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Español P, Luzarraga A, Teixeira N, Soler C, Luna-Guibourg R, Rovira R. An institutional study: Does Body Mass Index influence surgical approach, surgical morbidities, and outcomes in endometrial cancer patients? Facts Views Vis Obgyn 2023; 15:259-268. [PMID: 37742203 PMCID: PMC10643010 DOI: 10.52054/fvvo.15.3.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Endometrial Cancer (EC), the most common genital tract malignancy in women, is recognised to be associated with a high Body Mass Index (BMI). Objective The aim of the study was to evaluate the impact of obesity on intra and post-operative morbidity for patients treated for EC. Materials and Methods This was a retrospective observational study including patients with EC that were surgically treated at Hospital de la Santa Creu i Sant Pau during nine consecutive years. The patients were divided in groups according to BMI: <30 Kg/m2, ≥30-<40 Kg/m2 and ≥40 Kg/m2. Demographic and pathological characteristics, surgical outcomes, perioperative complications and long-term outcomes were recorded. Results The study included 290 patients; 164 patients with BMI <30 Kg/m2(56.5%), 107 patients with ≥30-<40 Kg/m2 36.9%) and 19 patients with ≥40 Kg/m2(6.65%). Patients with BMI ≥40Kg/m2 were younger, presented a higher percentage of endometrioid histology (84.2%, p<0.01), well-differentiated tumours (73.7%, p<0.01) and were more frequently in the initial stages at diagnosis (94.7%) compared to the other groups. A significant percentage of the patients were operated on laparoscopically (88.7%, 88.8%, 94.7% respectively). No significant differences were found in the evaluation of the surgical outcomes. The results relative to complications showed an overall tendency toward increase in the ≥40 Kg/m2 BMI group but no statistical differences were identified among the groups in terms of complications or long-term outcomes. Conclusions There was a rising trend towards increased complications with increasing BMI in the study population, however, this was found not to be statistically significant. Therefore, the optimisation of co-morbidities and the adaptation of surgical treatment is important for the management of obese patients with endometrial cancer. What is new? The study allows the comparison between groups with different BMI in patients with endometrial cancer. Different surgical outcomes, intra operative, early, and late complications are clearly identified, and survival outcomes are also investigated in our study.
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Thrastardottir TO, Copeland VJ, Constantinou C. The Association Between Nutrition, Obesity, Inflammation, and Endometrial Cancer: A Scoping Review. Curr Nutr Rep 2023; 12:98-121. [PMID: 36513957 DOI: 10.1007/s13668-022-00447-8] [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: 12/15/2022]
Abstract
PURPOSE OF REVIEW Endometrial cancer is the most common gynecological malignancy and represents a notorious threat to women's health worldwide. Endometrial cancer predominantly affects post-menopausal women; yet the prevalence of this disease has been rising also among pre-menopausal women. Poor nutritional habits, inflammation, and obesity may be associated with endometrial cancer (EC) among both pre-menopausal and post-menopausal women and should be further assessed among a wide spectrum of age groups. RECENT FINDINGS This scoping review explores and reports on primary research studies conducted to investigate the impact of nutrition, inflammation, and/or obesity on endometrial cancer risk among both pre-menopausal and post-menopausal women. Using a predefined protocol in compliance with the PRISMA guidelines, a search was conducted on four separate databases including PubMed, Cochrane Library, ProQuest, and Google Scholar to investigate the association between nutrition, inflammation, obesity, and endometrial cancer. A total of 4862 articles were identified. Following a full article analysis, 27 articles met the full inclusion criteria and were included in the current review. Findings from the literature support a role of nutrition, obesity, and inflammation in the development of EC. The studies included in the current review supported that plant-based, Mediterranean, or ketogenic diets are associated with a lower risk of EC while there is no association between glycemic index and EC risk. On the other hand, increased BMI is associated with a higher risk of EC and there is a positive association between obesity-related pro-inflammatory biomarkers and increased risk for EC development. Further research needs to be conducted to gain more insight into the complex interactions between nutrition, obesity, and inflammation and their association with EC development among pre-, peri-, and post- menopausal women with the ultimate goal to improve management and preventive strategies and achieve reduced prevalence of endometrial cancer.
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Affiliation(s)
- Tinna Osk Thrastardottir
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, P.O. Box 24005, 21 Ilia Papakyriakou, 2414 Engomi, Nicosia, 1700, Cyprus
| | - Viana Jacquline Copeland
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, P.O. Box 24005, 21 Ilia Papakyriakou, 2414 Engomi, Nicosia, 1700, Cyprus
| | - Constantina Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, P.O. Box 24005, 21 Ilia Papakyriakou, 2414 Engomi, Nicosia, 1700, Cyprus.
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Andleeb A, Fatima K, Nasreen S, Sofi M, Qadri S. Endometrial carcinoma: A single institute experience. JOURNAL OF RADIATION AND CANCER RESEARCH 2021. [DOI: 10.4103/jrcr.jrcr_19_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Güzel AB, Khatib G, Küçükgöz Güleç Ü, Gümürdülü D, Vardar MA. The impact of morbid obesity on survival of endometrial cancer. Turk J Obstet Gynecol 2020; 17:209-214. [PMID: 33072426 PMCID: PMC7538820 DOI: 10.4274/tjod.galenos.2020.83773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/28/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: Morbid obesity is identified as patients with a body mass index more than 40 kg/m2. Obesity is known as a risk factor for endometrial cancer due to the increase of the deposited estrogen. This study was conducted to evaluate the effect of morbid obesity on the survival of endometrial cancer. Materials and Methods: The archival records and pathologic reports of patients with endometrial cancer who underwent surgery and were followed up in Çukurova University Gynecologic Oncology Center between January 1996 and December 2018 were reviewed, retrospectively. Data regarding body mass index and survival was reported in 520 patients. These patients were stratified into two groups according to their body mass index, <40 and ≥40 kg/m2. The groups’ clinic, pathologic features, and survival rates were compared. Results: There were 146 patients in the morbidly obese group and 374 patients in the obese group. The mean age of the groups was 58.5 and 56.2 years, respectively. The mean follow-up time was 51.6 months. Comorbidities were significantly higher in the morbidly obese group. The five-year disease-free and overall survival rates were 78.3% and 85.3% in the morbidly obese group, and 81.6% and 90.1% in the obese group, respectively. Although the groups’ clinical and pathologic features were homogeneously distributed, disease-free and overall survival rates were significantly different (p=0.053 and p=0.054, respectively). Conclusion: Morbidly obese patients with endometrial cancer were associated with 2.7-fold increased risk of death and 1.7-fold increased risk of recurrence compared with those who had body mass index <40 kg/m2. It is important to deal with the frequent comorbidities in this special group, which could be simply altered by lifestyle changes. Morbidly obese patients with endometrial cancer should be encouraged in lifestyle changes and consulted by dieticians and endocrinologists.
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Affiliation(s)
- Ahmet Barış Güzel
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Ghanim Khatib
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Ümran Küçükgöz Güleç
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Derya Gümürdülü
- Çukurova University Faculty of Medicine, Department of Pathology, Division of Gynecologic Pathology, Adana, Turkey
| | - Mehmet Ali Vardar
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
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Gambacorti-Passerini ZM, López-De la Manzanara Cano C, Pérez Parra C, Cespedes Casas MC, Sánchez Hipólito L, Martín Francisco C, Muñoz-Rodríguez JR. Obesity in Patients with Endometrial Cancer: May It Affect the Surgical Outcomes of Laparoscopic Approach? Obes Surg 2020; 29:3285-3290. [PMID: 31250386 DOI: 10.1007/s11695-019-03986-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the impact of obesity on surgical outcomes for women with endometrial cancer (EC) managed by laparoscopic surgery. Minimal invasive surgery has been incorporated in the surgical management of EC, improving perioperative outcomes. However, this approach may become more challenging in case of obesity. So it is important to accurately evaluate and establish the most appropriate surgical approach for these patients. MATERIALS AND METHODS From January 2008 through April 2016, we conducted a prospective observational study, including all consecutive patients with a histological diagnosis of EC undergoing surgical staging by laparoscopy at our institution. Patients were classified in two groups (obese vs non-obese) according to their body mass index. Information about short- and long-term outcomes were recorded and analyzed during an outpatient follow-up. RESULTS Between January 2008 and April 2016, 83 women underwent laparoscopic surgery for EC at our institution. Forty-six (56.6%) of them were classified as obese. Surgical outcomes were similar in both groups. No significant difference was reported in surgical time, number of lymph nodes removed, blood loss, length of hospital stay, and incidence of intra- or postoperative complications. Also, long-term outcomes did not show any statistical significant difference: recurrence rate was 6.4% (3/47) among obese patients and 13.9% (5/36) among non-obese (p = 0.251). No difference was reported even in time to recurrence (log-rank p = 0.280) and in survival time (log-tank p = 0.132) between the two groups. CONCLUSIONS Our results show that obesity did not impair the outcomes of laparoscopic surgery for EC. This surgical approach may be offered to obese patients with the same level of safety, radicality, and efficiency as for the normal-weight population.
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Affiliation(s)
- Z M Gambacorti-Passerini
- Department of Obstetrics and Gynecology, Ciudad Real University General Hospital, Calle del Obispo Rafael Torija, s/n, 13005, Ciudad Real, Spain.
| | - C López-De la Manzanara Cano
- Department of Obstetrics and Gynecology, Ciudad Real University General Hospital, Calle del Obispo Rafael Torija, s/n, 13005, Ciudad Real, Spain.,University of Castilla-La Mancha, Ciudad Real, Spain
| | - C Pérez Parra
- Department of Obstetrics and Gynecology, Ciudad Real University General Hospital, Calle del Obispo Rafael Torija, s/n, 13005, Ciudad Real, Spain.,Department of Obstetrics and Gynecology, Albacete University Hospital, Albacete, Spain
| | - M C Cespedes Casas
- Department of Obstetrics and Gynecology, Ciudad Real University General Hospital, Calle del Obispo Rafael Torija, s/n, 13005, Ciudad Real, Spain
| | - L Sánchez Hipólito
- Department of Obstetrics and Gynecology, Ciudad Real University General Hospital, Calle del Obispo Rafael Torija, s/n, 13005, Ciudad Real, Spain
| | - C Martín Francisco
- Department of Obstetrics and Gynecology, Ciudad Real University General Hospital, Calle del Obispo Rafael Torija, s/n, 13005, Ciudad Real, Spain
| | - J R Muñoz-Rodríguez
- Translational Research Unit, Ciudad Real University General Hospital, Ciudad Real, Spain
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Jayawickcrama WIU, Abeysena C. Risk factors for endometrial carcinoma among postmenopausal women in Sri Lanka: a case control study. BMC Public Health 2019; 19:1387. [PMID: 31660927 PMCID: PMC6816310 DOI: 10.1186/s12889-019-7757-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/07/2019] [Indexed: 11/12/2022] Open
Abstract
Background Endometrial carcinoma burden is on the rise globally. The objective of this study was to determine the risk factors for endometrial carcinoma among postmenopausal women in Western province in Sri Lanka. Methods A case control study was conducted recruiting 83 incident cases of endometrial carcinoma and 332 unmatched hospital controls from all the secondary and tertiary care hospitals in the province using consecutive sampling technique. A case was defined as a postmenopausal woman who had been residing in the province for at least a period of 1 year, diagnosed to have endometrial carcinoma with histological confirmation within 3 months of the initiation of data collection of the study. Data were collected using validated interviewer administered questionnaire. Risk factor were identified through multiple logistic regression and results were expressed as adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results The independent risk factors of endometrial carcinoma are having family history of any type of cancer among first degree relative (AOR = 12.6; 95% CI:5.14–30.9), generalized obesity (BMI ≥25 kg/m2) (AOR = 11.85; 95% CI:5.12–27.4), never conceived (AOR = 3.84; 95% CI:1.37–10.7), age at menarche ≤11 years (AOR = 4.07; 95% CI:1.16–14.2), age > 55 years (AOR = 4.69; 95% CI:2.16–10.2), monthly family income of ≤20,000 Rupees (AOR = 2.65; 95% CI:1.31–5.39), sub-optimal consumption of deep fried food (AOR = 0.17; 95% CI:0.06–0.46), and low level household activities (AOR = 2.82; 95% CI:1.34–5.92). Conclusions There were eight independent risk factors of endometrial carcinoma specific for Sri Lankan postmenopausal women identified. Some modifiable risk factors such as generalized obesity, sub-optimal dietary practices and low level physical activities need to be addressed at primary prevention level.
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Affiliation(s)
| | - Chrishantha Abeysena
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Pizzuti L, Sergi D, Sperduti I, Lauro LD, Mazzotta M, Botti C, Izzo F, Marchetti L, Tomao S, Marchetti P, Natoli C, Grassadonia A, Gamucci T, Mentuccia L, Magnolfi E, Vaccaro A, Cassano A, Rossi E, Botticelli A, Sini V, Sarobba MG, Fabbri MA, Moscetti L, Astone A, Michelotti A, De Angelis C, Bertolini I, Angelini F, Ciliberto G, Maugeri-Saccà M, Giordano A, Barba M, Vici P. Body mass index in HER2-negative metastatic breast cancer treated with first-line paclitaxel and bevacizumab. Cancer Biol Ther 2018; 19:328-334. [PMID: 29336662 DOI: 10.1080/15384047.2017.1416938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The evidence emerged from the TOURANDOT trial encourages evaluating the role of anthropometric determinants on treatment outcomes in HER2-negative metastatic breast cancer patients treated with bevacizumab-including regimens. We thus analyzed data from a subgroup of these patients from a larger cohort previously assessed for treatment outcomes. Patients were included in the present analysis if body mass index values had been recorded at baseline. Clinical benefit rates, progression free survival and overall survival were assessed for the overall study population and subgroups defined upon molecular subtype. One hundred ninety six patients were included (N:196). Body mass index showed no impact on clinical benefit rates in the overall study sample and in the luminal cancer subset (p = 0.12 and p = 0.79, respectively), but did so in the triple negative subgroup, with higher rates in patients with body mass index ≥25 (p = 0.03). In the overall study sample, body mass index did no impact progression free or overall survival (p = 0.33 and p = 0.67, respectively). Conversely, in triple negative patients, progression free survival was significantly longer with body mass index ≥25 (6 vs 14 months, p = 0.04). In this subset, overall survival was more favorable (25 vs 19 months, p = 0.02). The impact of the molecular subtype was confirmed in multivariate models including the length of progression free survival, and number of metastatic sites (p < 0.0001). Further studies are warranted to confirm our findings in more adequately sized, ad hoc, prospective studies.
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Affiliation(s)
- Laura Pizzuti
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Domenico Sergi
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Isabella Sperduti
- b Biostatistics Unit and Clinical Trial Center, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Luigi Di Lauro
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Marco Mazzotta
- c Medical Oncology Unit, Policlinico Sant'Andrea , Rome , Italy
| | - Claudio Botti
- d Department of Surgery , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Fiorentino Izzo
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Luca Marchetti
- e Division of Medical Oncology, Villa San Pietro Hospital , Rome , Italy
| | - Silverio Tomao
- f Department of Medical-Surgical Sciences and Biotechnologies , La "Sapienza" University of Rome , Italy
| | - Paolo Marchetti
- c Medical Oncology Unit, Policlinico Sant'Andrea , Rome , Italy
| | - Clara Natoli
- g Department of Medical , Oral and Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University , Chieti , Italy
| | - Antonino Grassadonia
- g Department of Medical , Oral and Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University , Chieti , Italy
| | - Teresa Gamucci
- h Medical Oncology Unit, ASL Frosinone , Frosinone , Italy
| | | | | | - Angela Vaccaro
- h Medical Oncology Unit, ASL Frosinone , Frosinone , Italy
| | - Alessandra Cassano
- i Department of Medical Oncology , Catholic University of Sacred Heart , Rome , Italy
| | - Ernesto Rossi
- i Department of Medical Oncology , Catholic University of Sacred Heart , Rome , Italy
| | | | - Valentina Sini
- c Medical Oncology Unit, Policlinico Sant'Andrea , Rome , Italy.,j Oncology Unit , ASL Roma 1, Santo Spirito Hospital , Rome , Italy
| | | | - Maria Agnese Fabbri
- l Division of Oncology, Complesso Ospedaliero Belcolle, AUSL Viterbo , Viterbo , Italy
| | - Luca Moscetti
- m Division of Medical Oncology , Department of Oncology and Hematology, University Hospital of Modena , Modena , Italy
| | - Antonio Astone
- e Division of Medical Oncology, Villa San Pietro Hospital , Rome , Italy.,i Department of Medical Oncology , Catholic University of Sacred Heart , Rome , Italy
| | - Andrea Michelotti
- n Oncology Unit I, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Claudia De Angelis
- n Oncology Unit I, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Ilaria Bertolini
- n Oncology Unit I, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Francesco Angelini
- o Medical Oncology Unit, Regina Apostolorum Hospital , Albano, Rome , Italy
| | - Gennaro Ciliberto
- p Scientific Direction, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Marcello Maugeri-Saccà
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy.,p Scientific Direction, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Antonio Giordano
- q Sbarro Institute for Cancer Research and Molecular Medicine e del Center for Biotechnology, College of Science and Technology, Temple University , Philadelphia , USA
| | - Maddalena Barba
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy.,p Scientific Direction, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Patrizia Vici
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
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Dorn J, Bayani J, Yousef GM, Yang F, Magdolen V, Kiechle M, Diamandis EP, Schmitt M. Clinical utility of kallikrein-related peptidases (KLK) in urogenital malignancies. Thromb Haemost 2017; 110:408-22. [DOI: 10.1160/th13-03-0206] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 05/25/2013] [Indexed: 12/19/2022]
Abstract
SummaryKallikrein-related peptidases (KLK), which represent a major tissue-associated proteolytic system, stand for a rich source of biomarkers that may allow molecular classification, early diagnosis and prognosis of human malignancies as well as prediction of response or failure to cancer-directed drugs. International research points to an important role of certain KLKs in female and male urogenital tract malignancies, in addition to cancers of the lung, brain, skin, head and neck, and the gastrointestinal tract. Regarding the female/male urogenital tract, remarkably, all of the KLKs are expressed in the normal prostate, testis, and kidney whereas the uterus, the ovary, and the urinary bladder are expressing a limited number of KLKs only. Most of the information regarding KLK expression in tumour-affected organs is available for ovarian cancer; all of the 12 KLKs tested so far were found to be elevated in the malignant state, depicting them as valuable biomarkers to distinguish between the normal and the cancerous phenotype. In contrast, for kidney cancer, a series of KLKs was found to be downregulated, while other KLKs were not expressed. Evidently, depending on the type of cancer or cancer stage, individual KLKs may show characteristics of a Janus-faced behaviour, by either expanding or inhibiting cancer progression and metastasis.
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Influence of Body Mass Index on Tumor Pathology and Survival in Uterine Cancer: A Danish Register Study. Int J Gynecol Cancer 2017; 27:281-288. [DOI: 10.1097/igc.0000000000000874] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
ObjectiveTo evaluate the influence of body mass index (BMI) on endometrial tumor pathology, stage and complication rate and to identify individual prognostic factors, such as BMI, in types I and II endometrial cancer.DesignRegister study included all Danish women who underwent surgery for uterine cancer or atypical endometrial hyperplasia (International Classification of Diseases-10 codes D070, DC549) 2005 to 2012 (n = 6003).Main Outcome MeasuresImpact of BMI on type I and II endometrial cancer survival.Materials and MethodsDanish Gynecological Cancer Database data on women with type I and II endometrial cancer were retrieved. Kaplan-Meier plot was used to illustrate differences in survival in relation to BMI. Log-rank test was used to demonstrate difference between the curves. Cox regression hazard model was used to estimate hazard ratios (HR) of the effect of BMI on overall survival.ResultsFour thousand three hundred thirty women were included. Women with type I cancer had a significantly better overall survival compared with those with type II cancer. Low BMI was associated with increased mortality in type I (HR, 2.07; 95% confidence interval [CI], 1.20–3.55), whereas in type II both low (HR, 1.68; 95% CI, 1.03–2.74) and high BMI (BMI, 30–35: HR, 1.54; 95% CI, 1.01–2.26 and BMI >40: HR, 2.15; 95% CI, 1.12–4.11) were significantly associated with increased mortality.ConclusionAbnormal BMI is associated with increased mortality in subtypes of endometrial cancer. Underweight was associated with increased overall mortality in both types I and II, whereas obesity only disclosed a significant impact on overall mortality in type II.
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Referring survivors of endometrial cancer and complex atypical hyperplasia to bariatric specialists: a prospective cohort study. Am J Obstet Gynecol 2015; 213:350.e1-10. [PMID: 25981846 DOI: 10.1016/j.ajog.2015.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/21/2015] [Accepted: 05/07/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the acceptability of bariatric referrals when offered by gynecologic oncologists to women with a history of complex atypical hyperplasia or early-stage endometrial cancer and to detail compliance with referrals and weight loss attempts that are initiated 3 months after the referral. STUDY DESIGN Obese women with complex atypical hyperplasia or early-stage endometrial cancer were approached for inclusion in this prospective cohort study. Those women who were not in the care of a bariatric specialist were offered a medical referral with or without a surgical referral. A survey was administered at inclusion and after 3 months. RESULTS Of 121 women who were approached, 106 women were consented. Women reported that it was acceptable for their gynecologic oncologist to discuss weight loss (91.09%) and that a 10% loss of body weight would be beneficial (86.14%). Six women were already in the care of a bariatric specialist. Of the remaining 100 women, 43 accepted a referral: 35 of 100 medical and 8 of 66 surgical referrals that were offered. At 3 months, 17 women complied with a referral (16 medical and 1 surgical), and 59 women had initiated any weight loss attempt. On multivariate analysis, a higher initial weight (P = .0403), Charlson Comorbidity Index ≥5 (P = .0278), and shorter time from surgery to bariatric referral (P = .0338) predicted acceptance of a referral. CONCLUSION Weight-loss counseling is well received by these women. After being offered bariatric referral, only 17% comply, but most women (59%) subsequently initiate a weight loss attempt. Referrals should be offered early in the course of cancer care to maximize acceptance.
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A systematic review and meta-analysis of physical activity and endometrial cancer risk. Eur J Epidemiol 2015; 30:397-412. [PMID: 25800123 DOI: 10.1007/s10654-015-0017-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 03/10/2015] [Indexed: 12/11/2022]
Abstract
Physical activity is related to decreased endometrial cancer risk. However, a comprehensive investigation of activity domains, intensities, time periods in life, and potential interaction with body mass index is unavailable. We performed a meta-analysis of physical activity and endometrial cancer studies published through October 2014. We identified 33 eligible studies comprising 19,558 endometrial cancer cases. High versus low physical activity was related to reduced endometrial cancer risk [relative risk (RR) = 0.80; 95% confidence interval (CI) 0.75-0.85]. The corresponding RRs for recreational activity, occupational activity, household activity, and walking were 0.84 (95% CI 0.78-0.91), 0.81 (95% CI 0.75-0.87), 0.70 (95% CI 0.47-1.02), and 0.82 (95% CI 0.69-0.97), respectively (Pdifference). Walking/biking for transportation, walking for recreation, and walking without specification revealed summary RRs of 0.70 (95% CI 0.58-0.85), 0.94 (95% CI 0.76-1.17), and 0.88 (95% CI 0.52-1.50), respectively (Pdifference). Inverse associations were noted for light (RR 0.65; 95% CI 0.49-0.86), moderate to vigorous (RR 0.83; 95 % CI 0.71-0.96), and vigorous activity (RR 0.80; 95% CI 0.72-0.90; (Pdifference). A statistically significant inverse relation was found for postmenopausal (RR 0.81; 95% CI 0.67-0.97), but not premenopausal women (RR 0.74; 95% CI 0.49-1.13; (Pdifference). Physical activity performed during childhood/adolescence, young adulthood/midlife, and older age yielded RRs of 0.94 (95% CI 0.82-1.08), 0.77 (95% CI 0.58-1.01), and 0.69 (95% CI 0.37-1.28), respectively (Pdifference). An inverse relation was evident in overweight/obese (RR 0.69; 95% CI 0.52-0.91), but not normal weight women (RR 0.97; 95% CI 0.84-1.13; (Pdifference). In conclusion, recreational physical activity, occupational physical activity, and walking/biking for transportation are related to decreased endometrial cancer risk. Inverse associations are evident for physical activity of light, moderate to vigorous, and vigorous intensities. The inverse relation with physical activity is limited to women who are overweight or obese.
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Mahdi H, Jernigan AM, Aljebori Q, Lockhart D, Moslemi-Kebria M. The Impact of Obesity on the 30-Day Morbidity and Mortality After Surgery for Endometrial Cancer. J Minim Invasive Gynecol 2015; 22:94-102. [DOI: 10.1016/j.jmig.2014.07.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 02/07/2023]
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Popovic MD, Banicevic AC, Popovic B, Ceric A, Banicevic A, Popadic D. Treatment of endometrial cancer in patient with malignant obesity. Med Arch 2014; 68:69-70. [PMID: 24783920 PMCID: PMC4272475 DOI: 10.5455/medarh.2014.68.69-70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our 60-year-old patient menarche in 13-year, two delivery, last menstruation in 53-year, without uterine bleeding or any kind of symptomatology. The gynecological transvaginal ultrasound examination showed hyperplasio endometrii (20mm). After curettage, pathological examination was diagnostic polypus carcinomatoides. The patient with HTA and obesity was admitted to and operated on at the Gynecological Department due to endometrial carcinoma (FIGO stage IA1). Because of her giant obesity, BMI – 71.50 kg/m2, weight 219 kg and height 175cm, surgery by the abdominal approach was very difficult to perform, so vaginal hysterectomy was carried out. The procedure was completed within 127 minutes without any intraoperative complications. Blood loss was less than 100ml. The patient was discharged on postoperative day 7. The patient was followed up for 6 months after surgery. No complications or recurrence were reported during the 6-month follow up.
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Affiliation(s)
- Miroslav D. Popovic
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
- Corresponding author: Miroslav D. Popovic, MD, Msc., gynecologist-oncologist, Head of Surgical-Oncology Department of the Clinic of Obstetrics and Gynecology. Clinical Center Banja Luka. Trive Amelice 30/3, Banja Luka, Bosnia and Herzegovina. Phone: +387 (0)51/342-204, Mob:+387 (0)65/188-888. E–mail : drpopovic.gin1 @ gmail.com;
| | - Arnela Ceric Banicevic
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
| | - Biljana Popovic
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
| | - Amela Ceric
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
| | - Andrija Banicevic
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
| | - Danijela Popadic
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
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Yin XH, Jia HY, Xue XR, Yang SZ, Wang ZQ. Clinical analysis of endometrial cancer patients with obesity, diabetes, and hypertension. Int J Clin Exp Med 2014; 7:736-43. [PMID: 24753771 PMCID: PMC3992416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/27/2014] [Indexed: 06/03/2023]
Abstract
The purpose of our study was to study the postoperation outcome and incidence of deep vein thrombosis (DVT) in endometrial cancer (EC) patients with or without hypertension, diabetes, and obesity. This analysis included 219 patients with endometrial carcinoma who were treated between 2002 and 2012 at the Department of Obstetrics and Gynecology, Yangzhou University Hospital. Patients were divided into five groups based on the comorbidities. Group 1 EC & Diabetes, Group 2 EC & Hypertension, Group 3 EC & Obesity, Group 4 EC Combined two, Group 5 no combined. Then the five groups were analyzed in postoperation outcomes and DVT incidence using one-way analysis of variance or Pearson χ(2) tests. we found that there was no significant difference in pelvic lymph node metastasis (P=0.102), aortic lymph node metastasis (P=0.221), and operative time (P=0.503). But there was significant difference in blood loss (P<0.01), hospital stay (P<0.01). No significant difference (P>0.05) in treatment outcome between surgical operation, surgical operation+ radiotherapy and radiotherapy. Deep vein thrombosis and pulmonary embolism have some significantly (P<0.01) (P<0.01), respectively. Compared to patients who simply suffer from endometrial cancer, diabetes make patients easy bleeding in surgery and increase hospitalization time in corresponding. VTE is a common complication of EC surgery with comorbidities, such as diabetes and hypertension, and it's a remarkable proportion of events occurring late after surgery.
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Affiliation(s)
- Xiang-Hua Yin
- Department of Obstetrics and Gynecology, Subei People's Hospital of Jiangsu Province, Clinical Medical College of Yangzhou University Yangzhou, 225000, Jiangsu Province, People's Republic of China
| | - Hong-Yan Jia
- Department of Obstetrics and Gynecology, Subei People's Hospital of Jiangsu Province, Clinical Medical College of Yangzhou University Yangzhou, 225000, Jiangsu Province, People's Republic of China
| | - Xiao-Rui Xue
- Department of Obstetrics and Gynecology, Subei People's Hospital of Jiangsu Province, Clinical Medical College of Yangzhou University Yangzhou, 225000, Jiangsu Province, People's Republic of China
| | - Shi-Zhang Yang
- Department of Obstetrics and Gynecology, Subei People's Hospital of Jiangsu Province, Clinical Medical College of Yangzhou University Yangzhou, 225000, Jiangsu Province, People's Republic of China
| | - Zhong-Qin Wang
- Department of Obstetrics and Gynecology, Subei People's Hospital of Jiangsu Province, Clinical Medical College of Yangzhou University Yangzhou, 225000, Jiangsu Province, People's Republic of China
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