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Affiliation(s)
- Hui Guo
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan University, Jinan, P.R. China.,Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA.,School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Shandong, P.R. China
| | - Yan Zhong
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA.,Department of Gynecologic Oncology, Linyi Cancer Hospital, Linyi, P.R. China
| | - Amanda L Jackson
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Leslie H Clark
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Josh Kilgore
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Lu Zhang
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan University, Jinan, P.R. China.,Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA.,School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Shandong, P.R. China
| | - Jianjun Han
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA.,Department of Surgical Oncology, Shandong Cancer Hospital and Institute, Jinan, P.R. China
| | - Xiugui Sheng
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan University, Jinan, P.R. China
| | - Timothy P Gilliam
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Paola A Gehrig
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Chunxiao Zhou
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Victoria L Bae-Jump
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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24
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The effect of celecoxib on tumor growth in ovarian cancer cells and a genetically engineered mouse model of serous ovarian cancer. Oncotarget 2018; 7:39582-39594. [PMID: 27074576 PMCID: PMC5129955 DOI: 10.18632/oncotarget.8659] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/28/2016] [Indexed: 12/20/2022] Open
Abstract
Our objective was to evaluate the effect of the COX-2 inhibitor, celecoxib, on (1) proliferation and apoptosis in human ovarian cancer cell lines and primary cultures of ovarian cancer cells, and (2) inhibition of tumor growth in a genetically engineered mouse model of serous ovarian cancer under obese and non-obese conditions. Celecoxib inhibited cell proliferation in three ovarian cancer cell lines and five primary cultures of human ovarian cancer after 72 hours of exposure. Treatment with celecoxib resulted in G1 cell cycle arrest, induction of apoptosis, inhibition of cellular adhesion and invasion and reduction of expression of hTERT mRNA and COX-2 protein in all of the ovarian cancer cell lines. In the KpB mice fed a high fat diet (obese) and treated with celecoxib, tumor weight decreased by 66% when compared with control animals. Among KpB mice fed a low fat diet (non-obese), tumor weight decreased by 46% after treatment with celecoxib. In the ovarian tumors from obese and non-obese KpB mice, treatment with celecoxib as compared to control resulted in decreased proliferation, increased apoptosis and reduced COX-2 and MMP9 protein expression, as assessed by immunohistochemistry. Celecoxib strongly decreased the serum level of VEGF and blood vessel density in the tumors from the KpB ovarian cancer mouse model under obese and non-obese conditions. This work suggests that celecoxib may be a novel chemotherapeutic agent for ovarian cancer prevention and treatment and be potentially beneficial in both obese and non-obese women.
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25
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Han J, Wysham WZ, Zhong Y, Guo H, Zhang L, Malloy KM, Dickens HK, Huh G, Lee D, Makowski L, Zhou C, Bae-Jump VL. Increased efficacy of metformin corresponds to differential metabolic effects in the ovarian tumors from obese versus lean mice. Oncotarget 2017; 8:110965-110982. [PMID: 29340030 PMCID: PMC5762298 DOI: 10.18632/oncotarget.20754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/03/2017] [Indexed: 12/21/2022] Open
Abstract
Obesity is a significant risk factor for ovarian cancer (OC) and associated with worse outcomes for this disease. We assessed the anti-tumorigenic effects of metformin in human OC cell lines and a genetically engineered mouse model of high grade serous OC under obese and lean conditions. Metformin potently inhibited growth in a dose-dependent manner in all four human OC cell lines through AMPK/mTOR pathways. Treatment with metformin resulted in G1 arrest, induction of apoptosis, reduction of invasion and decreased hTERT expression. In the K18-gT121+/-; p53fl/fl; Brca1fl/fl (KpB) mouse model, metformin inhibited tumor growth in both lean and obese mice. However, in the obese mice, metformin decreased tumor growth by 60%, whereas tumor growth was only decreased by 32% in the lean mice (p=0.003) compared to vehicle-treated mice. The ovarian tumors from obese mice had evidence of impaired mitochondrial complex 2 function and energy supplied by omega fatty acid oxidation rather than glycolysis as compared to lean mice, as assessed by metabolomic profiling. The improved efficacy of metformin in obesity corresponded with inhibition of mitochondrial complex 1 and fatty acid oxidation, and stimulation of glycolysis in only the OCs of obese versus lean mice. In conclusion, metformin had anti-tumorigenic effects in OC cell lines and the KpB OC pre-clinical mouse model, with increased efficacy in obese versus lean mice. Detected metabolic changes may underlie why ovarian tumors in obese mice have heightened susceptibility to metformin.
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Affiliation(s)
- Jianjun Han
- Department of Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Postdoctoral Mobile Station of Tianjin Medical University, Tianjin, P.R. China.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Weiya Z Wysham
- Legacy Medical Group, Gynecologic Oncology, Portland, OR, USA
| | - Yan Zhong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.,Department of Gynecologic Oncology, Linyi Cancer Hospital, Linyi, Shandong, P.R. China
| | - Hui Guo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.,Department of Gynecologic Oncology, Shandong Cancer Hospital & Institute, Jinan, P.R. China
| | - Lu Zhang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.,Department of Gynecologic Oncology, Shandong Cancer Hospital & Institute, Jinan, P.R. China
| | - Kim M Malloy
- Virginia Tech/Carilion Clinic, Department of Obstetrics and Gynecology, Blacksburg, VA, USA
| | - Hallum K Dickens
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Gene Huh
- Seoul National University College of Medicine, Seoul, South Korea
| | | | - Liza Makowski
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Chunxiao Zhou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Victoria L Bae-Jump
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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26
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Abstract
Background Older patients have an average of three comorbidities in addition to their cancer. Oncologic studies have usually ignored this aspect when adjusting for confounders. There is mounting evidence that comorbidity interacts with risk, survival, disease progression, and treatment of elderly patients with cancer. The strength of many of these interactions increases with age. Methods A review of the literature was undertaken regarding two of these interactions: cancer risk and prognosis. Results In older patients, the risk and behavior of cancer can be strongly affected by comorbidities and their related treatment. Rather than a blanket effect, this effect might be attached to groups of syndromes with common pathophysiologic mechanisms. This is notably true for metabolic disorders and inflammatory diseases. Conclusions In addition to focusing on the influence of cancer treatment on comorbidity or on the effect of comorbidity in delivering cancer treatment, future endeavors will need to consider the direct impact of comorbidity on the risk and the behavior of the cancer in elderly patients.
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Affiliation(s)
- Martine Extermann
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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27
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Bandera EV, Lee VS, Qin B, Rodriguez-Rodriguez L, Powell CB, Kushi LH. Impact of body mass index on ovarian cancer survival varies by stage. Br J Cancer 2017; 117:282-289. [PMID: 28588323 PMCID: PMC5520512 DOI: 10.1038/bjc.2017.162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/04/2017] [Accepted: 05/15/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Research on the effect of body mass index (BMI) on ovarian cancer survival is inconsistent, but previous studies did not consider the possible impact of ascites, bowel obstruction, or cachexia, which commonly occur in late-stage disease. METHODS We evaluated the association of BMI, before and around the time of diagnosis, with overall and disease-specific survival in a cohort study of primary invasive epithelial ovarian cancers diagnosed from 2000 to 2013 in Kaiser Permanente Northern California (KPNC) (n=1184). Deaths were identified through December 2014, with a median follow-up of 37 months. Proportional hazards regression was used to estimate overall and ovarian cancer-specific mortality, accounting for prognostic variables including age at diagnosis, race, stage, grade, histology, comorbidities, treatment, post-treatment CA125 levels, ascites, and bowel obstruction. RESULTS There was no evidence of an association between BMI and overall or ovarian cancer-specific survival. However, we found strong effect modification by stage (Pinteraction<0.01). Compared with normal prediagnosis BMI (18.5-24.9 kg m-2), for women who were obese before diagnosis (BMI⩾35 kg m-2) ovarian cancer-specific survival was lower among those diagnosed at stages I/II (hazard ratio (HR): 3.40; 95% confidence interval (CI): 1.16-9.99), but increased among those diagnosed with stage IV disease (HR: 0.58; 95% CI: 0.35-0.96). Associations were attenuated after excluding those diagnosed with cachexia (n=82) and further adjustment for ascites and bowel obstruction, with no evidence of effect modification by these factors. CONCLUSIONS Associations of obesity with ovarian cancer survival may differ by stage, with decreased survival among those with localised disease and increased survival among those with late-stage disease. Stage-specific effects of obesity on survival suggest a tailored approach to improve prognosis may be appropriate.
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Affiliation(s)
- Elisa V Bandera
- Population Science, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
- Department of Medical Oncology, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Bo Qin
- Population Science, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
| | - Lorna Rodriguez-Rodriguez
- Precision Medicine, Division of Gynecology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - C Bethan Powell
- Gynecologic Oncology Program, Kaiser Permanente Northern California, San Francisco, CA 94115, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
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28
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Chen Y, Zhang L, Liu W, Wang K. Case-control study of metabolic syndrome and ovarian cancer in Chinese population. Nutr Metab (Lond) 2017; 14:21. [PMID: 28261315 PMCID: PMC5330115 DOI: 10.1186/s12986-017-0176-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/17/2017] [Indexed: 12/25/2022] Open
Abstract
Background Recent studies have proved metabolic syndrome (MetS) was linked to cancer risks. However, few data has examined the relationship between MetS and epithelial ovarian cancer (EOC). Methods We conducted a population-based case-control study in Tianjin Medical University Cancer Institute and Hospital, China (2010–2015) that enrolled 573 EOC patients and 1146 matched controls. Data were collected through in-person interviews, anthropometric measurement, and 8-h fasting bloods drawn. MetS was estimated by Chinese Diabetes Society (CDS) definition requiring presence of ≥3 of the following risk factors: 1) body mass index (BMI) ≥25.0 kg/m2,2) fasting plasma glucose ≥6.1 mmol/L or 2-h plasma glucose ≥ 7.8 mmol/L, 3) systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, 4) triglyceride (TG) ≥1.70 mmol/L or high-density lipoprotein cholesterol (HDL-C) < 1.0 mmol/L. Statistics were completed using chi-square tests and logistic regression analysis. The survival analysis was conducted by the Kaplan-Meier method and Cox proportional hazard regression models. Results MetS was significantly more prevalent among EOC (25.13%) than controls (6.89%). A statistically significant increase risk for EOC was observed for MetS (multivariable-adjusted OR = 3.187; 95% CI: 2.135–4.756). MetS was significantly associated with histological grade (P < 0.001), FIGO stage (P = 0.003), and lymph node (LN) status (P = 0.002) of EOC. In binary logistic regression analysis, the presence of MetS predicts the risk of advanced FIGO stage (OR = 2.155, 95% CI: 1.327–3.498, P = 0.002), lower differentiation (OR = 2.472, 95% CI: 1.164–5.250, P = 0.019), and LN metastasis (OR = 2.590, 95% CI: 1.089–6.160, P = 0.031) of EOC. Moreover, MetS is the independent factor for the evaluation of PFS and OS of EOC patients (both of them P < 0.001) in Cox proportional hazard model. Conclusion MetS is obviously related to increased EOC risk. EOC patients with MetS in Chinese population were found to have statistically significant tumor advanced stage, low differentiation, LN metastasis and poor prognosis.
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Affiliation(s)
- Ying Chen
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060 China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060 China.,National Clinical Research Centre of Cancer, Tianjin, 300060 China
| | - Lei Zhang
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060 China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060 China.,National Clinical Research Centre of Cancer, Tianjin, 300060 China
| | - Wenxin Liu
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060 China
| | - Ke Wang
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060 China
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29
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Abstract
Measures of body weight and anthropometrics such as body mass index (BMI) are commonly used to assess nutritional status in clinical conditions including cancer. Extensive research has evaluated associations between body weight and prognosis in ovarian cancer patients, yet little is known about the potential impact of body composition (fat mass (FM) and fat-free mass (FFM)) in these patients. Thus, the purpose of this publication was to review the literature (using PubMed and EMBASE) evaluating the impact of body weight and particularly body composition on surgical complications, morbidity, chemotherapy dosing and toxicity (as predictors of prognosis), and survival in ovarian cancer patients. Body weight is rarely associated with intra-operative complications, but obesity predicts higher rates of venous thromboembolism and wound complications post-operatively in ovarian cancer patients. Low levels of FM and FFM are superior predictors of length of hospital stay compared to measures of body weight alone, but the role of body composition on other surgical morbidities is unknown. Obesity complicates chemotherapy dosing due to altered pharmacokinetics, imprecise dosing strategies, and wide variability in FM and FFM. Measurement of body composition has the potential to reduce toxicity if the results are incorporated into chemotherapy dosing calculations. Some findings suggest that excess body weight adversely affects survival, while others find no such association. Limited studies indicate that FM is a better predictor of survival than body weight in ovarian cancer patients, but the direction of this relationship has not been determined. In conclusion, body composition as an indicator of nutritional status is a better prognostic tool than body weight or BMI alone in ovarian cancer patients.
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30
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Pergialiotis V, Doumouchtsis SK, Perrea D, Vlachos GD. The Impact of Underweight Status on the Prognosis of Ovarian Cancer Patients: A Meta-Analysis. Nutr Cancer 2016; 68:918-25. [PMID: 27351098 DOI: 10.1080/01635581.2016.1190021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Malnutrition and underweight status pose an unfavorable prognosis for cancer patients. Several studies have addressed the impact of a low body mass index (BMI) (<18.5 kg/m(2)) on ovarian cancer progression. However, their results seem to be conflicting. The present meta-analysis investigates whether the underweight status negatively affects the progress of ovarian cancer. We conducted a systematic review searching the Medline (1966-2014), Scopus (2004-2014), Popline (1974-2014), ClinicalTrials.gov (2008-2014), and Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2014) databases together with reference lists from included studies. All prospective and retrospective observational cohort studies were included. Statistical meta-analysis was performed using the RevMan 5.1 software. Current evidence suggests that the stage of the disease does not differ between underweight and normal-weight patients [odds ratio (OR) 0.80, 95% confidence interval (CI) 0.46-1.39 for stage I; OR 1.27, 95% CI 0.71-2.27 for stage II; OR 1.03, 95% CI 0.71-1.51 for stage III; and OR 1.05, 95% CI 0.63-1.76 for stage IV disease]. Concurrently, the risk of residual disease after surgery (OR 1.03, 95% CI 0.69-1.52) and the risk of dying due to ovarian cancer (OR 1.08, 95% CI 0.64-1.85) seem to be similar. According to the findings of our systematic review, the underweight status does not seem to have a detrimental impact on ovarian cancer prognosis. However, the methodological limitations of published studies and the small number of enrolled underweight patients preclude firm results. Thus, future research in this field is necessary.
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Affiliation(s)
- Vasilios Pergialiotis
- a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , University of Athens , Athens , Greece
| | - Stergios K Doumouchtsis
- b Department of Obstetrics and Gynaecology , St George's Healthcare NHS Trust/St George's University of London , London , UK
| | - Despina Perrea
- a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , University of Athens , Athens , Greece
| | - Georgios D Vlachos
- c 1st Department of Obstetrics and Gynaecology , Division of Gynecologic Oncology, Alexandra Hospital, University of Athens , Athens , Greece
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The Impact of Obesity on the 30-day Morbidity and Mortality After Surgery for Ovarian Cancer. Int J Gynecol Cancer 2016; 26:276-81. [DOI: 10.1097/igc.0000000000000619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Smits A, Smits E, Lopes A, Das N, Hughes G, Talaat A, Pollard A, Bouwman F, Massuger L, Bekkers R, Galaal K. Body mass index, physical activity and quality of life of ovarian cancer survivors: Time to get moving? Gynecol Oncol 2015; 139:148-54. [DOI: 10.1016/j.ygyno.2015.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/05/2015] [Accepted: 08/12/2015] [Indexed: 02/06/2023]
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Nagle CM, Dixon SC, Jensen A, Kjaer SK, Modugno F, deFazio A, Fereday S, Hung J, Johnatty SE, Fasching PA, Beckmann MW, Lambrechts D, Vergote I, Van Nieuwenhuysen E, Lambrechts S, Risch HA, Rossing MA, Doherty JA, Wicklund KG, Chang-Claude J, Goodman MT, Ness RB, Moysich K, Heitz F, du Bois A, Harter P, Schwaab I, Matsuo K, Hosono S, Goode EL, Vierkant RA, Larson MC, Fridley BL, Høgdall C, Schildkraut JM, Weber RP, Cramer DW, Terry KL, Bandera EV, Paddock L, Rodriguez-Rodriguez L, Wentzensen N, Yang HP, Brinton LA, Lissowska J, Høgdall E, Lundvall L, Whittemore A, McGuire V, Sieh W, Rothstein J, Sutphen R, Anton-Culver H, Ziogas A, Pearce CL, Wu AH, Webb PM. Obesity and survival among women with ovarian cancer: results from the Ovarian Cancer Association Consortium. Br J Cancer 2015; 113:817-26. [PMID: 26151456 PMCID: PMC4559823 DOI: 10.1038/bjc.2015.245] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Observational studies have reported a modest association between obesity and risk of ovarian cancer; however, whether it is also associated with survival and whether this association varies for the different histologic subtypes are not clear. We undertook an international collaborative analysis to assess the association between body mass index (BMI), assessed shortly before diagnosis, progression-free survival (PFS), ovarian cancer-specific survival and overall survival (OS) among women with invasive ovarian cancer. METHODS We used original data from 21 studies, which included 12 390 women with ovarian carcinoma. We combined study-specific adjusted hazard ratios (HRs) using random-effects models to estimate pooled HRs (pHR). We further explored associations by histologic subtype. RESULTS Overall, 6715 (54%) deaths occurred during follow-up. A significant OS disadvantage was observed for women who were obese (BMI: 30-34.9, pHR: 1.10 (95% confidence intervals (CIs): 0.99-1.23); BMI: ⩾35, pHR: 1.12 (95% CI: 1.01-1.25)). Results were similar for PFS and ovarian cancer-specific survival. In analyses stratified by histologic subtype, associations were strongest for women with low-grade serous (pHR: 1.12 per 5 kg m(-2)) and endometrioid subtypes (pHR: 1.08 per 5 kg m(-2)), and more modest for the high-grade serous (pHR: 1.04 per 5 kg m(-2)) subtype, but only the association with high-grade serous cancers was significant. CONCLUSIONS Higher BMI is associated with adverse survival among the majority of women with ovarian cancer.
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Affiliation(s)
- C M Nagle
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - S C Dixon
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Population Health, University of Queensland, Brisbane, QLD, Australia
| | - A Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - S K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - F Modugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, PA, USA
- Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pennsylvania, PA, USA
| | - A deFazio
- Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia
- Center for Cancer Research, University of Sydney at the Westmead Millennium Institute, Westmead, NSW, Australia
| | - S Fereday
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - J Hung
- Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia
- Center for Cancer Research, University of Sydney at the Westmead Millennium Institute, Westmead, NSW, Australia
| | - S E Johnatty
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Australian Ovarian Cancer Study Group
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - P A Fasching
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, CA, USA
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - D Lambrechts
- Vesalius Research Center, VIB, Leuven, Belgium
- Department of Oncology, University of Leuven, Leuven, Belgium
| | - I Vergote
- Department of Obstetrics and Gynecology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - E Van Nieuwenhuysen
- Department of Obstetrics and Gynecology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Lambrechts
- Department of Obstetrics and Gynecology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - H A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - M A Rossing
- Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J A Doherty
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - K G Wicklund
- Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - M T Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - R B Ness
- School of Public Health, University of Texas, Houston, TX, USA
| | - K Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - F Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
- Department of Gynecology and Gynecologic Oncology, Dr Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - A du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
- Department of Gynecology and Gynecologic Oncology, Dr Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - P Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
- Department of Gynecology and Gynecologic Oncology, Dr Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - I Schwaab
- Institut für Humangenetik Wiesbaden, Wiesbaden, Germany
| | - K Matsuo
- Department of Preventive Medicine, Faculty of Medical Sciences, Kyushu University, Nagoya, Aichi, Japan
| | - S Hosono
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - E L Goode
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - R A Vierkant
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - M C Larson
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - B L Fridley
- Department of Biostatistics, University of Kansas, Kansas City, KS, USA
| | - C Høgdall
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J M Schildkraut
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
| | - R P Weber
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
| | - D W Cramer
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA
| | - K L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA
| | - E V Bandera
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - L Paddock
- New Jersey State Cancer Registry, Trenton, NJ, USA
| | - L Rodriguez-Rodriguez
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - N Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - H P Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - L A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Cancer Center, Warsaw, Poland
| | - E Høgdall
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Molecular Unit, Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Lundvall
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Whittemore
- Department of Health Research and Policy–Epidemiology, Stanford University School of Medicine, Stanford, CA, USA
| | - V McGuire
- Department of Health Research and Policy–Epidemiology, Stanford University School of Medicine, Stanford, CA, USA
| | - W Sieh
- Department of Health Research and Policy–Epidemiology, Stanford University School of Medicine, Stanford, CA, USA
| | - J Rothstein
- Department of Health Research and Policy–Epidemiology, Stanford University School of Medicine, Stanford, CA, USA
| | - R Sutphen
- Epidemiology Center, College of Medicine, University of South Florida, Tampa, FL, USA
| | - H Anton-Culver
- Department of Epidemiology, School of Medicine, University of California Irvine, Irvine, California, USA
| | - A Ziogas
- Department of Epidemiology, School of Medicine, University of California Irvine, Irvine, California, USA
| | - C L Pearce
- Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - A H Wu
- Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - P M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Population Health, University of Queensland, Brisbane, QLD, Australia
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Kim JJ, Shin YA, Suk MH. Effect of a 12-week walking exercise program on body composition and immune cell count in patients with breast cancer who are undergoing chemotherapy. J Exerc Nutrition Biochem 2015; 19:255-62. [PMID: 26525495 PMCID: PMC4624127 DOI: 10.5717/jenb.2015.15092812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/18/2015] [Accepted: 09/28/2015] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the effect of a 12-week walking exercise program on body composition and immune cell count in patients with breast cancer who are undergoing chemotherapy. METHODS Twenty patients (age, 47.8 ± 3.12) participated in the study. Body composition (weight, body mass index, muscle weight, body fat mass, and percent body fat) and the cell counts for immune cells (white blood corpuscles, lymphocytes, helper T cells, cytotoxic T cells, natural killer cells, and natural killer T cells) were measured before and after the 12-week walking exercise program. SPSS 17.0 statistical software was used. The two-way repeated ANOVA with post hoc was used to determine the difference between time and interaction. RESULTS There were significant reductions in the weight (p < .05), BMI (p < .01), and percent body fat (p < .05) after the 12-week walking exercise program. However, the immune cell counts did not change significantly. CONCLUSION These results indicated that the 12-week walking exercise program had an effect on the balances among weight, BMI and percent body fat in patients with breast cancer.
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Affiliation(s)
- Ji Jeong Kim
- College of Sports Science, Department of exercise prescription and rehabilitation, Dankook University, Cheonan,
Republic of Korea
| | - Yun A Shin
- College of Sports Science, Department of exercise prescription and rehabilitation, Dankook University, Cheonan,
Republic of Korea
| | - Min Hwa Suk
- College of Sports Science, Department of exercise prescription and rehabilitation, Dankook University, Cheonan,
Republic of Korea
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Tran AQ, Cohen JG, Li AJ. Impact of obesity on secondary cytoreductive surgery and overall survival in women with recurrent ovarian cancer. Gynecol Oncol 2015; 138:263-6. [PMID: 26037901 DOI: 10.1016/j.ygyno.2015.05.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Obesity may negatively influence tumor biology in women with epithelial ovarian cancers. To date, only body mass indices (BMI) determined at the time of diagnosis have correlated with clinical outcome. We hypothesized that obesity negatively affects survival throughout the disease course, and sought to determine the prognostic role of BMI at the time of secondary cytoreductive surgery (SCS) for recurrent ovarian cancer. METHODS We performed a review of patients undergoing SCS for recurrent epithelial ovarian or peritoneal cancer between 1997 and 2012. We retrospectively reviewed data which were analyzed using Fisher's exact test, Kaplan-Meier survival, and Cox regression analysis. BMI was defined according to the National Institutes of Health's categorizations. RESULTS We identified 104 patients; 2 were underweight, 46 were of ideal body weight, 32 were overweight, and 24 were obese. Overall, 90 patients underwent optimal resection and BMI did not correlate with ability to perform optimal SCS (p=0.25). When examining BMI strata (underweight, ideal, overweight, and obese), we observed a statistical trend between increasing BMI and poor outcome; median survival was undetermined (greater than 50 months), 46 months, 38 months, and 34 months, respectively (p=0.04). In a multivariate analysis, BMI was an independent predictor of survival (p=0.02). CONCLUSIONS In this cohort of women undergoing SCS for recurrent ovarian cancer, BMI significantly and independently correlated with overall survival. This observation suggests an effect of excess weight on tumor biology and/or response to treatment that is prevalent throughout the disease course.
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Affiliation(s)
- Arthur-Quan Tran
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Andrew J Li
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA.
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Abstract
ObjectiveIn this study, we evaluated the effect of body mass index (BMI) on the quality of life of ovarian cancer survivors.MethodsWomen diagnosed with ovarian cancer at the Royal Cornwall Hospital Trust between January 2008 and May 2013 were identified. Ovarian cancer survivors were invited to participate by completing the European Organization for Research and Treatment of Cancer QLQ-C30 (quality of life) questionnaire. Univariate and multiple regression analyses were used to determine associations between BMI and quality-of-life outcomes.ResultsA total of 176 ovarian cancer survivors were invited to participate, of which 133 were eligible for this study. In total, 81 ovarian cancer survivors (60.4%) completed the questionnaire, of which 26 responders (32.1%) were overweight (BMI, 25–29.9 kg/m2) and 27 (33.3%) were obese (BMI, ≥30 kg/m2). Increasing BMI was significantly associated with poorer quality-of-life outcomes in terms of physical functioning and emotional functioning, and this effect persisted for physical functioning after multiple regression analysis.ConclusionsIncreasing BMI is associated with poorer quality-of-life outcomes in terms of physical and emotional functioning in ovarian cancer survivors. Further research is needed to evaluate the association between BMI and quality of life from diagnosis to survivorship to develop novel interventions.
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Horowitz NS, Wright AA. Impact of obesity on chemotherapy management and outcomes in women with gynecologic malignancies. Gynecol Oncol 2015; 138:201-6. [PMID: 25870918 DOI: 10.1016/j.ygyno.2015.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/02/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe the effects of obesity on the pharmacokinetics and dosing of chemotherapies and provide recommendations for chemotherapy management in obese women with gynecologic malignancies. METHODS PubMEd and MEDLINE databases were searched for articles published before June 2014. Only English-language articles were considered. 84 manuscripts were reviewed and 66 were included. Search terms included: obesity, overweight, body mass index, body surface area, glomerular filtration rate, chemotherapy, ovarian cancer, endometrial cancer, inflammation, and pharmacokinetics, RESULTS Obese cancer patients have worse clinical outcomes, compared with non-obese patients. This may be because of differences in pharmacokinetics, metabolic dysregulation, or physicians' decisions to reduce chemotherapy dose-intensity during treatment to minimize toxicities. A 2012 American Society of Clinical Oncology Clinical Practice Guideline recommends using actual body weight for chemotherapy dosing in all patients treated with curative intent, irrespective of obesity, to avoid compromising clinical outcomes, including progression free survival (PFS) and overall survival (OS). In women with gynecologic cancers most studies demonstrate no difference in PFS or OS when obese patients receive the same chemotherapy dose intensity as non-obese patients, except perhaps with bevacizumab. CONCLUSIONS Chemotherapy dose-intensity is a critical determinant of cancer outcomes and should be maintained in all patients, irrespective of obesity. Future studies should prospectively examine the impact of obesity on clinical outcomes (adverse events, survival) to improve the care of this growing population of patients who are at risk for inferior clinical outcomes.
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Affiliation(s)
- Neil S Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, USA; Division of Medical Oncology, Dana Farber Cancer Institute, USA.
| | - Alexi A Wright
- Division of Medical Oncology, Dana Farber Cancer Institute, USA
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Motoyama H, Kobayashi A, Yokoyama T, Shimizu A, Sakai H, Furusawa N, Notake T, Kitagawa N, Arai T, Yokoi K, Okubo Y, Miyagawa SI. Impact of advanced age on the short- and long-term outcomes in patients undergoing hepatectomy for hepatocellular carcinoma: a single-center analysis over a 20-year period. Am J Surg 2015; 209:733-41. [DOI: 10.1016/j.amjsurg.2014.05.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/13/2014] [Accepted: 05/19/2014] [Indexed: 02/07/2023]
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Obesity is associated with worse overall survival in women with low-grade papillary serous epithelial ovarian cancer. Int J Gynecol Cancer 2015; 24:670-5. [PMID: 24614825 DOI: 10.1097/igc.0000000000000109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate prognostic risk factors for survival in women with low-grade serous epithelial ovarian cancer (LGSC). METHODS A multicenter retrospective analysis of patients with LGSC was conducted. Potential epidemiologic risk factors evaluated included obesity, age, parity, race, smoking, oral contraceptive pill and/or hormonal replacement therapy use, and previous hysterectomy or surgery on fallopian tubes and/or ovaries. Additional factors included stage, extent of debulking, residual disease, and disease status. RESULTS Eighty-one patients were identified, and pathologic diagnosis was independently confirmed. Median age at diagnosis was 56 years (range, 21-86 years). Thirty-four percent were obese, and 80% had optimally debulked disease. Forty-six percent were alive, 14% with disease, whereas 25% were dead of disease, 2% died of intercurrent disease, and 27% had an unknown status. In a univariate analysis, optimal surgical debulking was associated with improved progression-free survival (P = 0.01), disease-specific survival (P = 0.03), and overall survival (OS) (P < 0.001) and body mass index with worse OS (P = 0.05). On multivariate analysis, obesity (hazard ratio, 2.8; 95% confidence interval, 1.05-7.3; P = 0.04) and optimal tumor debulking (hazard ratio, 0.05; 95% confidence interval, 0.008-0.29; P = 0.001) were a significant predictor of OS. CONCLUSIONS In a multivariate analysis, obesity and optimal tumor cytoreduction were significant predictors of OS. However, obesity was not associated with worse disease-specific survival, suggesting that mortality of obese patients with LGSC may result from other comorbidities. Interventions addressing obesity may improve survival for women diagnosed with LGSC, and further study is warranted to address the role of obesity in LGSC.
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Yu AP, Tam BT, Yau WY, Chan KS, Yu SS, Chung TL, Siu PM. Association of endothelin-1 and matrix metallopeptidase-9 with metabolic syndrome in middle-aged and older adults. Diabetol Metab Syndr 2015; 7:111. [PMID: 26692905 PMCID: PMC4676096 DOI: 10.1186/s13098-015-0108-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/25/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) contains a cluster of cardiovascular risk factors. People with MetS are more susceptible to cardiovascular disease, diabetes mellitus, and cancer. Endothelin-1 (ET-1) and matrix metallopeptidase-9 (MMP-9) have been implicated in the development of cardiovascular diseases, diabetes mellitus and cancers. This cross-sectional study aimed to examine the association of ET-1 and MMP-9 with MetS in middle-aged and older Hong Kong Chinese adults. METHODS 149 adults aged 50 to 92 (n = 75 for non-MetS group and n = 74 for MetS group) were examined. All subjects were screened for MetS according to the diagnostic guideline of the United States National Cholesterol Education Program (NCEP) Expert Panel Adult Treatment Panel (ATP) III criteria. Serum levels of ET-1 and MMP-9 were measured. Independent t test was used to detect differences between non-MetS and MetS groups and between subjects with or without certain metabolic abnormality. The association of the serum concentration of MMP-9 and ET-1 with MetS parameters were examined by Pearson's correlation analysis. RESULTS Serum level of ET-1 is higher in MetS-positive subjects and in subjects with high blood pressure, elevated fasting blood glucose, and central obesity. The serum concentration of MMP-9 is higher in subjects positively diagnosed with MetS and subjects with high blood pressure, elevated fasting blood glucose, low blood high-density lipoprotein-cholesterol (HDL-C), high blood triglycerides, and central obesity. Correlation analyses revealed that serum concentration of ET-1 is positively correlated to systolic blood pressure, waist circumference, fasting blood glucose, and age whereas it is negatively correlated to HDL-C. MMP-9 is positively correlated to systolic blood pressure, waist circumference, fasting blood glucose, and age whereas it is negatively correlated to HDL-C. CONCLUSION Serum ET-1 is higher in subjects with hypertension, hyperglycemia, central obesity or MetS. Serum MMP-9 is higher in subjects diagnosed with MetS or having either one of the MetS parameters. Both circulating levels of ET-1 and MMP-9 are correlated to systolic blood pressure, waist circumference, fasting blood glucose, HDL-C, and age. Further research is needed to fully dissect the role of ET-1 and MMP-9 in the development of cancers, diabetes and cardiovascular disease in relation to MetS.
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Affiliation(s)
- A. P. Yu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - B. T. Tam
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - W. Y. Yau
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - K. S. Chan
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - S. S. Yu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - T. L. Chung
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - P. M. Siu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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O'Neill S, O'Driscoll L. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies. Obes Rev 2015; 16:1-12. [PMID: 25407540 DOI: 10.1111/obr.12229] [Citation(s) in RCA: 967] [Impact Index Per Article: 107.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/05/2014] [Accepted: 09/10/2014] [Indexed: 12/13/2022]
Abstract
Obesity is reaching epidemic proportions with recent worldwide figures estimated at 1.4 billion and rising year-on-year. Obesity affects all socioeconomic backgrounds and ethnicities and is a pre-requisite for metabolic syndrome. Metabolic syndrome is a clustering of risk factors, such as central obesity, insulin resistance, dyslipidaemia and hypertension that together culminate in the increased risk of type 2 diabetes mellitus and cardiovascular disease. As these conditions are among the leading causes of deaths worldwide and metabolic syndrome increases the risk of type 2 diabetes mellitus fivefold and cardiovascular disease threefold, it is of critical importance that a precise definition is agreed upon by all interested parties. Also of particular interest is the relationship between metabolic syndrome and cancer. Metabolic syndrome has been associated with a plethora of cancers including breast, pancreatic, colon and liver cancer. Furthermore, each individual risk factor for metabolic syndrome has also an association with cancer. Our review collates internationally generated information on metabolic syndrome, its many definitions and its associations with life-threatening conditions including type 2 diabetes mellitus, cardiovascular disease and cancer, providing a foundation for future advancements on this topic.
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Affiliation(s)
- S O'Neill
- School of Pharmacy and Pharmaceutical Sciences, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Schorge JO, Clark RM, Lee SI, Penson RT. Primary debulking surgery for advanced ovarian cancer: Are you a believer or a dissenter? Gynecol Oncol 2014; 135:595-605. [DOI: 10.1016/j.ygyno.2014.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 10/01/2014] [Accepted: 10/07/2014] [Indexed: 01/16/2023]
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Shah MM, Erickson BK, Matin T, McGwin G, Martin JY, Daily LB, Pasko D, Haygood CW, Fauci JM, Leath CA. Diabetes mellitus and ovarian cancer: more complex than just increasing risk. Gynecol Oncol 2014; 135:273-7. [PMID: 25220626 PMCID: PMC4252660 DOI: 10.1016/j.ygyno.2014.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Diabetes mellitus (DM) is a risk factor for endometrial cancer and is associated with poorer outcomes in breast and colon cancers. This association is less clear in epithelial ovarian cancer (EOC). We sought to examine the effect of DM on progression-free (PFS) and overall survival (OS) in women with EOC. METHODS A retrospective cohort study of EOC patients diagnosed between 2004 and 2009 at a single institution was performed. Demographic, pathologic and DM diagnosis data were abstracted. Pearson chi-square test and t test were used to compare variables. The Kaplan-Meier method and the log rank test were used to compare PFS and OS between non-diabetic (ND) and DM patients. RESULTS 62 (17%) of 367 patients had a diagnosis of DM. No differences in age, histology, debulking status, or administration of intraperitoneal chemotherapy between ND and DM patients were present, although there were more stage I and IV patients in the ND group (p=0.04). BMI was significantly different between the two groups (ND vs. DM, 27.5 vs. 30.7kg/m(2), p<0.001). While there were no differences in survival based on BMI, diabetic patients had a poorer PFS (10.3 vs. 16.3months, p=0.024) and OS (26.1 vs. 42.2months, p=0.005) compared to ND patients. Metformin use among diabetic patients did not appear to affect PFS or OS. CONCLUSIONS EOC patients with DM have poorer survival than patients without diabetes; this association is independent of obesity. Metformin use did not affect outcomes. The pathophysiology of this observation requires more inquiry.
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MESH Headings
- Adenocarcinoma, Papillary/complications
- Adenocarcinoma, Papillary/mortality
- Adenocarcinoma, Papillary/therapy
- Aged
- Carcinoma, Endometrioid/complications
- Carcinoma, Endometrioid/mortality
- Carcinoma, Endometrioid/therapy
- Carcinoma, Ovarian Epithelial
- Comorbidity
- Diabetes Mellitus, Type 2/complications
- Epidemiologic Methods
- Female
- Humans
- Hypoglycemic Agents/therapeutic use
- Metformin/therapeutic use
- Middle Aged
- Neoplasms, Glandular and Epithelial/complications
- Neoplasms, Glandular and Epithelial/mortality
- Neoplasms, Glandular and Epithelial/therapy
- Obesity/complications
- Ovarian Neoplasms/complications
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/therapy
- Prognosis
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Affiliation(s)
- Monjri M Shah
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Britt K Erickson
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tasnia Matin
- School of Medicine, University of Alabama at Birmingham, United States
| | - Gerald McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, United States
| | - Jovana Y Martin
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States
| | - Laura Becca Daily
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States
| | - Daniel Pasko
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States
| | - Christen W Haygood
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Janelle M Fauci
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
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Mardas M, Jamka M, Mądry R, Walkowiak J, Krótkopad M, Stelmach-Mardas M. Dietary habits changes and quality of life in patients undergoing chemotherapy for epithelial ovarian cancer. Support Care Cancer 2014; 23:1015-23. [PMID: 25270849 DOI: 10.1007/s00520-014-2462-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 09/22/2014] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this study was to evaluate dietary habit changes in patients undergoing chemotherapy for epithelial ovarian cancer. METHODS Sixty one patients undergoing chemotherapy for epithelial ovarian cancer were enrolled to the study and 44 completed. The dietary intake was evaluated by 7-day food records, and the changes in dietary intake and food-preparing methods were estimated based on a 101-item semiquantitative food frequency questionnaire. Nutritional status was checked with the use of body weight and height, waist and hip circumferences, skinfolds and subjective global assessment tool. Quality of life was measured with the use of EORTC QLQ-C30 and EORTC QLQ-OV28. RESULTS Despite high average body mass index (BMI) (26.7-28.0 kg/m(2)), malnutrition risk was observed in 43.7 and 10.7 % of patients receiving first-line and subsequent-line chemotherapy, respectively (p < 0.001). Dietary intake and quality of life did not differ between the studied groups. A lot of dietary habits changes were observed. Women undergoing subsequent-line chemotherapy consumed more frequently rye bread, pasta, buttermilk, vegetable, fruit, oils, nuts, and juices. Women undergoing first-line chemotherapy consumed more milk, cottage cheese, cream, eggs, fish and seafood, meat offal, salty snacks, and jam. Additionally, women undergoing subsequent-line chemotherapy more often applied cooking in water (p < 0.0001) and baking (p < 0.05). CONCLUSIONS Women undergoing chemotherapy for ovarian cancer change their dietary habits in a pro healthy direction, and these changes are more expressed in patients undergoing subsequent-line chemotherapy.
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Affiliation(s)
- Marcin Mardas
- Department of Human Nutrition and Hygiene, Poznan University of Life Sciences, Poznan, Poland
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Impact of obesity on surgical and oncologic outcomes in ovarian cancer. Gynecol Oncol 2014; 135:19-24. [DOI: 10.1016/j.ygyno.2014.07.103] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 02/02/2023]
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van Meurs HS, Schuit E, Horlings HM, van der Velden J, van Driel WJ, Mol BWJ, Kenter GG, Buist MR. Development and internal validation of a prognostic model to predict recurrence free survival in patients with adult granulosa cell tumors of the ovary. Gynecol Oncol 2014; 134:498-504. [PMID: 24983647 DOI: 10.1016/j.ygyno.2014.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/18/2014] [Accepted: 06/23/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Models to predict the probability of recurrence free survival exist for various types of malignancies, but a model for recurrence free survival in individuals with an adult granulosa cell tumor (GCT) of the ovary is lacking. We aimed to develop and internally validate such a prognostic model. METHODS We performed a multicenter retrospective cohort study of patients with a GCT. Demographic, clinical and pathological information were considered as potential predictors. Univariable and multivariable analyses were performed using a Cox proportional hazards model. Using backward stepwise selection we identified the combination of predictors that best predicted recurrence free survival. Discrimination (c-statistic) and calibration were used to assess model performance. The model was internally validated using bootstrapping techniques to correct for overfitting. To increase clinical applicability of the model we developed a nomogram to allow individual prediction of recurrence free survival. RESULTS We identified 127 patients with a GCT (median follow-up time was 131 months (IQR 70-215)). Recurrence of GCT occurred in 81 out of 127 patients (64%). The following four variables jointly best predicted recurrence free survival; clinical stage, Body Mass Index (BMI), tumor diameter and mitotic index. The model had a c-statistic of 0.73 (95% CI 0.66-0.80) and showed accurate calibration. CONCLUSIONS Recurrence free survival in patients with an adult GCT of the ovary can be accurately predicted by a combination of BMI, clinical stage, tumor diameter and mitotic index. The introduced nomogram could facilitate in counseling patients and may help to guide patients and caregivers in joint decisions on post-treatment surveillance.
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Affiliation(s)
- Hannah S van Meurs
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Ewoud Schuit
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
| | - Hugo M Horlings
- Department of Pathology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Jacobus van der Velden
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Willemien J van Driel
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | - Ben Willem J Mol
- The Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Level 3 Medical School South Building, Frome Road, SA 5005 Adelaide, Australia.
| | - Gemma G Kenter
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Marrije R Buist
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Bae HS, Hong JH, Ki KD, Song JY, Shin JW, Lee JM, Lee JK, Lee NW, Lee C, Lee KW, Kim YM. The effect of body mass index on survival in advanced epithelial ovarian cancer. J Korean Med Sci 2014; 29:793-7. [PMID: 24932080 PMCID: PMC4055812 DOI: 10.3346/jkms.2014.29.6.793] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 04/02/2014] [Indexed: 01/09/2023] Open
Abstract
Controversy remains regarding the effect of obesity on the survival of patients with ovarian cancer in Asia. This study examined the impact of obesity on the survival outcomes in advanced epithelial ovarian cancer (EOC) using Asian body mass index (BMI) criteria. The medical records of patients undergoing surgery for advanced (stage III and IV) EOC were reviewed. Statistical analyses included ANOVA, chi-square test, Kaplan-Meier survival and Cox regression analysis. Among all 236 patients, there were no differences in overall survival according to BMI except in underweight patients. In a multivariate Cox analysis, surgical optimality and underweight status were independent and significant prognostic factors for survival (HR, 2.302; 95% CI, 1.326-3.995; P=0.003 and HR, 8.622; 95% CI, 1.871-39.737; P = 0.006, respectively). In the subgroup of serous histology and optimal surgery, overweight and obese I patients showed better survival than normal weight patients (P = 0.012). We found that underweight BMI and surgical optimality are independent risk factors for the survival of patients with advanced ovarian cancer. High BMI groups (overweight, obese I and II) are not associated with the survival of advanced EOC patient. However, in the subgroup of EOC patients with serous histology and after optimal operation, overweight and obese I group patients show better survival than the normal weight group patients.
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Affiliation(s)
- Hyo Sook Bae
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Kyoung-Do Ki
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jin Woo Shin
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jong Min Lee
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Nak Woo Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Chan Lee
- Department of Gynecologic Oncology, College of Medicine, CHA University, Seongnam, Korea
| | - Kyu Wan Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Yong Min Kim
- Department of Gynecologic Oncology, College of Medicine, CHA University, Seongnam, Korea
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49
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Makowski L, Zhou C, Zhong Y, Kuan PF, Fan C, Sampey BP, Difurio M, Bae-Jump VL. Obesity increases tumor aggressiveness in a genetically engineered mouse model of serous ovarian cancer. Gynecol Oncol 2014; 133:90-7. [PMID: 24680597 DOI: 10.1016/j.ygyno.2013.12.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/10/2013] [Accepted: 12/17/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Obesity is associated with increased risk and worse outcomes for ovarian cancer. Thus, we examined the effects of obesity on ovarian cancer progression in a genetically engineered mouse model of serous ovarian cancer. METHODS We utilized a unique serous ovarian cancer mouse model that specifically deletes the tumor suppressor genes, Brca1 and p53, and inactivates the retinoblastoma (Rb) proteins in adult ovarian surface epithelial cells, via injection of an adenoviral vector expressing Cre (AdCre) into the ovarian bursa cavity of adult female mice (KpB mouse model). KpB mice were subjected to a 60% calories-derived from fat in a high fat diet (HFD) versus 10% calories from fat in a low fat diet (LFD) to mimic diet-induced obesity. Tumors were isolated at 6 months after AdCre injection and evaluated histologically. Untargeted metabolomic and gene expression profiling was performed to assess differences in the ovarian tumors from obese versus non-obese KpB mice. RESULTS At sacrifice, mice on the HFD (obese) were twice the weight of mice on the LFD (non-obese) (51g versus 31g, p=0.0003). Ovarian tumors were significantly larger in the obese versus non-obese mice (3.7cm(2) versus 1.2cm(2), p=0.0065). Gene expression and metabolomic profiling indicated statistically significant differences between the ovarian tumors from the obese versus non-obese mice, including metabolically relevant pathways.
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Affiliation(s)
- Liza Makowski
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Chunxiao Zhou
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Yan Zhong
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Pei Fen Kuan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Cheng Fan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Megan Difurio
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Victoria L Bae-Jump
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA.
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50
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Oshakbayev KP, Alibek K, Ponomarev IO, Uderbayev NN, Dukenbayeva BA. Weight change therapy as a potential treatment for end-stage ovarian carcinoma. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:203-11. [PMID: 24847411 PMCID: PMC4025513 DOI: 10.12659/ajcr.890229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 01/27/2014] [Indexed: 12/18/2022]
Abstract
Patient: Female, 41 Final Diagnosis: Ovarian carcinoma Symptoms: Ascites • hepatomegaly • weight loss Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
| | - Kenneth Alibek
- Department of Oncology, Republican Scientific Center for Emergency Medicine, Astana, Republic of Kazakhstan
| | - Igor Olegovich Ponomarev
- Department of Oncology, Republican Scientific Center for Emergency Medicine, Astana, Republic of Kazakhstan
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