Metabolic Syndrome and Incidence of Laryngeal Cancer: A Nationwide Cohort Study

LncRNA BBOX1-AS1 Contributes to Laryngeal Carcinoma Progression by Recruiting SRSF1 to Maintain EFNB2 mRNA Stability

Laryngeal cancer is a common malignancy of the larynx with a generally poor prognosis. This study systematically assessed the functional role of lncRNA BBOX1-AS1 in laryngeal carcinoma progression and associated molecular regulatory mechanisms. The proliferation, migration, and invasion of laryngeal carcinoma cells were detected by Cell Counting Kit-8, wound healing, clonal formation, and transwell assays. In addition, the interaction between BBOX1-AS1, Serine/Arginine Splicing Factor 1 (SRSF1), and Ephrin-B2 (EFNB2) mRNA was examined employing RNA immunoprecipitation and RNA pull-down experiments. Furthermore, western blotting, and RT-qPCR assays were adopted to detect the expression levels of BBOX1-AS1, SRSF1, and EFNB2. The impact of BBOX1-AS1 and SRSF1 on EFNB2 mRNA stability was examined using the RNA stability assay. BBOX1-AS1 was highly expressed in human laryngeal carcinoma tissues and cell lines. BBOX1-AS1 knockdown suppressed the growth, proliferation, migration, and invasion of laryngeal carcinoma cells. BBOX1-AS1 maintained the stability of EFNB2 mRNA in laryngeal carcinoma cells by recruiting SRSF1. EFNB2 knockdown inhibited the growth and metastatic function of laryngeal carcinoma cells in vitro. EFNB2 overexpression reversed the influence of BBOX1-AS1 knockdown on laryngeal cancer tumorigenesis. BBOX1-AS1 maintained EFNB2 mRNA stability by recruiting SRSF1, thereby aggravating laryngeal carcinoma malignant phenotypes. BBOX1-AS1 might be a new theoretical target for the treatment of laryngeal carcinoma.

Laryngeal Cancer: Epidemiology, Etiology, and Prevention: A Narrative Review

Laryngeal cancer comprises 30%-40% of head and neck malignancies, and it is the most common malignancy in otolaryngology. The main risk factors for laryngeal cancer are tobacco use, excessive alcohol consumption, gastroesophageal reflex, Plummer-Vinson syndrome, exposure to heat, chemicals, and some viral infections. This literature review summarizes all known data over the past decade with an assessment of the main etiological factors related to cancer incidence, general measurement issues in the cancer epidemiology and the current state of science in relation to laryngeal cancer. The geographical distribution of laryngeal cancer also reveals some important aspects. Europe remains the most prevalent continent for this type of malignancy, whilst the epidemiologic burden in Africa remains low. Overall, there are clear differences in morbidity and mortality from laryngeal cancer between urban and rural areas, with gender inequalities. In some countries, the incidence rates are high in rural areas, and in some, such as in China, the urban population is more affected. High rates of laryngeal cancer are closely associated with both low average income and a high percentage of the population with lower-than-average education countries with higher Socio-demographic Index (SDI) have made greater improvements in the treatment of LC than countries with lower SDI. Epidemiological data on risk factors can provide valuable information for developing cancer prevention strategies.

Association between metabolic syndrome and gastric cancer risk: results from the Health Examinees Study

BACKGROUND

Previous studies suggested that metabolic syndrome (MetS) might create a pro-cancer environment and increase cancer incidence. However, evidence on the risk of gastric cancer (GC) was limited. This study aimed to evaluate the association between MetS and its components and GC in the Korean population.

METHODS

Included were 108,397 individuals who participated in the large-scale prospective cohort study, the Health Examinees-Gem study during 2004-2017. The multivariable Cox proportional was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) on the association between MetS and its components with GC risk. Age was used as the time scale in the analyses. The stratified analysis was performed to determine the joint effect of lifestyle factors and MetS on GC risk in different groups.

RESULTS

During the mean follow-up of 9.1 years, 759 cases of newly diagnosed cancer (408 men and 351 women) were identified. Overall, participants with MetS had a 26% increased risk of GC than those without MetS (HR 1.26; 95% CI 1.07-1.47); the risk increased with the number of MetS components (p for trend 0.01). Hypertriglyceridemia, low HDL-cholesterol, and hyperglycemia were independently associated with the risk of GC. The potential joint effect of MetS and current smokers (p for interaction 0.02) and obesity (BMI ≥ 25.0) (p for interaction 0.03) in GC.

CONCLUSIONS

In this prospective cohort study, we found that MetS were associated with an increased risk of GC in the Korean population. Our findings suggest that MetS may be a potentially modifiable risk factor for GC risk.

Association of Metabolic Syndrome Components and Nutritional Status with Kidney Cancer in Young Adult Population: A Nationwide Population-Based Cohort Study in Korea

The aim of this study was to determine the association of metabolic syndrome (MetS) with kidney cancer and the impact of age and gender on such an association. Using the Korean National Health Insurance Service database, 9,932,670 subjects who had check-ups in 2009 were followed up until the diagnosis of kidney cancer or death or until 2019. Kidney cancer was significantly associated with MetS (HR 1.56). This association was higher in the younger age group (HR: 1.82, 1.5, and 1.37 in 20-39 years, 40-64 years, and ≥65 years, respectively). In terms of the association of kidney cancer with obesity and central obesity, young-aged males showed higher HR for kidney cancer than old-aged ones (HR of obesity: 1.96, 1.52, and 1.25; HR of central obesity: 1.94, 1.53, and 1.3 in 20-39 years, 40-64 years, ≥65 years, respectively), while young-aged females showed lower HR. Kidney cancer was associated with obesity and MetS. The association was higher in younger populations than in older ones. Regarding gender, MetS, obesity, and central obesity showed higher associations with kidney cancer in younger aged male population, while there was no significant difference in such associations according to age in the female population.

Evaluating the effect of metabolic traits on oral and oropharyngeal cancer risk using Mendelian randomization

A recent World Health Organization report states that at least 40% of all cancer cases may be preventable, with smoking, alcohol consumption, and obesity identified as three of the most important modifiable lifestyle factors. Given the significant decline in smoking rates, particularly within developed countries, other potentially modifiable risk factors for head and neck cancer warrant investigation. Obesity and related metabolic disorders such as type 2 diabetes (T2D) and hypertension have been associated with head and neck cancer risk in multiple observational studies. However, adiposity has also been correlated with smoking, with bias, confounding or reverse causality possibly explaining these findings. To overcome the challenges of observational studies, we conducted two-sample Mendelian randomization (inverse variance weighted [IVW] method) using genetic variants which were robustly associated with adiposity, glycaemic and blood pressure traits in genome-wide association studies (GWAS). Outcome data were taken from the largest available GWAS of 6034 oral and oropharyngeal cases, with 6585 controls. We found limited evidence of a causal effect of genetically proxied body mass index (BMI; OR IVW = 0.89, 95% CI 0.72-1.09, p = 0.26 per 1 standard deviation in BMI [4.81kg/m2]) on oral and oropharyngeal cancer risk. Similarly, there was limited evidence for related traits including T2D and hypertension. Small effects cannot be excluded given the lack of power to detect them in currently available GWAS.

Blood metabolic biomarkers and the risk of head and neck cancer: An epidemiological study in the Swedish AMORIS Cohort

Multiple studies have investigated the role of carbohydrate and lipid metabolism on the risk of head and neck cancer (HNC), with however conflicting results. We performed a study of 561,388 individuals of the Swedish AMORIS Cohort with blood test results on nine biomarkers for carbohydrate, lipid, and apolipoprotein metabolism during 1985-1996. We examined the associations of these biomarkers with the future risk of HNC through 2020 and demonstrated the temporal changes of these biomarkers during the decades before cancer diagnosis. We found that there was a positive association between blood level of glucose, total cholesterol (TC), triglycerides (TG), and Apoprotein A-I (ApoA-I) and the risk of HNC. Per standard deviation increase, the hazard ratio (HR) was 1.05 (95% confidence interval [CI] 1.02-1.09) for glucose, 1.09 (95% CI 1.05-1.13) for TC, 1.13 (95% CI 1.08-1.17) for TG, and 1.11 (95% CI 1.04-1.19) for ApoA-I. The associations were primarily noted for squamous cell carcinoma but not adenocarcinoma. Compared to controls, patients with HNC, primarily squamous cell carcinoma, showed constantly higher levels of glucose, TC, TG, and ApoA-I during the 30 years before diagnosis. In conclusion, findings of the study add new and high-quality evidence to the early involvement of carbohydrate and lipid metabolism in the oncogenesis of human cancer.

Identification of Metabolic Syndrome-Related miRNA-mRNA Regulatory Networks and Key Genes Based on Bioinformatics Analysis

Metabolic syndrome, which affects approximately one-quarter of the world's population, is a combination of multiple traits and is associated with high all-cause mortality, increased cancer risk, and other hazards. It has been shown that the epigenetic functions of miRNAs are closely related to metabolic syndrome, but epigenetic studies have not yet fully elucidated the regulatory network and key genes associated with metabolic syndrome. To perform data analysis and screening of potential differentially expressed target miRNAs, mRNAs and genes based on a bioinformatics approach using a metabolic syndrome mRNA and miRNA gene microarray, leading to further analysis and identification of metabolic syndrome-related miRNA-mRNA regulatory networks and key genes. The miRNA gene set (GSE98896) and mRNA gene set (GSE98895) of peripheral blood samples from patients with metabolic syndrome from the GEO database were screened, and set|logFC|> 1 and adjusted P < 0.05 were used to identify the differentially expressed miRNAs and mRNAs. Differentially expressed miRNA transcription factors were predicted using FunRich software and subjected to GO and KEGG enrichment analysis. Next, biological process enrichment analysis of differentially expressed mRNAs was performed with Metascape. Differentially expressed miRNAs and mRNAs were identified and visualized as miRNA-mRNA regulatory networks based on the complementary pairing principle. Data analysis of genome-wide metabolic syndrome-related mRNAs was performed using the gene set enrichment analysis (GSEA) database. Finally, further WGCNA of the set of genes most closely associated with metabolic syndrome was performed to validate the findings. A total of 217 differentially expressed mRNAs and 158 differentially expressed miRNAs were identified by screening the metabolic syndrome miRNA and mRNA gene sets, and these molecules mainly included transcription factors, such as SP1, SP4, and EGR1, that function in the IL-17 signalling pathway; cytokine-cytokine receptor interaction; proteoglycan syndecan-mediated signalling events; and the glypican pathway, which is involved in the inflammatory response and glucose and lipid metabolism. miR-34C-5P, which was identified by constructing a miRNA-mRNA regulatory network, could regulate DPYSL4 expression to influence insulin β-cells, the inflammatory response and glucose oxidative catabolism. Based on GSEA, metabolic syndrome is known to be closely related to oxidative phosphorylation, DNA repair, neuronal damage, and glycolysis. Finally, RStudio and DAVID were used to perform WGCNA of the gene sets most closely associated with metabolic syndrome, and the results further validated the conclusions. Metabolic syndrome is a common metabolic disease worldwide, and its mechanism of action is closely related to the inflammatory response, glycolipid metabolism, and impaired mitochondrial function. miR-34C-5P can regulate DPYSL4 expression and can be a potential research target. In addition, UQCRQ and NDUFA8 are core genes of oxidative phosphorylation and have also been identified as potential targets for the future treatment of metabolic syndrome.

Relationship between Chronic Rhinosinusitis and the Incidence of Head and Neck Cancer: A National Population-Based Study

We analyzed the relationship between chronic rhinosinusitis (CRS) and the incidence of head and neck cancers (HNCs) in a Korean adult population. This retrospective cohort study included data from the Korean National Health Insurance Service database. Adjustments were made to minimize risk variables for sex, age, diabetes, hypertension, dyslipidemia, and rhinitis between the two groups. The primary endpoint was newly diagnosed HNC between January 2009 and December 2018. Among 1,337,120 subjects in the Korean National Health Insurance Service database, data from 324,774 diagnosed with CRS (CRS group) and 649,548 control subjects (control group) were selected. Patients with CRS exhibited a statistically significant greater risk for nasal cavity/paranasal sinus cancer, hypopharynx/larynx cancer, and thyroid cancer compared with the control group. In the CRS group, the adjusted hazard ratios for nasal cavity/paranasal sinus cancer were 1.809 (95% confidence interval (CI) 1.085–3.016), 1.343 (95% CI 1.031–1.748) for hypopharynx and larynx cancer, and 1.116 (95% CI 1.063–1.173) for thyroid cancer. CRS was associated with a higher incidence of HNCs. Therefore, physicians should carefully consider the possibility of HNC progression and implement therapeutic strategies to minimize the impact of these diseases.

Different effect of obesity and metabolic syndrome on prostate cancer by age group

Substantial evidence supports that metabolic syndrome (MetS) affects the incidence of several cancers, with different effects according to age group. We hypothesized that MetS has an age-specific effect on the occurrence of prostate cancer. We studied a National Health Insurance Service health checkup cohort. A total of 5,370,614 men in the cohort were categorized into three age groups in 2009 (20-39, 40-64, ≥65). Prostate cancer incidence was estimated on a cumulative basis from 2009 to 2018. We tried to identify the correlation of MetS components and prostate cancer by age group using this large retrospective cohort. MetS components included the body mass index (BMI), waist circumference (WC), hypertension, obesity, hyperlipidemia, cardiovascular disease, smoking, drinking, serum glucose, serum total cholesterol, serum triglyceride, serum high-density lipoprotein (HDL)-cholesterol and serum low-density lipoprotein (LDL)-cholesterol. A multivariate Cox proportional hazard model was used for the incidence of prostate cancer according to the MetS component. In the young age (20-39) group, the MetS component was not related to prostate cancer. In the middle-aged (40-64) group, the presence of MetS, WC, HDL cholesterol, and hypertension was significantly associated with an increased prevalence of prostate cancer. In the old age (≥65) group, the presence of MetS, WC, HDL cholesterol, triglycerides, and hypertension were significant factors for the incidence of prostate cancer. This tendency was marked in BMI>30 in the old age group (odds ratio: 1.32; P<0.0001). MetS components were age-specifically associated with an increased incidence of prostate cancer. Because the MetS components were related to prostate cancer from middle age to old age, preventing MetS for these age groups is crucial.

Head and Neck Cancer Types and Risks of Cervical-Cranial Vascular Complications within 5 Years after Radiation Therapy

Background and purpose: to investigate the frequency of cervical−cranial vascular complications soon after radiation therapy (RT) and identify differences among patients with various types of head and neck cancer (HNC). Methods: We enrolled 496 patients with HNC who had received their final RT dose in our hospital. These patients underwent carotid duplex ultrasound (CDU) for monitoring significant carotid artery stenosis (CAS). Brain imaging were reviewed to detect vertebral, intracranial artery stenosis, or preexisted CAS before RT. Primary outcome was significant CAS at the internal or common carotid artery within first 5 years after RT. We categorized the patients into nasopharyngeal carcinoma (NPC) and non-NPC groups and compared the cumulative occurrence of significant CAS between the groups using Kaplan−Meier and Cox-regression analyses. Results: Compared to the NPC group, the non-NPC group had a higher frequency of significant CAS (12.7% vs. 2.0%) and were more commonly associated with significant CAS after adjusting the covariates (Adjusted hazard ratio: 0.17, 95% confident interval: 0.05−0.57) during the follow-up period. All the non-NPC subtypes (oral cancer/oropharyngeal, hypopharyngeal, and laryngeal cancers) were associated with higher risks of significant CAS than the NPC group (p < 0.001 respectively). Conclusion: Significant CAS was more frequently noted within 5 years of RT among the patients with non-NPC HNC than among the patients with NPC. Scheduled carotid artery surveillance and vascular risk monitoring should be commenced earlier for patients with non-NPC HNC. By contrast, vascular surveillance could be deferred to 5 years after RT completion in NPC patients.

Synergistic association between underweight and type 2 diabetes on the development of laryngeal cancer: a national population-based retrospective cohort study

Background

Although cigarette smoking is the most significant risk factor for laryngeal cancer, other risk factors might also be associated with the development of laryngeal cancer. We investigated whether underweight and type 2 diabetes are associated with laryngeal cancer in a Korean population.

Methods

A total of 9,957,059 participants (≥20 years) without prior history of cancer who underwent a National Health Insurance Service health checkup in 2009 were followed up until December 31, 2018. Newly diagnosed laryngeal cancer was identified using claim data, and underweight was defined as body mass index (BMI) < 18.5 kg/m². A Cox proportional-hazards models with multivariable adjustment were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs).

Results

During the median follow-up period of 8.3 years, 3504 cases of laryngeal cancer occurred. Underweight was associated with increased risk of laryngeal cancer after adjusting for potential confounders (HR: 1.43, 95% CI: 1.22–1.69) compared to those who were not underweight. Underweight and type 2 diabetes were synergistically associated with higher risk of laryngeal cancer (HR: 2.33, 95% CI: 1.54–3.51), compared to those without either condition. This relationship was stronger in those with an age < 65 years (HR: 3.33, 95% CI: 1.88–5.87) and alcohol consumption (HR: 2.72, 95% CI: 1.64–4.53).

Conclusions

These results suggest that underweight may be a significant risk factor for laryngeal cancer and that underweight and type 2 diabetes might synergistically increase the risk of laryngeal cancer.

Changes in metabolic syndrome status and risk of laryngeal cancer: A nationwide cohort study

BACKGROUND

Whether dynamic changes of metabolic syndrome (MetS) affects the subsequent laryngeal cancer occurrence remains unknown.

OBJECTIVE

This study investigated the effects of changes of MetS on the incidence of laryngeal cancer due to a lack of knowledge regarding the development of MetS in Korean population.

METHODS

A total of 6,757,048 individuals who received national health checkup in 2009 and follow-up health examination in 2011 were analyzed and followed up until 2018. MetS status included the following categories: MetS-chronic (n = 941,609), MetS-developed (n = 614,229), MetS-recovery (n = 455,835), and MetS-free (n = 4,745,375).

RESULTS

With a median follow-up duration of 6.403 years, 1,350 subjects were newly diagnosed with laryngeal cancer. Compared to participants without MetS, adjusted hazard ratios (HR) (95% confidence interval) for those with MetS were 1.320 (1.17-1.489) for laryngeal cancer. The HR of laryngeal cancer was found to be increased with increasing number of MetS components. The MetS-developed group had a significantly higher risk of laryngeal cancer than the MetS-free group (HR: 1.296; 95% CI: 1.093-1.537). The MetS-recovery group within two years also had an increased risk of laryngeal cancer compared with the MetS-free group (HR: 1.220; 95% CI: 1.008-1.476). Among MetS components, abdominal obesity had the highest risk of laryngeal cancer (HR: 1.374; 95% CI: 1.123-1.681).

CONCLUSION

Changes in MetS status were associated with the risk of laryngeal cancer. Results of this study have implications for etiological investigations and prevention strategies.

The effect of metabolic syndrome on head and neck cancer incidence risk: a population-based prospective cohort study

BACKGROUND

There are limited evidences clarifying the impact of metabolic syndrome (MS) and its components on head and neck cancer (HNC) incidence risk. We explored the correlation between MS, MS components, and the combined effects of MS and C-reactive protein (CRP) and HNC risk.

METHODS

This is a prospective analysis of 474,929 participants from the UK Biobank cohort. Cox proportional hazard regression was utilized to assess the hazard ratio (HR) and 95% confidence interval (CI) and to explore the non-linear correlation between an individual MS component and HNC risk.

RESULTS

Individuals with MS (HR, 1.05; 95%CI, 0.90-1.22) had no higher HNC risk than those without MS. More MS components showed no higher HNC risk. Nevertheless, hyperglycemia (HR, 1.22; 95%CI, 1.02-1.45) was independently correlated with elevated HNC risk. In a non-linear manner, waist circumference and high-density lipoprotein cholesterol (HDL-C) showed a U-shaped association with HNC risk. Further, piecewise linear model analysis indicated that higher male waist circumference, female waist circumference (≥93.16 cm), blood glucose (≥4.70 mmol/L) and male HDL-C (≥1.26mmo/L), and lower male HDL-C (<1.26mmo/L) were correlated with higher HNC risk. Increased CRP (≥1.00mg/dL) elevated HNC risk and individuals with MS and CRP≥1.00mg/dL had the highest HNC risk (HR, 1.29; 95%CI, 1.05-1.58). But no joint effect between MS and CRP was detected (p-interaction=0.501).

CONCLUSIONS

MS are not correlated with elevated HNC risk. High waist circumference and blood glucose are independent risk factor of HNC incidence. Controlling HDL-C in an appropriate range can get the lowest risk of male HNC. No joint effect of MS and CRP exists in HNC tumorigenesis.

Metabolic syndrome and gastric cancer risk: a systematic review and meta-analysis

INTRODUCTION

Gastric cancer (GC) is the fifth diagnosed cancer worldwide and the third leading cause of death for cancer. Recent reports suggest that metabolic syndrome (MetS) has a role in etiology, progression or prognosis on GC. The aim of this study is to systematically review the evidence on the association between MetS and GC risk and prognosis.

METHODS

Literature search was performed using the electronic databases Pubmed, Web of Knowledge, Embase and Cinahl Complete until December 2019. Cohort and case-control studies were included. Study-specific association measures were pooled using a random-effect model.

RESULTS

A total of 14 studies included in the qualitative synthesis of which nine were meta-analyzed. The majority were cohort studies (92%) and set in Asia (57%). The pooled analysis reported no association between MetS and GC risk [hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.92-1.18; I2 = 74.2%, P < 0.001], however when the analysis was stratified according to the geographic area and sex, Western women with MetS had an increased risk of GC (HR 1.24, 95% CI 1.05-1.47; I2 = 4.6%, P = 0.351). We did not observe an increased risk of unfavorable prognosis for individuals with MetS (HR 1.23, 95% CI 0.25-6.08).

CONCLUSION

This systematic review and meta-analysis suggests that GC risk might be associated with MetS in women although larger studies are needed. Preventing and treating MetS, however, might have overall beneficial effect on several noncommunicable diseases and in this sense should be pursued.

Association between Hearing Loss and Cognitive Disorder: A Nationwide Population-Based Study

PURPOSE

To investigate the relationship between hearing loss and cognitive disorder with memory dysfunction in South Korea using data from the Korean Health Insurance claims database for 2009-2015.

MATERIALS AND METHODS

We analyzed cross-sectional data of 66-year-old individuals who completed the Korea National Health and Nutrition Examination Surveys. Auditory function was evaluated using pure-tone audiometric testing. Cognitive disorder with memory dysfunction was assessed using standardized scores of the Prescreening Korean Dementia Screening Questionnaire.

RESULTS

Among 1815835 participants at the age of 66 years, the prevalence of unilateral hearing loss was 5.84%, and that of bilateral hearing loss was 3.40%. The normal cognitive group comprised 86.35% of the participants, and the high-risk group for cognitive disorder with memory dysfunction totaled 13.65% of the participants. The bilateral hearing loss group had the highest percentage of subjects who responded "sometimes or frequently" to all five questions about cognitive disorder with memory dysfunction, compared to the normal hearing group or the unilateral hearing loss group. After adjusting for sex, smoking status, alcohol intake, exercise, income, diabetes, hypertension, dyslipidemia, and depression, the odds ratios for cognitive disorder with memory dysfunction was 1.183 [95% confidence interval (CI): 1.163-1.203] for bilateral hearing loss and 1.141 (95% CI: 1.126-1.156) for unilateral hearing loss, compared to the normal cognitive group.

CONCLUSION

Hearing loss has a significant effect on cognitive function in the Korean population. In our study, individuals with bilateral hearing loss showed poorer cognitive function than those with unilateral hearing loss.

Contribution of RAGE axis activation to the association between metabolic syndrome and cancer

Far beyond the compelling proofs supporting that the metabolic syndrome represents a risk factor for diabetes and cardiovascular diseases, a growing body of evidence suggests that it is also a risk factor for different types of cancer. However, the involved molecular mechanisms underlying this association are not fully understood, and they have been mainly focused on the individual contributions of each component of the metabolic syndrome such as obesity, hyperglycemia, and high blood pressure to the development of cancer. The Receptor for Advanced Glycation End-products (RAGE) axis activation has emerged as an important contributor to the pathophysiology of many clinical entities, by fueling a chronic inflammatory milieu, and thus supporting an optimal microenvironment to promote tumor growth and progression. In the present review, we intend to highlight that RAGE axis activation is a crosswise element on the potential mechanistic contributions of some relevant components of metabolic syndrome into the association with cancer.

Determining the association between repeatedly elevated serum gamma-glutamyltransferase levels and risk of respiratory cancer: A nationwide population-based cohort study

Background

Although elevated serum gamma‐glutamyltransferase (GGT) is a known indicator of increased risk of several cancers, the clinical value of repeated measurements of GGT has not been determined. Therefore, we aimed to investigate whether repeatedly elevated serum GGT levels are associated with the risk of respiratory cancer incidence.

Methods

We included participants who had undergone the Korean Health screening four times during 2009–2012 and had previously undergone four consecutive examinations. Those who were diagnosed with respiratory cancer before the date of examination were excluded. The participants obtained one GGT point if their GGT levels were in the highest quartile (the quartile 4 group). We analyzed the association between GGT points and respiratory cancer incidence by Cox proportional hazard models.

Results

During mean follow‐up of 6.39 ± 1.2 years, 3,559,109 participants were enrolled. Of them, 8,944 (0.34%) men and 1,484 (0.14%) women were newly diagnosed with respiratory cancer. In multivariate analysis adjusted for confounding factors, male participants with 4 GGT points had a significantly higher hazards of developing respiratory cancer than those with 0 GGT points (hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.31–1.48). Among female, participants with the highest points of GGT also had sixfold increased risk of developing laryngeal cancer. However, no significant association was observed between GGT points and lung cancer incidence among women (HR: 0.95; 95% CI: 0.81–1.11).

Conclusion

Repeatedly elevated serum levels of GGT were associated with a higher risk of respiratory cancer incidence, especially in men. This finding suggests that physicians can identify a person with a higher risk of respiratory cancer through a simple repeated measurement of GGT.

Physical activity and laryngeal cancer

Although an active lifestyle physical has been convincingly associated with a decreased risk of developing many forms of cancers, including neck and head malignancies, uncertainty surrounds the relationship between physical activity (PA) and laryngeal carcinogenesis. Epidemiologic evidence, garnered from some well-conducted cross-sectional, prospective and retrospective studies, seemingly attests that the impact of PA may be not so straightforward in lowering laryngeal cancer risk as for other malignancies. Reasonable consensus has been reached that moderate-intensity PA may generate the larger potential benefits, whilst the effect of high-intensity PA appears more controversial and even contradictory. This is mainly attributable to the fact that moderate PA may have more favorable effects than high-intensity exercise in decreasing the impact of some risk factors of laryngeal cancer such as metabolic syndrome, cigarette smoking, inflammation, and gastroesophageal reflux disease. Significant biological and psychological benefits from moderate-intensity exercise have also been described in patients surviving from primary laryngeal cancers. This would hence lead us to conclude that promotion of an active lifestyle, characterized by performance of moderate-intensity PA (e.g., between 3 and 6 metabolic equivalents, equaling short distance running), may be beneficial for lowering the risk of developing laryngeal cancer and for improving the quality of life of larynx cancer survivors.