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Zhao Q, Wang M, Chen M. Tumor polo-like kinase 4 protein expression reflects lymphovascular invasion, higher Federation of Gynecology and Obstetrics stage, and shortened survival in endometrial cancer patients who undergo surgical resection. BMC Womens Health 2024; 24:101. [PMID: 38326803 PMCID: PMC10851612 DOI: 10.1186/s12905-024-02911-9] [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] [Received: 09/27/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Polo-like kinase 4 (PLK4) serves as a marker for tumor features and poor outcomes in cancers. This study aimed to explore the associations of tumor PLK4 protein expression with tumor characteristics and survival in endometrial cancer (EC) patients who underwent surgical resection. METHODS This study included 142 EC patients who underwent surgical resection. Tumor tissue samples were obtained for tumor PLK4 protein expression detection via immunohistochemistry (IHC). RESULTS Among EC patients, 26.1% had a PLK4 IHC score of 0, 24.6% had a score of 1-3, 27.5% had a score of 4-6, and 21.8% had a score of 7-12. Tumor PLK4 protein expression positively associated with lymphovascular invasion (P = 0.008) and Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.005). Disease-free survival (DFS) was not different between patients with tumor PLK4 IHC scores > 0 and ≤ 0 (P = 0.154) but was reduced in patients with scores > 3 vs. ≤ 3 (P = 0.009) and > 6 vs. ≤ 6 (P < 0.001). Similarly, overall survival (OS) was not different between patients with scores > 0 and ≤ 0 (P = 0.322) but was shorter in patients with scores > 3 vs. ≤ 3 (P = 0.011) and > 6 vs. ≤ 6 (P = 0.006). After adjustment, a tumor PLK4 IHC score > 6 (vs. ≤ 6) (hazard ratio (HR): 3.156, P = 0.008) or > 3 (vs. ≤ 3) (HR: 3.918, P = 0.026) was independently associated with shortened DFS and OS. CONCLUSION A tumor PLK4 IHC score > 6 or > 3 associates with shortened DFS and OS in EC patients who undergo surgical resection.
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Affiliation(s)
- Qinyan Zhao
- Department of Radiation, Taizhou Cancer Hospital, Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou, 317502, China
| | - Minli Wang
- Department of Radiation, Taizhou Cancer Hospital, Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou, 317502, China
| | - Mingcong Chen
- Department of Radiation, Taizhou Cancer Hospital, Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou, 317502, China.
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2
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Wei S, Yi T, OuYang Z, Wu J. Association between ABO blood type and type I endometrial cancer: a retrospective study. J OBSTET GYNAECOL 2023; 43:2153026. [PMID: 36606697 DOI: 10.1080/01443615.2022.2153026] [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: 01/07/2023]
Abstract
This study aimed to assess the association between ABO blood type and incident of type I endometrial cancer (EC), as well as the stage and differentiation. 213 patients with type I EC and 300 healthy controls were included. As a result, the frequencies of A, B, O, and AB blood types among patients with type I EC were 51 (23.9%), 59 (27.7%), 93 (43.7%) and 10 (4.7%), respectively. There were no significant differences in age, body mass index, and other baseline covariates between groups of ABO blood types (p > .05). Logistic regression model showed that women with blood type O was more likely to develop type I EC than those with type A (odds ratio (OR): 1.66, 95% confidence interval (CI): 1.05-2.63). However, there was no significant association of ABO blood type with stage and differentiation of type I EC (p > .05). In conclusion, blood type O was the most prevalent ABO blood type among patients with type I EC and was associated with increased risk of type I EC, while ABO blood type was not significantly associated with stage or differentiation of type I EC.IMPACT STATEMENTWhat is already known on this subject? Previous studies have produced inconsistent findings on association of ABO blood type with EC. Those studies also did not explore the relationship between ABO blood type and stage or differentiation of type I EC.What the results of this study add? The present study showed that women with blood type O was more likely to develop type I EC than those with type A and there was no significant association of ABO blood type with stage or differentiation of type I EC.What the implications are of these findings for clinical practice and/or further research? Gynaecologists should pay more attention to women with blood type O, who should undergo more active EC screening.
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Affiliation(s)
- Shiyuan Wei
- The Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tingting Yi
- Department of Hematology, The First Affiliated Hospital of Shaoyang University, Shaoyang, China
| | - Zhenbo OuYang
- The Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jiawen Wu
- The Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
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3
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Xu B, Lv L, Chen X, Li X, Zhao X, Yang H, Feng W, Jiang X, Li J. Temporal relationships between BMI and obesity-related predictors of cardiometabolic and breast cancer risk in a longitudinal cohort. Sci Rep 2023; 13:12361. [PMID: 37524743 PMCID: PMC10390576 DOI: 10.1038/s41598-023-39387-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
Prospective inter-relationships among biomarkers were unexplored, which may provide mechanistic insights into diseases. We investigated the longitudinal associations of BMI change with trajectories of biomarkers related to cardiometabolic or breast cancer risk. A longitudinal study was conducted among 444 healthy women between 2019 to 2021. Cross‑lagged path analysis was used to examine the temporal relationships among BMI, cardiometabolic risk score (CRS), and obesity‑related proteins score (OPS) of breast cancer. Linear mixed-effect models were applied to investigate associations of time-varying BMI with biomarker-based risk score trajectories. Baseline BMI was associated with subsequent change of breast cancer predictors (P = 0.03), and baseline CRS were positively associated with OPS change (P < 0.001) but not vice versa. After fully adjustment of confounders, we found a 0.058 (95%CI = 0.009-0.107, P = 0.020) units increase of CRS and a 1.021 (95%CI = 0.041-1.995, P = 0.040) units increase of OPS as BMI increased 1 kg/m2 per year in postmenopausal women. OPS increased 0.784 (95%CI = 0.053-1.512, P = 0.035) units as CRS increased 1 unit per year. However, among premenopausal women, BMI only significantly affected CRS (β = 0.057, 95%CI = 0.007 to 0.107, P = 0.025). No significant change of OPS with time-varying CRS was found. Higher increase rates of BMI were associated with worse trajectories of biomarker-based risk of cardiometabolic and breast cancer. The longitudinal impact of CRS on OPS is unidirectional. Recommendations such as weight control for the reduction of cardiometabolic risk factors may benefit breast cancer prevention, especially in postmenopausal women.
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Affiliation(s)
- Bin Xu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, 16#, Section 3, Renmin Nan Lu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Liang Lv
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, 16#, Section 3, Renmin Nan Lu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Chen
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, 16#, Section 3, Renmin Nan Lu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xingyue Li
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, 16#, Section 3, Renmin Nan Lu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xunying Zhao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, 16#, Section 3, Renmin Nan Lu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Huifang Yang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, 16#, Section 3, Renmin Nan Lu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wanting Feng
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, 16#, Section 3, Renmin Nan Lu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xia Jiang
- Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, 16#, Section 3, Renmin Nan Lu, Chengdu, 610041, Sichuan, People's Republic of China.
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Alrobaiq BM, Alharbi RS, Alhoshan FS, Alnasyan MA, Alahideb A, Omair A. Hypertension and Ovarian Cancer: A Case-Control Study in Saudi Arabia. Cureus 2023; 15:e35294. [PMID: 36968893 PMCID: PMC10037349 DOI: 10.7759/cureus.35294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Background There is limited evidence that evaluates the association between hypertension and ovarian cancer. The study aims to investigate the association between ovarian cancer and hypertension, the difference in lipid profile, and the association between body mass index (BMI) and ovarian cancer. Methods We conducted a case-control study at King Abdelaziz Medical City (KAMC), oncology department. All Saudi female patients who were diagnosed with primary ovarian cancer admitted to the oncology department at KAMC from 2016 to 2019 were selected. The data were collected from medical records of patients of the KAMC by chart review using The Ministry of National Guard Health Affairs BESTCare database. Results A total of 137 Saudi female patients diagnosed with ovarian cancer attending to gynecology and oncology center in KAMC from 2016 to 2019 were included in this study. The mean age of participants was 57 in cases and 56 in controls with a mean BMI of 29.64 in cases and 31 in controls. There were 63 obese cases, therefore, the proportion of obesity was 46%. Approximately one-third of cases were overweight (28%) while one-fourth (26%) of them were underweight or normal weight. Roughly two-thirds of cases were hypertensive with an overall proportion of 66 % (95% confidence interval (CI) 58-74) while one-third of controls were hypertensive with an overall proportion of 32%. Cases were having significantly higher triglycerides (p=0.03) and lower high-density lipoprotein (HDL) (p=0.001) than controls. The significant variables were analyzed using logistic regression. It was found that hypertensive subjects were 10.06 times more likely (95% CI: 4.88-20.71) to be associated with the cases as compared to controls (p<0.001). Also, an increase in BMI was significantly associated with being a case with OR = 1.07 (95% CI: 1.02-1.12; p=0.004). Conclusion In conclusion, hypertension, elevated BMI, higher triglycerides, and lower HDL were significantly associated with ovarian cancer.
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Evaluation of Tissue Expression of Vaspin and Serum Vaspin Concentration as a Prognostic and Risk Factor in Endometrial Cancer. Cells 2022; 11:cells11203196. [PMID: 36291064 PMCID: PMC9600625 DOI: 10.3390/cells11203196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/23/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
Adipose tissue is a multifunctional endocrine organ. One of the biologically active substances is vaspin, which is part of the serpin family. The purpose of the following study is to determine the possibility of using vaspin as a prognostic and risk factor in endometrial cancer. The study included 127 patients with abnormal uterine bleeding. To determine the value of adipokine, the study used Kaplan-Meier curves to estimate patients survival. Univariate and multivariate analyses were performed simultaneously using the Cox regression model. Tissue expression of vaspin was assessed in patients from the study group (endometrial cancer) and the control group (non-cancerous). We found that higher levels of vaspin are found in obese people, with lower staging (FIGO I and II), lower grading (G1), no LVSI metastases and no lymph node metastases. Higher serum vaspin levels are an independent protective factor for endometrial cancer. We concluded that endometrial cancer patients with serum vaspin concentrations above the median have longer DFS compared to patients with concentrations below the median. Considering multivariate analysis, vaspin concentrations above the median are independent favourable prognostic factors for endometrial cancer. Tissue expression of vaspin cannot be a histological marker to distinguish between cancer and non-cancerous lesions and between different grading levels.
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Hypertension in Cancer Survivors. Curr Hypertens Rep 2022; 24:435-443. [PMID: 35852781 DOI: 10.1007/s11906-022-01208-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
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Ibrahim AH, Abd El Wahab MH, Shash E. Quality of Life and Endometrial Cancer. HANDBOOK OF QUALITY OF LIFE IN CANCER 2022:425-437. [DOI: 10.1007/978-3-030-84702-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Akinyemiju T, Oyekunle T, Salako O, Gupta A, Alatise O, Ogun G, Adeniyi A, Deveaux A, Hall A, Ayandipo O, Olajide T, Olasehinde O, Arowolo O, Adisa A, Afuwape O, Olusanya A, Adegoke A, Tollefsbol TO, Arnett D, Muehlbauer MJ, Newgard CB, Daramola A. Metabolic Syndrome and Risk of Breast Cancer by Molecular Subtype: Analysis of the MEND Study. Clin Breast Cancer 2021; 22:e463-e472. [PMID: 34980540 PMCID: PMC9641637 DOI: 10.1016/j.clbc.2021.11.004] [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: 08/02/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 12/17/2022]
Abstract
Metabolic syndrome is a cluster of biological irregularities that is a known risk factor for cardiovascular disease, stroke, and diabetes. In a case-control study of 555 West African women, we observed that metabolic syndrome was strongly associated with breast cancer and the aggressive triple-negative molecular subtype, highlighting a need for clinical and lifestyle interventions targeting metabolic syndrome to reduce breast cancer risk in this population.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC; Duke Cancer Institute, School of Medicine, Duke University, Durham, NC; Duke Global Health Institute, Duke University, Durham, NC.
| | - Taofik Oyekunle
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC
| | - Omolola Salako
- College of Medicine and Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria
| | - Anjali Gupta
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC
| | - Olusegun Alatise
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Gabriel Ogun
- Unversity College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - April Deveaux
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC
| | - Allison Hall
- Department of Pathology, School of Medicine, Duke University, Durham, NC
| | - Omobolaji Ayandipo
- Unversity College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Thomas Olajide
- College of Medicine and Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria
| | | | - Olukayode Arowolo
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Adewale Adisa
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Oludolapo Afuwape
- Unversity College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Aralola Olusanya
- Unversity College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Aderemi Adegoke
- Our Lady of Apostle Catholic Hospital, Ibadan, Oyo State, Nigeria
| | | | - Donna Arnett
- College of Public Health, University of Kentucky, Lexington, KY
| | - Michael J Muehlbauer
- Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC
| | - Christopher B Newgard
- Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC
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- University of Kansas Medical Center, Kansas City, KS
| | - Adetola Daramola
- College of Medicine and Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria; University of Kansas Medical Center, Kansas City, KS
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Yue W, Tran HT, Wang JP, Schiermeyer K, Gildea JJ, Xu P, Felder RA. The Hypertension Related Gene G-Protein Coupled Receptor Kinase 4 Contributes to Breast Cancer Proliferation. Breast Cancer (Auckl) 2021; 15:11782234211015753. [PMID: 34103922 PMCID: PMC8145586 DOI: 10.1177/11782234211015753] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/12/2021] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Clinical studies have shown that breast cancer risk is increased in hypertensive women. The underlying molecular mechanism remains undetermined. The current study tests our hypothesis that G protein coupled receptor kinase 4 (GRK4) is a molecule that links hypertension and breast cancer. GRK4 plays an important role in regulation of renal sodium excretion. Sustained activation of GRK4 as in the circumstances of single nucleotide polymorphism (SNPs) causes hypertension. Expression of GRK4 in the kidney is regulated by cMyc, an oncogene that is amplified in breast cancer. METHODS Western analysis was used to evaluate GRK4 protein expression in seven breast cancer cell lines. GRK4 gene single nucleotide polymorphism in breast cancer cell lines and in breast cancer cDNA arrays were determined using TaqMan Genotyping qPRC. The function of GRK4 was evaluated in MCF-7 cells with cMyc knock-down and GRK4 re-expression and in MDA-MB-468 cells expressing inducible GRK4 shRNA lentivirus constructs. Nuclei counting and 5-Bromo-2'-deoxy-uridine (BrdU) labeling were used to evaluate cell growth and proliferation. RESULTS Genotyping of GRK4 SNPs in breast cancer cDNA arrays (n = 94) revealed that the frequency of carrying two hypertension related SNPs A142 V or R65 L is threefold higher in breast cancer patients than in healthy people (P = 7.53E-11). GRK4 protein is expressed in seven breast cancer cell lines but not the benign mammary epithelial cell line, MCF-10A. Three hypertension related SNPs in the GRK4 gene were identified in the breast cancer cell lines. Except for BT20, all other breast cancer lines have 1-3 GRK4 SNPs of which A142 V occurs in all 6 lines. MDA-MB-468 cells contain homozygous A142 V and R65 L SNPs. Knocking down cMyc in MCF-7 cells significantly reduced the growth rate, which was rescued by re-expression of GRK4. We then generated three stable GRK4 knock-down MDA-MB-468 lines using inducible lentiviral shRNA vectors. Doxycycline (Dox) induced GRK4 silencing significantly reduced GRK4 mRNA and protein levels, growth rates, and proliferation. As a marker of cell proliferation, the percentage of BrdU-labeled cells decreased from 45 ± 3% in the cells without Dox to 32 ± 5% in the cells treated with 0.1 µg/mL Dox. CONCLUSIONS GRK4 acts as an independent proliferation promotor in breast cancer. Our results suggest that targeted inhibition of GRK4 could be a new therapy for both hypertension and breast cancer.
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Affiliation(s)
- Wei Yue
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Hanh T. Tran
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ji-ping Wang
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Katherine Schiermeyer
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - John J. Gildea
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Peng Xu
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Robin A. Felder
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
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Histopathological Findings in Iranian Patients with Postmenopausal Uterine Bleeding. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00515-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kidoguchi S, Sugano N, Tokudome G, Yokoo T, Yano Y, Hatake K, Nishiyama A. New Concept of Onco-Hypertension and Future Perspectives. Hypertension 2020; 77:16-27. [PMID: 33222548 DOI: 10.1161/hypertensionaha.120.16044] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Owing to aging populations, the prevalence of hypertension and associated cardiovascular events has been increasing worldwide. The morbidity and mortality due to cancer have also been increasing with aging populations. Several small-molecule inhibitors have been used in cancer therapy, which have a positive impact on the prognosis and survival of patients with cancer. Consequently, the number of cancer survivors with hypertension has been rapidly increasing. Anticancer therapy, including vascular endothelial growth factor inhibitors, increases blood pressure. However, both clinical and laboratory evidence are lacking regarding optimal blood pressure control in patients with hypertension with cancer. Here, we propose the concept of onco-hypertension, which is an evolving subspecialty focused on the complex pathophysiology of hypertension and cancer. In this review, we highlight blood pressure changes in cancer, hypertension induced by anticancer therapy, and optimal blood pressure management in patients with hypertension with cancer. In addition, we discuss needed studies to further establish this new onco-hypertension concept.
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Affiliation(s)
- Satoshi Kidoguchi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan (S.K., N.S., G.T., T.Y.).,Department of Pharmacology, Faculty of Medicine, Kagawa University, Japan (S.K., A.N.)
| | - Naoki Sugano
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan (S.K., N.S., G.T., T.Y.)
| | - Gorou Tokudome
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan (S.K., N.S., G.T., T.Y.)
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan (S.K., N.S., G.T., T.Y.)
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.)
| | - Kiyohiko Hatake
- Department of Lymphoma/Hematologic Malignancy Center, Mita Hospital, International University of Health and Welfare, Tokyo, Japan (K.H.)
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Japan (S.K., A.N.)
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Radiation and hormonal therapy for primary treatment of stage I endometrial cancer and long-term survival. Gynecol Oncol 2020; 158:331-338. [DOI: 10.1016/j.ygyno.2020.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/13/2020] [Indexed: 12/29/2022]
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13
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Association between metabolic syndrome and endometrial cancer risk: a systematic review and meta-analysis of observational studies. Aging (Albany NY) 2020; 12:9825-9839. [PMID: 32439832 PMCID: PMC7288955 DOI: 10.18632/aging.103247] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/20/2020] [Indexed: 12/24/2022]
Abstract
Existing evidence has revealed inconsistent results on the association between metabolic syndrome (MetS) and endometrial cancer (EC) risk. Herein, we aim to better understand this association. Systematic searches of PubMed, EMBASE, and Web of Science through 12 December 2019 were conducted. Observational studies that provided risk estimates of MetS and EC risk were eligible. The quality of the included studies was judged based on the Newcastle–Ottawa scale. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Six studies, comprising 17,772 EC cases and 150,371 participants were included. MetS, diagnosed according to the criteria of the National Cholesterol Education Program—Third Adult Treatment Panel, was associated with an increased risk of EC (OR: 1.62; 95% CI = 1.26–2.07) with substantial heterogeneity (I2 = 78.3%). Furthermore, we found that women with MetS, diagnosed according to the criteria of the International Diabetes Federation, had a significantly higher risk of EC compared to healthy controls (OR: 1.45; 95% CI = 1.16–1.81; I2 = 64.6%). Our findings were generally consistent with the main results in the majority of prespecified subgroups, as well as in sensitivity analyses. In conclusion, MetS is associated with EC risk.
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Christakoudi S, Kakourou A, Markozannes G, Tzoulaki I, Weiderpass E, Brennan P, Gunter M, Dahm CC, Overvad K, Olsen A, Tjønneland A, Boutron-Ruault MC, Madika AL, Severi G, Katzke V, Kühn T, Bergmann MM, Boeing H, Karakatsani A, Martimianaki G, Thriskos P, Masala G, Sieri S, Panico S, Tumino R, Ricceri F, Agudo A, Redondo-Sánchez D, Colorado-Yohar SM, Mokoroa O, Melander O, Stocks T, Häggström C, Harlid S, Bueno-de-Mesquita B, van Gils CH, Vermeulen RC, Khaw KT, Wareham NJ, Tong TY, Freisling H, Johansson M, Lennon H, Aune D, Riboli E, Trichopoulos D, Trichopoulou A, Tsilidis KK. Blood pressure and risk of cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2020; 146:2680-2693. [PMID: 31319002 PMCID: PMC7115826 DOI: 10.1002/ijc.32576] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/23/2019] [Accepted: 06/14/2019] [Indexed: 12/19/2022]
Abstract
Several studies have reported associations of hypertension with cancer, but not all results were conclusive. We examined the association of systolic (SBP) and diastolic (DBP) blood pressure with the development of incident cancer at all anatomical sites in the European Prospective Investigation into Cancer and Nutrition (EPIC). Hazard ratios (HRs) (95% confidence intervals) were estimated using multivariable Cox proportional hazards models, stratified by EPIC-participating center and age at recruitment, and adjusted for sex, education, smoking, body mass index, physical activity, diabetes and dietary (in women also reproductive) factors. The study included 307,318 men and women, with an average follow-up of 13.7 (standard deviation 4.4) years and 39,298 incident cancers. We confirmed the expected positive association with renal cell carcinoma: HR = 1.12 (1.08-1.17) per 10 mm Hg higher SBP and HR = 1.23 (1.14-1.32) for DBP. We additionally found positive associations for esophageal squamous cell carcinoma (SCC): HR = 1.16 (1.07-1.26) (SBP), HR = 1.31 (1.13-1.51) (DBP), weaker for head and neck cancers: HR = 1.08 (1.04-1.12) (SBP), HR = 1.09 (1.01-1.17) (DBP) and, similarly, for skin SCC, colon cancer, postmenopausal breast cancer and uterine adenocarcinoma (AC), but not for esophageal AC, lung SCC, lung AC or uterine endometroid cancer. We observed weak inverse associations of SBP with cervical SCC: HR = 0.91 (0.82-1.00) and lymphomas: HR = 0.97 (0.93-1.00). There were no consistent associations with cancers in other locations. Our results are largely compatible with published studies and support weak associations of blood pressure with cancers in specific locations and morphologies.
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Affiliation(s)
- Sofia Christakoudi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk place, London W2 1PG, United Kingdom
- MRC Centre for Transplantation, King’s College London, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Artemisia Kakourou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk place, London W2 1PG, United Kingdom
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon CEDEX 08, France
| | - Paul Brennan
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon CEDEX 08, France
| | - Marc Gunter
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon CEDEX 08, France
| | - Christina C. Dahm
- Department of Public Health, Aarhus University, DK-8000, Aarhus, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, DK-8000, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anja Olsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie-Christine Boutron-Ruault
- Centre de recherche en Epidemiologie et Sante des Populations (CESP), Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Anne-Laure Madika
- Centre de recherche en Epidemiologie et Sante des Populations (CESP), Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
- Université Lille, CHU Lille, EA2694, Lille, France
| | - Gianluca Severi
- Centre de recherche en Epidemiologie et Sante des Populations (CESP), Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Manuela M. Bergmann
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Arthur-Scheunert-Allee 114-116, Nuthetal, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Arthur-Scheunert-Allee 114-116, Nuthetal, Germany
| | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2 Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University Hospital, Haidari, Greece
| | | | | | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133, Milano, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, "M.P.Arezzo" Hospital, ASP Ragusa, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Antonio Agudo
- Unit of Nutrition and Cancer. Cancer Epidemiology Research Program. Catalan Institute of Oncology-IDIBELL. L’Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Redondo-Sánchez
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA, Universidad de Granada. Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sandra M. Colorado-Yohar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - Olatz Mokoroa
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Christel Häggström
- Department of Biobank Research, Umeå University, Umeå, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sophia Harlid
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Bas Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk place, London W2 1PG, United Kingdom
- Dept. for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Dept. of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Pantai Valley, 50603, Kuala Lumpur, Malaysia
| | - Carla H. van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Roel C.H. Vermeulen
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk place, London W2 1PG, United Kingdom
- Environmental Epidemiology Group, Institute of Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- Public Health Department, University Medical Center, Utrecht, The Netherlands
| | - Kay-Tee Khaw
- University of Cambridge, School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge CB2 2QQ, United Kingdom
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Tammy Y.N. Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford. United Kingdom
| | - Heinz Freisling
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon CEDEX 08, France
| | - Mattias Johansson
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon CEDEX 08, France
| | - Hannah Lennon
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon CEDEX 08, France
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk place, London W2 1PG, United Kingdom
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk place, London W2 1PG, United Kingdom
| | - Dimitrios Trichopoulos
- Hellenic Health Foundation, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | | | - Konstantinos K. Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk place, London W2 1PG, United Kingdom
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
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15
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Cardiometabolic comorbidities and epithelial ovarian cancer risk among African-American women in the African-American Cancer Epidemiology Study (AACES). Gynecol Oncol 2020; 158:123-129. [PMID: 32362566 DOI: 10.1016/j.ygyno.2020.04.700] [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] [Received: 01/30/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies that have examined the association between cardiovascular comorbidities and epithelial ovarian cancer (EOC) have yielded inconsistent results. It remains unknown whether cardiometabolic disease is associated with EOC in African American (AA) women, who have a higher prevalence of cardiovascular disease and lower risk of EOC than White women. Here, we estimate the effect of cardiovascular comorbid conditions and EOC risk among AA women. METHODS Data were available from 593 ovarian carcinoma patients and 752 controls enrolled in the African American Cancer Epidemiology Study (AACES). Participants were asked to self-report a history of hypertension, hyperlipidemia, and diabetes and any current medication use. The relationship between hypertension, hyperlipidemia, diabetes, and medications taken for these conditions was determined using multivariate logistic regression. RESULTS Hypertension was associated with an increased risk (adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.01, 1.73), whereas diabetes and hyperlipidemia were associated with a decreased risk (aOR = 0.67, 95% CI = 0.49, 0.91 and aOR = 0.61, 95% CI = 0.47, 0.80, respectively) of EOC. Use of anti-diabetic medication was inversely associated with EOC risk, as was use of lipid lowering medications (in the overall study population), which were predominantly statins. Among women with hypertension, use of anti-hypertensive medications was inversely associated with EOC risk, with associations that were most pronounced for diuretics, ARBs and ACE inhibitors. CONCLUSION Hypertension was associated with an increased EOC risk in this patient population, whereas an inverse association was observed for diabetes and hyperlipidemia. The decreased risk of EOC identified with use of anti-hypertensive, anti-diabetes or lipid-lowering medications could have implications for risk reduction strategies.
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16
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Eskandari D, Khodabandehloo N, Gholami A, Samadanifard H, Hejrati A. Investigation of the association between metabolic syndrome and breast cancer patients. Eur J Transl Myol 2020; 30:8776. [PMID: 32499883 PMCID: PMC7254422 DOI: 10.4081/ejtm.2019.8776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 12/13/2022] Open
Abstract
One of the most serious cancers among women is breast cancer. This disease is the first reason for the death of women due to cancer. Increasing breast cancer risk may associate with many factors including genetic, reproductive factors, people's lifestyle, metabolic syndrome (MS) and hormones. MS has been known as a risk factor for prostate, pancreatic, breast and colorectal cancers. The purpose of this review is to identify the relationship between MS components and breast cancer individually. This study was performed by researching electronic database references including PubMed, Google Scholar, CINAHL ProQuest, and web of science through 2019. The effect of MS with its components and breast cancer was reported in many studies. Nevertheless, a thorough understanding of the mechanisms involved remains a challenge. However, one can take several preventive measures, including a proper diet, which is one of the most important determinants of metabolic status. Also, general preventive recommendations are including reducing alcohol consumption, red meat and total fat in the diet. Moreover, increasing the consumption of vegetable and fruit reduce the proportion of MS patients to improve the outcome of breast cancer patients.
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Affiliation(s)
- Delaram Eskandari
- Department of endocrinology, School of Medicine, Hazrat-e Rasool Hospital, Iran University of Medical Sciences. Tehran, Iran
| | - Niloofar Khodabandehloo
- School of Medicine, Hazrat-e Rasool Hospital, Iran University of Medical Sciences. Tehran, Iran
| | - Abbas Gholami
- Department of Internal Medicine, School of Medicine, Hazrat-e Rasool Hospital, Iran University of Medical Sciences. Tehran, Iran
| | - Hosein Samadanifard
- Department of endocrinology, School of Medicine, Hazrat-e Rasool Hospital, Iran University of Medical Sciences. Tehran, Iran
| | - Alireza Hejrati
- Department of Internal Medicine, School of Medicine, Hazrat-e Rasool Hospital, Iran University of Medical Sciences. Tehran, Iran
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17
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Raglan O, Kalliala I, Markozannes G, Cividini S, Gunter MJ, Nautiyal J, Gabra H, Paraskevaidis E, Martin-Hirsch P, Tsilidis KK, Kyrgiou M. Risk factors for endometrial cancer: An umbrella review of the literature. Int J Cancer 2019; 145:1719-1730. [PMID: 30387875 DOI: 10.1002/ijc.31961] [Citation(s) in RCA: 258] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/19/2018] [Indexed: 03/25/2024]
Abstract
Although many risk factors could have causal association with endometrial cancer, they are also prone to residual confounding or other biases which could lead to over- or underestimation. This umbrella review evaluates the strength and validity of evidence pertaining risk factors for endometrial cancer. Systematic reviews or meta-analyses of observational studies evaluating the association between non-genetic risk factors and risk of developing or dying from endometrial cancer were identified from inception to April 2018 using PubMed, the Cochrane database and manual reference screening. Evidence was graded strong, highly suggestive, suggestive or weak based on statistical significance of random-effects summary estimate, largest study included, number of cases, between-study heterogeneity, 95% prediction intervals, small study effects, excess significance bias and sensitivity analysis with credibility ceilings. We identified 171 meta-analyses investigating associations between 53 risk factors and endometrial cancer incidence and mortality. Risk factors were categorised: anthropometric indices, dietary intake, physical activity, medical conditions, hormonal therapy use, biochemical markers, gynaecological history and smoking. Of 127 meta-analyses including cohort studies, three associations were graded with strong evidence. Body mass index and waist-to-hip ratio were associated with increased cancer risk in premenopausal women (RR per 5 kg/m2 1.49; CI 1.39-1.61) and for total endometrial cancer (RR per 0.1unit 1.21; CI 1.13-1.29), respectively. Parity reduced risk of disease (RR 0.66, CI 0.60-0.74). Of many proposed risk factors, only three had strong association without hints of bias. Identification of genuine risk factors associated with endometrial cancer may assist in developing targeted prevention strategies for women at high risk.
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Affiliation(s)
- Olivia Raglan
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ilkka Kalliala
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | | | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Jaya Nautiyal
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Hani Gabra
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom
- Early Clinical Development, IMED Biotech Unit, Cambridge, United Kingdom
| | | | - Pierre Martin-Hirsch
- Department of Gynaecologic Oncology, Lancashire Teaching Hospitals, Preston, United Kingdom
- Department of Biophysics, University of Lancaster, Lancaster, United Kingdom
| | - Kostas K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Maria Kyrgiou
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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18
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Seretis A, Cividini S, Markozannes G, Tseretopoulou X, Lopez DS, Ntzani EE, Tsilidis KK. Association between blood pressure and risk of cancer development: a systematic review and meta-analysis of observational studies. Sci Rep 2019; 9:8565. [PMID: 31189941 PMCID: PMC6561976 DOI: 10.1038/s41598-019-45014-4] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/28/2019] [Indexed: 12/13/2022] Open
Abstract
With the exception of renal cell carcinoma, studies assessing the association between hypertension and other cancers are inconsistent. We conducted a meta-analysis to assess this evidence. We included observational studies investigating the association between any definition of hypertension or systolic and diastolic blood pressure and risk of any cancer, after searching PubMed until November 2017. We calculated summary relative risks (RR) and 95% confidence intervals (CI) using inverse-variance weighted random effects methods. A total of 148 eligible publications were identified out of 39,891 initially screened citations. Considering only evidence from 85 prospective studies, positive associations were observed between hypertension and kidney, colorectal and breast cancer. Positive associations between hypertension and risk of oesophageal adenocarcinoma and squamous cell carcinoma, liver and endometrial cancer were also observed, but the majority of studies did not perform comprehensive multivariable adjustments. Systolic and diastolic blood pressure were positively associated with risk of kidney cancer but not with other cancers. In addition to the previously well-described association between hypertension and risk of kidney cancer, the current meta-analysis suggested that hypertensive individuals may also be at higher risk of colorectal and breast cancer. However, careful interpretation is required as most meta-analyses included relatively small number of studies, several relative risks had weak or moderate magnitude and maybe affected by residual confounding.
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Affiliation(s)
- Aristeidis Seretis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | | | - Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Xanthippi Tseretopoulou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - David S Lopez
- The University of Texas School of Public Health, Houston, TX, USA
| | - Evangelia E Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.,Center for Evidence-Based Medicine, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. .,Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK.
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19
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Adambekov S, Yi Y, Fabio A, Miljkovic I, Edwards RP, Lopa S, Linkov F. Metabolic Syndrome in Endometrial Cancer Patients: Systematic Review. Metab Syndr Relat Disord 2019; 17:241-249. [PMID: 30932741 DOI: 10.1089/met.2018.0106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Large numbers of previously published studies show the importance of Metabolic syndrome (MetS) in the development of endometrial cancer (EC), the most common gynecologic malignancy in the United States. Defining the association between EC and MetS is complicated by inconsistencies among the MetS definitions used in EC. The aim of this study was to identify the MetS definition that is most practical for EC patients, as well as to estimate the prevalence of MetS using each definition in EC patients. A systematic literature search of PubMed and Embase was conducted to identify studies published between 1988 and 2018 and reporting the components of MetS in EC patients. Relevant studies were selected based on the presence of key MetS components, including central obesity, dyslipidemia, elevated blood pressure, and impaired glucose metabolism. Two independent reviewers extracted information from these articles. Our literature search has identified 400 articles, 8 of which were used for the final analyses. In this systematic review, the prevalence of MetS in EC patients varied based on the definition used, ranging from 6% for International Diabetes Federation (IDF) to 62% for Harmonized. IDF and Harmonized of MetS were the most practical definitions for women with EC. While our review included different approaches to diagnosing MetS and linking it to EC, we argue that there is a need for single and practical MetS definition criteria to improve diagnostics, decrease the inconsistencies across the future EC studies, and foster a cohesive understanding of the evidence regarding the association between MetS and EC.
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Affiliation(s)
- Shalkar Adambekov
- 1 Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Yan Yi
- 1 Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anthony Fabio
- 1 Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Iva Miljkovic
- 1 Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Robert P Edwards
- 2 Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,3 Magee Womens Research Institute, Pittsburgh, Pennsylvania.,4 UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Samia Lopa
- 2 Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,3 Magee Womens Research Institute, Pittsburgh, Pennsylvania
| | - Faina Linkov
- 1 Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania.,2 Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,3 Magee Womens Research Institute, Pittsburgh, Pennsylvania.,4 UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
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20
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Degasper C, Brunner A, Sampson N, Tsibulak I, Wieser V, Welponer H, Marth C, Fiegl H, Zeimet AG. NADPH oxidase 4 expression in the normal endometrium and in endometrial cancer. Tumour Biol 2019; 41:1010428319830002. [PMID: 30813866 DOI: 10.1177/1010428319830002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
The aim of this study was to explore the role of NOX4 in the biology of the normal endometrium and endometrial cancer. NOX4 plays a key role in other adenocarcinomas and has been implicated in the pathogenesis of diabetes and obesity, which are important risk factors for endometrial cancer. NOX4 expression was assessed in 239 endometrial cancer and 25 normal endometrium samples by quantitative real-time polymerase chain reaction, in situ hybridization, and immunohistochemistry. DNA methylation of the NOX4 promoter was determined by means of MethyLight PCR. Data were correlated with clinicopathological parameters and analyzed in the context of diabetes and body mass index. In the normal endometrium, NOX4 microRNA expression was significantly higher in the secretory transformed compared with proliferative endometrium ( p = 0.008). In endometrial cancer specimens, NOX4 expression did not differ between diabetic and non-diabetic patients, but was the highest in patients with a body mass index ≤ 26 ( p = 0.037). The lowest NOX4 expression was found in carcinosarcomas ( p = 0.007). High NOX4 expression predicted poorer clinical outcome with regard to overall survival, especially in non-diabetic patients and those with a body mass index > 20. Independent prognostic significance of NOX4 transcripts was retained in type I endometrial cancer and was the most meaningful in patients with a body mass index > 20. No prognostic impact was shown for NOX4 promoter methylation in endometrial cancer. For the first time, we demonstrate that NOX4 plays a considerable role in the cycle-dependent changes in the normal endometrium and in the biology of endometrial cancer.
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Affiliation(s)
- Christine Degasper
- 1 Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Brunner
- 2 Department of Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Natalie Sampson
- 3 Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Irina Tsibulak
- 1 Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Wieser
- 1 Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hannah Welponer
- 1 Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Marth
- 1 Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Heidi Fiegl
- 1 Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alain Gustave Zeimet
- 1 Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
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21
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Dibaba DT, Ogunsina K, Braithwaite D, Akinyemiju T. Metabolic syndrome and risk of breast cancer mortality by menopause, obesity, and subtype. Breast Cancer Res Treat 2018; 174:209-218. [PMID: 30465158 DOI: 10.1007/s10549-018-5056-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate the association between metabolic syndrome (MetS) and risk of breast cancer mortality by menopausal status, obesity, and subtype. METHODS Data from 94,555 women free of cancer at baseline in the National Institute of Health-American Association of Retired Persons Diet and Health Study cohort (NIH-AARP) were used to investigate the prospective associations of baseline MetS and components with risk of breast cancer mortality using Cox proportional hazard regression models adjusted for baseline behavioral and demographic covariates. RESULTS During a mean follow-up duration of 14 years, 607 women in the cohort died of breast cancer. Overall, MetS was associated with a 73% increased risk of breast cancer mortality (HR 1.73; 95% CI 1.09-2.75); the association remained significant among post-menopausal women overall (HR 2.07, 95% CI 1.32, 3.25), and among those with overweight/obesity (HR 1.15, 95% CI 0.81, 1.64). MetS was associated with increased risk of breast cancer mortality for ER+/PR+ (HR 1.28, 95% CI 0.52, 3.16) and lower risk for ER-/PR- (HR 0.44, 95% CI 0.11, 1.75) subtypes; however, the associations were not statistically significant. Of the individual MetS components, high waist circumference (HR 1.32, 95% CI 1.03, 1.70), high cholesterol (HR 1.24, 95% CI 1.05, 1.46), and hypertension (HR 1.24, 95% CI 1.05, 1.46) were independently associated with increased risk of breast cancer mortality. CONCLUSIONS MetS was associated with increased risk of breast cancer mortality, especially among post-menopausal women. Further studies with larger sample sizes are needed to definitively determine the extent to which these associations vary by breast cancer subtype.
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Affiliation(s)
- Daniel T Dibaba
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Kemi Ogunsina
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | | | - Tomi Akinyemiju
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA.
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
- College of Public Health and Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
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Ray A. Cancer and comorbidity: The role of leptin in breast cancer and associated pathologies. World J Clin Cases 2018; 6:483-492. [PMID: 30397604 PMCID: PMC6212611 DOI: 10.12998/wjcc.v6.i12.483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 02/05/2023] Open
Abstract
Obesity is an important risk factor for postmenopausal breast cancer and also a poor prognostic factor among cancer patients. Moreover, obesity is associated with a number of health disorders such as insulin resistance/type-2 diabetes mellitus, hypertension, and other cardiovascular diseases. Frequently, these health disorders exhibit as components/complications of the metabolic syndrome. Nevertheless, obesity-related diseases may coexist with postmenopausal breast cancer; and these comorbid conditions could be substantial. Therefore, it may be assumed that different diseases including breast cancer could originate from a common pathological background in excessive adipose tissue. Adipocyte-released hormone-like cytokine (or adipokine) leptin behaves differently in a normal healthy state and obesity. A growing body of evidence suggests an important role of leptin in our major obesity-related health issues such as insulin resistance, hypertension, and neoplasia. In this context, this review describes the relationships of the abovementioned pathologies with leptin.
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Affiliation(s)
- Amitabha Ray
- Lake Erie College of Osteopathic Medicine, Seton Hill University, Greensburg, PA 15601, United State
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23
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Metabolic Syndrome and the Risk of Breast Cancer and Subtypes by Race, Menopause and BMI. Cancers (Basel) 2018; 10:cancers10090299. [PMID: 30200454 PMCID: PMC6162759 DOI: 10.3390/cancers10090299] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 01/08/2023] Open
Abstract
The objective of this study was to investigate the association of metabolic syndrome (MetS) with the risk of invasive breast cancer and molecular subtypes across race, menopause, and body mass index (BMI) groups. We examined the association of metabolic syndrome and its components with risk of invasive breast cancer among 94,555 female participants of the National Institute of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study, accounting for ductal carcinoma in situ as a competing risk. Cox proportional hazard regression with the Fine and Gray method was used to generate hazard ratios (HR) and 95% confidence intervals (CI) adjusting for baseline sociodemographic, behavioral, and clinical covariates. During a mean follow-up of 14 years, 5380 (5.7%) women developed breast cancer. Overall, MetS at baseline was associated with a 13% increased risk of breast cancer compared to women without MetS (HR: 1.13, 95% CI: 1.00, 1.27); similar estimates were obtained among postmenopausal women (HR: 1.14, 95% CI: 1.01, 1.29). MetS was associated with a slight but non-significantly increased risk of breast cancer among those with both normal weight and overweight/obesity, and those with estrogen receptor positive breast cancer subtype. In the NIH-AARP cohort, MetS was associated with an increased risk of breast cancer. Further studies are needed to definitively evaluate the association of MetS with triple negative breast cancer subtypes across all levels of BMI.
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24
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Higgs P, Janda M, Asher R, Gebski V, Forder P, Obermair A. Pelvic floor functional outcomes after total abdominal vs total laparoscopic hysterectomy for endometrial cancer. Am J Obstet Gynecol 2018; 218:419.e1-419.e14. [PMID: 29305254 DOI: 10.1016/j.ajog.2017.12.233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/15/2017] [Accepted: 12/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer. OBJECTIVE We sought to evaluate pelvic floor function in women who have had surgical treatment for early-stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium trial and to compare patients' outcomes who had total abdominal vs total laparoscopic hysterectomy. STUDY DESIGN A multinational, phase III, randomized noninferiority trial compared disease-free survival of patients who had total abdominal hysterectomy vs total laparoscopic hysterectomy. This substudy analyzes the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory) administered preoperatively, and at follow-up visits 6, 18, 30, 42, and 54 months postoperatively. RESULTS Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy, n = 195; total laparoscopic hysterectomy, n = 186). At 6 months postsurgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor well-being (total abdominal hysterectomy: mean change -11.17; 95% confidence interval, -17.11 to -5.24; total laparoscopic hysterectomy: mean change -10.25; 95% confidence interval, -16.31 to -4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months postsurgery. CONCLUSION These findings suggest that pelvic floor function in terms of urinary, bowel, and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early-stage endometrial cancer.
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Affiliation(s)
- Peta Higgs
- Department of Urogynecology, Buderim Private Hospital, Buderim, Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Center, University of Sydney, Sydney, Australia
| | - Val Gebski
- Research Center for Generational Health and Aging, University of Newcastle, Newcastle, Australia
| | - Peta Forder
- Research Center for Generational Health and Aging, University of Newcastle, Newcastle, Australia
| | - Andreas Obermair
- Queensland Center for Gynecological Cancer and Faculty of Medicine, University of Queensland, Brisbane, Australia.
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25
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Akinyemiju T, Moore JX, Judd S, Lakoski S, Goodman M, Safford MM, Pisu M. Metabolic dysregulation and cancer mortality in a national cohort of blacks and whites. BMC Cancer 2017; 17:856. [PMID: 29246121 PMCID: PMC5731092 DOI: 10.1186/s12885-017-3807-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 11/21/2017] [Indexed: 12/13/2022] Open
Abstract
Background We examined the association between metabolic dysregulation and cancer mortality in a prospective cohort of Black and White adults. Methods A total of 25,038 Black and White adults were included in the analysis. Metabolic dysregulation was defined in two ways: 1) using the joint harmonized criteria for metabolic syndrome (MetS) and 2) based on factor analysis of 15 variables characterizing metabolic dysregulation. We estimated hazards ratios (HRs) and 95% confidence intervals (CIs) for the association of MetS and metabolic dysregulation with cancer mortality during follow-up using Cox proportional hazards models. Results About 46% of Black and 39% of White participants met the criteria for MetS. Overall, participants with MetS (HR: 1.22, 95% CI: 1.03–1.45) were at increased risk of cancer-related death. In race-stratified analysis, Black participants with MetS had significantly increased risk of cancer mortality compared with those without MetS (HR: 1.32, 95% CI: 1.01–1.72), increasing to more than a 2-fold risk of cancer mortality among those with five metabolic syndrome components (HR: 2.35, 95% CI: 1.01–5.51). Conclusions There are marked racial differences in the prevalence of metabolic dysregulation defined as MetS based on the harmonized criteria. The strong positive associations between MetS and cancer mortality suggests that efforts to improve cancer outcomes in general, and racial disparities in cancer outcomes specifically, may benefit from prevention and management of MetS and its components. Electronic supplementary material The online version of this article (10.1186/s12885-017-3807-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tomi Akinyemiju
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. .,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. .,Department of Epidemiology, University of Kentucky, Lexington, KY, USA.
| | - Justin Xavier Moore
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Lakoski
- Division of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University School of Public Health, Atlanta, GA, USA
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medical College, New York, NY, USA.,Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pisu
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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26
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Kariri M, Jalambo MO, Kanou B, Deqes S, Younis S, Zabut B, Balawi U. Risk Factors for Breast Cancer in Gaza Strip, Palestine: a Case-Control Study. Clin Nutr Res 2017; 6:161-171. [PMID: 28770179 PMCID: PMC5539210 DOI: 10.7762/cnr.2017.6.3.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/26/2017] [Accepted: 07/10/2017] [Indexed: 12/29/2022] Open
Abstract
Breast cancer (BC) is the main common cause of cancer mortality among women in the world. This study aims at investigating BC epidemiology and identifying the different risk factors associated and the most affecting ones among women in the Gaza Strip, Palestine. This study was a hospital-based case-control (1:2), as the study was carried out over the period of October 2014 to February 2015. A total of 105 BC patients, chosen from Al-Shifa Hospital in Gaza City and European hospital for the south governorate, were the case and compared to 209 women as a control group who matched the cases in age, residence, and with no history of breast problems. The age of the enrolled cases and controlled ranged between 18 to 60 years. The face-to-face interview was conducted during the patient visit to the oncology department and the control visit in their home. The result illustrated that women who had late pregnancy (> 35 years) (odds ratio [OR], 11.56; 95% confidence interval [CI], 1.64-81.35), or high body mass index (BMI; ≥ 30 kg/m2) (OR, 4.70; 95% CI, 1.62-13.69), or first-degree family history of BC (OR, 2.7; 95% CI, 1.04-7.20), or hypertensive patients (OR, 12.13; 95% CI, 1.93-76.10), or diabetic (OR, 6.84; 95% CI, 1.77-26.36) were more likely to have increased BC risk. The findings of the present study suggest that positive family history of BC, high BMI, and some common diseases (hypertension, diabetes mellitus) may be the epigenetic factors promoting the occurrence of BC.
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Affiliation(s)
| | | | | | | | | | - Baker Zabut
- Biochemistry Department, Islamic University of Gaza, Gaza, Palestine
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27
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Abstract
Ovarian cancer is the most fatal gynecologic cancer and is an important source of cancer-related mortality, particularly in developed countries. Despite substantial research examining adiposity (primarily adult body mass index [BMI]), the overall evidence suggests only a weak positive association between adiposity and risk of ovarian cancer, with stronger associations observed for population-based case-control studies compared to prospective studies. Ovarian cancer is not one disease and emerging data suggest that higher BMI may only be associated with risk of certain histologic subtypes, including low-grade serous and invasive mucinous tumors. Interestingly, some larger studies and meta-analyses have reported a stronger relationship with premenopausal ovarian cancers, which are more likely to be of these subtypes. Relatively few studies have conducted detailed examinations of other adiposity-related factors such as measures of abdominal adiposity, early-life body size and weight change. While the underlying mechanisms that may relate adiposity to risk are unclear, increased inflammatory biomarkers have been associated with risk and hormonal factors, including androgen levels, may be important for the development of mucinous tumors. Future research should leverage the large sample sizes of consortia to evaluate associations by key tumor characteristics as well as consider patterns of weight change over the life course with both ovarian cancer risk and survival.
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28
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Aune D, Sen A, Vatten LJ. Hypertension and the risk of endometrial cancer: a systematic review and meta-analysis of case-control and cohort studies. Sci Rep 2017; 7:44808. [PMID: 28387226 PMCID: PMC5384280 DOI: 10.1038/srep44808] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/15/2017] [Indexed: 12/12/2022] Open
Abstract
A history of hypertension has been associated with increased risk of endometrial cancer in several studies, but the results have not been consistent. We conducted a systematic review and meta-analysis of case-control and cohort studies to clarify the association between hypertension and endometrial cancer risk. PubMed and Embase databases were searched up to 27th of February 2016. Prospective and case-control studies which reported adjusted relative risk estimates and 95% confidence intervals of endometrial cancer associated with a hypertension diagnosis were included. Summary relative risks were estimated using a random effects model. Nineteen case-control studies and 6 cohort studies were included. The summary RR was 1.61 (95% CI: 1.41–1.85, I2 = 86%) for all studies, 1.73 (95% CI: 1.45–2.06, I2 = 89%) for case-control studies and 1.32 (95% CI: 1.12–1.56, I2 = 47%) for cohort studies. The association between hypertension and endometrial cancer was weaker, but still significant, among studies with adjustment for smoking, BMI, oral contraceptive use, and parity, compared to studies without such adjustment. This meta-analysis suggest an increased risk of endometrial cancer among patients with hypertension, however, further studies with more comprehensive adjustments for confounders are warranted to clarify the association.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, Imperial College, London, UK.,Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Bjørknes University College, Oslo, Norway
| | - Abhijit Sen
- Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Lars J Vatten
- Department of Epidemiology and Biostatistics, Imperial College, London, UK
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29
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Han H, Guo W, Shi W, Yu Y, Zhang Y, Ye X, He J. Hypertension and breast cancer risk: a systematic review and meta-analysis. Sci Rep 2017; 7:44877. [PMID: 28317900 PMCID: PMC5357949 DOI: 10.1038/srep44877] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/15/2017] [Indexed: 11/23/2022] Open
Abstract
Observational studies examining the relationship between hypertension and breast cancer risk have reported conflicting findings. We conducted this systematic review and meta-analysis to summarize the evidence regarding the association between hypertension and risk of breast cancer. Eligible studies were identified through a comprehensive literature search of PubMed, EMBASE, and the Cochrane library until August 2016. We included observational studies that reported relative risks (RR) with corresponding 95% confidence intervals (CIs). Results from individual studies were pooled by using a random-effects model. 29 articles of 30 studies, with totally 11643 cases of breast cancer, were eligible for inclusion in the meta-analysis. We observed a statistically significant association between hypertension and increased breast cancer risk (RR: 1.15; 95% CI: 1.08, 1.22). In the subgroup analysis, we found a positive association between hypertension and breast cancer incidence among postmenopausal women (RR: 1.20; 95% CI: 1.09, 1.31). In contrast, hypertension was not associated with risk of breast cancer among premenopausal women (RR: 0.97; 95% CI: 0.84, 1.12) and Asian population (RR: 1.07; 95% CI: 0.94, 1.22).This meta-analysis collectively suggests a significantly association between hypertension and breast cancer risk, specifically for postmenopausal hypertensive women.
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Affiliation(s)
- Hedong Han
- Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
| | - Wei Guo
- Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
| | - Wentao Shi
- Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
| | - Yamei Yu
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yunshuo Zhang
- Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xiaofei Ye
- Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
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30
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Huang T, Poole EM, Eliassen AH, Okereke OI, Kubzansky LD, Sood AK, Forman JP, Tworoger SS. Hypertension, use of antihypertensive medications, and risk of epithelial ovarian cancer. Int J Cancer 2016; 139:291-9. [PMID: 26934358 DOI: 10.1002/ijc.30066] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/19/2016] [Indexed: 01/20/2023]
Abstract
Few studies have examined the associations of hypertension and antihypertensive medications with ovarian cancer. In particular, beta-blockers, one of the most commonly prescribed medications to treat hypertension, may reduce ovarian cancer risk by inhibiting beta-adrenergic signaling. We prospectively followed 90,384 women in the Nurses' Health Study (NHS) between 1988-2012 and 113,121 NHSII participants between 1989-2011. Hypertension and use of antihypertensive medications were self-reported biennially. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). We documented 948 ovarian cancer cases during follow-up. Similar results were observed in the two cohorts. While hypertension was not associated with ovarian cancer risk (Pooled HR = 1.01; 95% CI = 0.88, 1.16), current use of any antihypertensive medication was associated with slightly increased risk compared to never users (Pooled HR = 1.18; 95% CI: 1.02, 1.37). This increased risk was primarily due to use of thiazide diuretics (Pooled HR = 1.37; 95% CI: 1.13, 1.68). No associations were observed for beta-blockers or angiotensin-converting-enzyme inhibitors. Calcium channel blockers (CCBs) were associated with suggestively reduced risk (NHS HR = 0.73; 95% CI: 0.53, 1.01), after adjusting for all antihypertensive medications. Associations were similar among hypertensive women and stronger for longer use of thiazide diuretics and CCBs. In conclusion, our results provided no evidence that beta-blockers were associated with reduced ovarian cancer risk. In contrast, we observed an increased risk for use of thiazide diuretics that should be confirmed in other studies.
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Affiliation(s)
- Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Elizabeth M Poole
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Olivia I Okereke
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Anil K Sood
- Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston, TX
| | - John P Forman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Renal Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Shelley S Tworoger
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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Abstract
Endometrial cancer is the sixth most common cancer in women worldwide and the most common gynecologic malignancy in the developed world. This chapter explores the current epidemiologic evidence on the association between obesity and endometrial cancer risk and mortality. Using body mass index (BMI) as a measure of obesity, we found that obesity (defined as BMI > 30 and < 35 kg/m2) was associated with a 2.6-fold increase in endometrial cancer risk, while severe obesity (BMI > 35 kg/m2) was associated with a 4.7-fold increase compared to normal-weight women (BMI < 25 kg/m2). Increased central adiposity also increased endometrial cancer risk by 1.5- to twofold. Among both healthy and endometrial cancer patient populations, obesity was associated with a roughly twofold increase in endometrial cancer-specific mortality. This risk reduction was also observed for obesity and all-cause mortality among endometrial cancer patients. In the few studies that assessed risk associated with weight change, an increased endometrial cancer risk with weight gain and weight cycling was observed, whereas some evidence for a protective effect of weight loss was found. Furthermore, early-life obesity was associated with a moderately increased risk of endometrial cancer later in life. There are several mechanisms whereby obesity is hypothesized to increase endometrial cancer risk, including increased endogenous sex steroid hormones, insulin resistance, chronic inflammation and adipokines. Further research should focus on histological subtypes or molecular phenotypes of endometrial tumors and population subgroups that could be at an increased risk of obesity-associated endometrial cancer. Additionally, studies on weight gain, loss or cycling and weight loss interventions can provide mechanistic insight into the obesity-endometrial cancer association. Sufficient evidence exists to recommend avoiding obesity to reduce endometrial cancer risk.
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Affiliation(s)
- Eileen Shaw
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Megan Farris
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jessica McNeil
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Christine Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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32
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Sun LM, Kuo HT, Jeng LB, Lin CL, Liang JA, Kao CH. Hypertension and subsequent genitourinary and gynecologic cancers risk: a population-based cohort study. Medicine (Baltimore) 2015; 94:e753. [PMID: 25906108 PMCID: PMC4602691 DOI: 10.1097/md.0000000000000753] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although a relationship between hypertension and the development of renal cancer and other types of cancer have been proposed for decades, the results of epidemiologic studies remain inconclusive. This study was conducted to evaluate the association between hypertension and genitourinary and gynecologic cancers in Taiwan.In this study, we conducted a populated-based retrospective cohort study by using data from the Taiwanese National Health Insurance program. The study period was from 2000 to 2011, and the cohort comprised 111,704 insurants: 57,961 patients with hypertension and 53,743 patients without hypertension. A Cox proportional hazard regression analysis was performed to estimate the effects of hypertension on genitourinary and gynecologic cancers risk.Among the patients with hypertension, the risks of developing renal and uterine corpus cancers were significantly higher in the hypertension group than they were in the nonhypertension group. Further stratified analyses by sex, age, and hypertension duration revealed distinct cancer-specific patterns. Higher cancer risk appears to be more obvious among younger hypertensive patients with longer follow-up time.The results of this study indicate that Taiwanese patients with hypertension have higher risks for some types of cancer, and cancer-specific patterns vary by sex, age, and hypertension duration.
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Affiliation(s)
- Li-Min Sun
- From the Department of Radiation Oncology (L-MS), Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung; School of Medicine (H-TK), China Medical University; Department of Developmental and Behavioral Pediatrics (H-TK), Children's Hospital of China Medical University; Department of Surgery (L-BJ), Organ Transplantation Center, China Medical University Hospital; Graduate Institute of Clinical Medical Science (L-BJ, J-AL, C-HK), School of Medicine, College of Medicine, China Medical University; Management Office for Health Data (C-LL), China Medical University Hospital; College of Medicine (C-LL), China Medical University; Department of Radiation Oncology (J-AL); and Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung, Taiwan
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33
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Resistin, visfatin, adiponectin, and leptin: risk of breast cancer in pre- and postmenopausal saudi females and their possible diagnostic and predictive implications as novel biomarkers. DISEASE MARKERS 2015; 2015:253519. [PMID: 25838618 PMCID: PMC4369904 DOI: 10.1155/2015/253519] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 02/12/2015] [Indexed: 12/21/2022]
Abstract
The mechanisms of obesity-induced breast carcinogenesis are not clear. One hypothesis is that high levels of adipokines could promote breast cancer (BC) development. The aim of this study was to investigate the correlation of resistin, visfatin, adiponectin, and leptin with BC risk in pre- and postmenopausal females. A total of 82 BC newly diagnosed and histologically confirmed patients and 68 age and BMI matched healthy controls were enrolled. Both groups were subdivided into post- and premenopausal subgroups. Resistin, visfatin, adiponectin, and leptin were measured by ELISA. There were significantly higher levels of leptin, resistin, and visfatin in postmenopausal BC patients than their respective controls. Only in postmenopausal subgroups, leptin, resistin, and visfatin levels were positively correlated with TNM staging, tumor size, lymph node (LN) metastasis, and histological grading. In postmenopausal females, multivariate logistic regression analysis revealed that adiponectin, leptin, visfatin, and resistin were risk factors for BC. Our results suggested that serum resistin, leptin, adiponectin, and visfatin levels as risk factors for postmenopausal BC may provide a potential link with clinicopathological features and are promising to be novel biomarkers for postmenopausal BC.
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Metabolic syndrome is associated with increased breast cancer risk: a systematic review with meta-analysis. Int J Breast Cancer 2014; 2014:189384. [PMID: 25653879 PMCID: PMC4295135 DOI: 10.1155/2014/189384] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 12/29/2022] Open
Abstract
Background. Although individual metabolic risk factors are reported to be associated with breast cancer risk, controversy surrounds risk of breast cancer from metabolic syndrome (MS). We report the first systematic review and meta-analysis of the association between MS and breast cancer risk in all adult females. Methods. Studies were retrieved by searching four electronic reference databases [PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and ProQuest through June 30, 2012] and cross-referencing retrieved articles. Eligible for inclusion were longitudinal studies reporting associations between MS and breast cancer risk among females aged 18 years and older. Relative risks and 95% confidence intervals were calculated for each study and pooled using random-effects models. Publication bias was assessed quantitatively (Trim and Fill) and qualitatively (funnel plots). Heterogeneity was examined using Q and I2 statistics. Results. Representing nine independent cohorts and 97,277 adult females, eight studies met the inclusion criteria. A modest, positive association was observed between MS and breast cancer risk (RR: 1.47, 95% CI, 1.15–1.87; z = 3.13; p = 0.002; Q = 26.28, p = 0.001; I2 = 69.55%). No publication bias was observed. Conclusions. MS is associated with increased breast cancer risk in adult women.
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Burke WM, Orr J, Leitao M, Salom E, Gehrig P, Olawaiye AB, Brewer M, Boruta D, Villella J, Herzog T, Abu Shahin F. Endometrial cancer: A review and current management strategies: Part I. Gynecol Oncol 2014; 134:385-92. [DOI: 10.1016/j.ygyno.2014.05.018] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 12/21/2022]
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Abstract
OBJECTIVE The role of metabolic syndrome (MS) and its individual components in postmenopausal breast cancer (PBC) risk is still unclear. We reviewed and summarized epidemiological studies assessing the association of MS with the risk of PBC. METHODS We conducted an electronic search, without restrictions, for articles published before October 31, 2012. Every included study was to report risk estimates with 95% CIs for the association between MS and PBC. Study-specific estimates were pooled using random-effects models. RESULTS Nine articles (with 6,417 cancer cases), all published in English, were included in the meta-analysis. MS was associated with a 52% increase in cancer risk (P < 0.001)-for the most part confined to noncohort studies (109% increased risk); the risk estimates changed little, depending on populations (United States and Europe) and definition of the syndrome (traditional vs nontraditional). The risk estimates for PBC were 1.12 (P = 0.068) for higher values of body mass index/waist circumference, 1.19 (P = 0.005) for hyperglycemia (higher fasting glucose or diabetes), 1.13 (P = 0.027) for higher blood pressure, 1.08 (P = 0.248) for higher triglycerides, and 1.39 (P = 0.008) for lower high-density lipoprotein cholesterol. All these estimates were lower than those associated with MS in the same studies. CONCLUSIONS MS is associated with a moderately increased risk of PBC. No single component explains the risk conveyed by the full syndrome.
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Park JE, Jung H, Lee JE. Dietary pattern and hypertension in Korean adults. Public Health Nutr 2014; 17:597-606. [PMID: 23442232 PMCID: PMC10282319 DOI: 10.1017/s1368980013000219] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 10/29/2012] [Accepted: 01/04/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the dietary pattern associated with hypertension and pre-hypertension among Korean male and female adults. DESIGN Cross-sectional study from a representative sample of the Korean population. SETTING The Korea National Health and Nutrition Examination Survey IV, which was conducted in 2007 and 2008. SUBJECTS Males and females (n 5308) over the age of 20 years. RESULTS Scores for three major dietary patterns ('whole food', 'Western' and 'drinking') were generated using a factor analysis of thirty predefined food groups based on the food items consumed. We used polytomous logistic regression analyses to obtain odds ratios and 95% confidence intervals for pre-hypertension and hypertension. Participants with a high drinking pattern score (moderate to high alcohol intake, salted fermented seafood intake) had a significantly higher prevalence of pre-hypertension or hypertension than those with a lower drinking pattern score; odds for the top quintile v. the bottom quintile were OR = 1·56 (95% CI 1·23, 1·99; P trend = 0·001) for pre-hypertension and OR = 3·05 (95% CI 2·12, 4·40; P trend < 0·001) for hypertension. The whole food pattern was not associated with either pre-hypertension or hypertension, while the Western pattern was associated with the prevalence of hypertension only among men. CONCLUSIONS Our finding warrants further prospective studies to examine whether alcohol drinking and salty food consumption increase the risk of developing hypertension in Koreans.
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Affiliation(s)
- Jong Eun Park
- Department of Food and Nutrition, Sookmyung Women's University, 52 Hyochangwon gil, Yongsan gu, Seoul 140-742, Republic of Korea
| | - Hyeyoung Jung
- Department of Food and Nutrition, Sookmyung Women's University, 52 Hyochangwon gil, Yongsan gu, Seoul 140-742, Republic of Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Sookmyung Women's University, 52 Hyochangwon gil, Yongsan gu, Seoul 140-742, Republic of Korea
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Esposito K, Chiodini P, Capuano A, Bellastella G, Maiorino MI, Giugliano D. Metabolic syndrome and endometrial cancer: a meta-analysis. Endocrine 2014; 45:28-36. [PMID: 23640372 DOI: 10.1007/s12020-013-9973-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/24/2013] [Indexed: 01/16/2023]
Abstract
We performed a systematic review and meta-analysis on the association of metabolic syndrome with endometrial cancer. A systematic literature search of electronic databases (Medline, ISI Web of Knowledge and Scopus) was conducted and complemented by cross-referencing to identify studies published before 31 January 2013. Core items of identified studies were independently extracted by two reviewers, and results were summarized by random effects meta-analysis. We identified six studies, which reported on 3,132 cancer cases. Metabolic syndrome was associated with an increased risk of endometrial cancer (RR: 1.89, 95 % CI 1.34-2.67, P < 0.001), with significant heterogeneity among studies (I (2) = 92 %, P < 0.001), but no indication for publication bias in the Egger's test (P = 0.240). A sensitivity analysis omitting two studies produced no heterogeneity (I (2) = 0 %) and attenuated the association (RR: 1.39, 1.31-1.48, P < 0.001). The risk estimates for any single factor of the syndrome were 2.21 (P < 0.001) for higher values of body mass index and/or waist, 1.81 (P = 0.044) for hyperglycemia, 1.81 (P = 0.024) for higher blood pressure values, and 1.17 (P < 0.001) for high triglyceride levels; there was no significant association with low HDL-cholesterol. Metabolic syndrome is associated with an increased risk of endometrial cancer; among the components of the syndrome, obesity/high waist is that more strongly associated with endometrial cancer.
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Affiliation(s)
- Katherine Esposito
- Division of Endocrinology, Diabetes, and Metabolic Diseases, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy,
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Jung SJ, Song M, Choi JY, Song N, Park SK, Yoo KY, Kang D. Association of selected medical conditions with breast cancer risk in Korea. J Prev Med Public Health 2013; 46:346-52. [PMID: 24349656 PMCID: PMC3859856 DOI: 10.3961/jpmph.2013.46.6.346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/17/2013] [Indexed: 12/11/2022] Open
Abstract
Objectives To estimate the effect of medical conditions in the population of Korea on breast cancer risk in a case-control study. Methods The cases were 3242 women with incident, histologically confirmed breast cancer in two major hospitals interviewed between 2001 and 2007. The controls were 1818 women each admitted to either of those two hospitals for a variety of non-neoplastic conditions. Information on each disease was obtained from a standardized questionnaire by trained personnel. Odds ratios (ORs) for each disease were derived from multiple logistic regression adjusted for age, age of menarche, pregnancy, age of first pregnancy, and family history of breast cancer. Results Among all of the incident breast cancer patients, pre-existing diabetes (OR, 1.33; 95% confidence interval [CI], 0.99 to 1.78), hypertension (OR, 1.46; 95% CI, 1.18 to 1.83), thyroid diseases (OR, 1.26; 95% CI, 1.00 to 1.58), and ovarian diseases (OR, 1.70; 95% CI, 1.23 to 2.35) were associated with an increased risk of breast cancer when other factors were adjusted for. In a stratified analysis by menopausal status, pre-existing hypertension (pre-menopause OR, 0.80; 95% CI, 0.48 to 1.34 vs. post-menopause OR, 1.87; 95% CI, 1.44 to 2.43; p-heterogeneity <0.01) and ovarian disease (pre-menopause OR, 4.20; 95% CI, 1.91 to 9.24 vs. post-menopause OR, 1.39; 95% CI, 1.02 to 1.91; p-heterogeneity 0.01) showed significantly different risks of breast cancer. Conclusions Our results suggest the possibility that medical conditions such as hypertension affect breast cancer development, and that this can differ by menopausal status. Our study also indicates a possible correlation between ovarian diseases and breast cancer risk.
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Affiliation(s)
- Sun Jae Jung
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Minkyo Song
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Ji-Yeob Choi
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Nan Song
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sue Kyung Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Keun-Young Yoo
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
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Belavy D, Janda M, Baker J, Obermair A. Epidural analgesia is associated with an increased incidence of postoperative complications in patients requiring an abdominal hysterectomy for early stage endometrial cancer. Gynecol Oncol 2013; 131:423-9. [DOI: 10.1016/j.ygyno.2013.08.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/19/2013] [Accepted: 08/23/2013] [Indexed: 11/25/2022]
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Suba Z. Circulatory estrogen level protects against breast cancer in obese women. Recent Pat Anticancer Drug Discov 2013; 8:154-67. [PMID: 23061769 PMCID: PMC3636519 DOI: 10.2174/1574892811308020004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 10/08/2012] [Accepted: 10/09/2012] [Indexed: 12/15/2022]
Abstract
Literary data suggest apparently ambiguous interaction between menopausal status and obesity-associated breast cancer risk based on the principle of the carcinogenic capacity of estrogen. Before menopause, breast cancer incidence is relatively low and adiposity is erroneously regarded as a protective factor against this tumor conferred by the obesity associated defective estrogen-synthesis. By contrast, in postmenopausal cases, obesity presents a strong risk factor for breast cancer being mistakenly attributed to the presumed excessive estrogen-production of their adipose-tissue mass. Obesity is associated with dysmetabolism and endangers the healthy equilibrium of sexual hormone-production and regular menstrual cycles in women, which are the prerequisites not only for reproductive capacity but also for somatic health. At the same time, literary data support that anovulatory infertility is a very strong risk for breast cancer in young women either with or without obesity. In the majority of premenopausal women, obesity associated insulin resistance is moderate and may be counteracted by their preserved circulatory estrogen level. Consequently, it is not obesity but rather the still sufficient estrogen-level, which may be protective against breast cancer in young adult females. In obese older women, never using hormone replacement therapy (HRT) the breast cancer risk is high, which is associated with their continuous estrogen loss and increasing insulin-resistance. By contrast, obese postmenopausal women using HRT, have a decreased risk for breast cancer as the protective effect of estrogen-substitution may counteract to their obesity associated systemic alterations. The revealed inverse correlation between circulatory estrogen-level and breast cancer risk in obese women should advance our understanding of breast cancer etiology and promotes primary prevention measures. New patents recommend various methods for the prevention and treatment of obesity-related systemic disorders and the associated breast cancer.
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Affiliation(s)
- Zsuzsanna Suba
- National Institute of Oncology, Surgical and Molecular Tumor Pathology Centre, Address: H-1122 Rath Gyorgy str. 7-9, Budapest, Hungary.
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Pereira A, Garmendia ML, Alvarado ME, Albala C. Hypertension and the risk of breast cancer in Chilean women: a case-control study. Asian Pac J Cancer Prev 2013; 13:5829-34. [PMID: 23317264 DOI: 10.7314/apjcp.2012.13.11.5829] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in women worldwide. Although different metabolic factors have been implicated in breast cancer development, the relationship between hypertension and breast cancer has not been elucidated. AIM To evaluate hypertension as a risk factor for breast cancer in Chilean women of low and middle socio-economic status. METHODS We conducted an age-matched (1:1) case-control study in 3 hospitals in Santiago, Chile. Breast cancer cases (n=170) were histopathologically confirmed. Controls had been classified as Breast Imaging Reporting and Data System I (negative) or II (benign findings) within 6 months of recruitment. Blood pressure was measured using a mercury sphygmomanometer and standardized procedures. We used 2 hypertension cut-off points: blood pressures of ≥140/90 mmHg and ≥130/85 mmHg. Fasting insulin and glucose levels were assessed, and anthropometric, sociodemographic, and behavioral information were collected. Odds ratios and 95% confidence intervals were estimated for the entire sample and restricted to postmenopausal women using multivariable conditional logistic regression models. RESULTS Hypertension (≥140/90 mmHg) was significantly higher in cases (37.1%) than controls (17.1%) for the entire sample and in postmenopausal pairs (44.0% compared to 23.8%). In crude and adjusted models, hypertensive women had a 4-fold increased risk of breast cancer (adjusted odds ratio: 4.2; 95% confidence interval: 1.8; 9.6) compared to non-hypertensive women in the entire sample. We found a similar association in the postmenopausal group (adjusted odds ratio: 2.8; 95% confidence interval: 1.1; 7.4). A significant effect was also observed when hypertension was defined as blood pressure of ≥130/85 mmHg. CONCLUSION A significant association was found between hypertension and breast cancer over the entire sample and when restricted to postmenopausal women. Hypertension is highly prevalent in Latin America and may be a modifiable risk factor for breast cancer; therefore, a small association between hypertension and breast cancer may have broad implications.
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Affiliation(s)
- Ana Pereira
- School of Public Health, Faculty of Medicine, Universidad de Chile
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Metabolic factors and breast cancer risk in Korean women. Cancer Causes Control 2013; 24:1061-8. [PMID: 23504150 DOI: 10.1007/s10552-013-0183-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/02/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Metabolic factors have been suggested to be associated with breast cancer. However, the findings are inconsistent among studies. We conducted a case-control study in Korean women to evaluate the association between metabolic factors and premenopausal and postmenopausal breast cancer. METHODS Incident breast cancer cases (270 women) and their controls (540 women) matched by age and menopausal status were recruited from the recipients of a health examination at the same institution. Five relevant factors of metabolic syndrome were evaluated. Odds ratios (OR) and 95 % confidence intervals (CI) for the association were estimated by conditional logistic regression analysis. RESULTS Proportions of cases and controls with each factors were 25.6 and 20.6 % for obesity (body mass index ≥ 25 kg/m(2)), 17.4 and 17.4 % for high fasting glucose (≥5.55 mmol/L or use of hypoglycemic medication), 13.0 and 18.9 % for high triglyceride (≥1.69 mmol/L), 26.3 % and 23.9 % for low high-density lipoprotein cholesterol (<1.29 mmol/L), and 29.6 and 30.6 % for high blood pressure (≥130/or 85 mmHg or use of antihypertensive medication), respectively. Although only the obesity was associated with an increased risk of postmenopausal breast cancer (OR = 2.24; 95 % CI 1.22-4.10) among individual metabolic factors, women with aggregation of three or more metabolic factors as defined by international diabetes federation criteria showed greater risk for postmenopausal breast cancer compared with women without any factor (OR = 2.36; 95 % CI 1.10-5.10). CONCLUSIONS Although obesity was the only metabolic factor associated with postmenopausal breast cancer, the presence of other metabolic factors may further increase the risk of postmenopausal breast cancer when combined with obesity.
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Alokail MS, Al-Daghri N, Abdulkareem A, Draz HM, Yakout SM, Alnaami AM, Sabico S, Alenad AM, Chrousos GP. Metabolic syndrome biomarkers and early breast cancer in Saudi women: evidence for the presence of a systemic stress response and/or a pre-existing metabolic syndrome-related neoplasia risk? BMC Cancer 2013; 13:54. [PMID: 23374911 PMCID: PMC3571930 DOI: 10.1186/1471-2407-13-54] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 01/30/2013] [Indexed: 12/13/2022] Open
Abstract
Background Obesity has been linked to many adverse health consequences, including breast cancer. This study aims to determine adipocytokine and other biological changes in recently diagnosed breast cancer patients before therapy is started. Methods A total of 109 female Saudi subjects [56 newly diagnosed, treatment-naïve, histologically-confirmed breast cancer cases and 53 age- and BMI-matched controls] were enrolled in this study. Anthropometric data were collected. Serum insulin, adipocytokines and plasminogen activator inhibitor-1 (PAI-1) concentrations were measured using a customized multiplex Luminex assay. Hypersensitive C-Reactive Protein (CRP), tumor necrosis factor-alpha (TNF-α), and angiotensin II (ANG II) were measured using ELISA. Results A few days in the diagnosis, breast cancer subjects had significantly higher systolic blood pressure (p = 0.03), glucose (p = 0.01), triglycerides (p = 0.001), leptin (p = 0.044), resistin (p = 0.04), ANG II (p = 0.02), TNF-α (p = 0.045), and CRP (p = 0.04) than the controls. On the other hand, HDL (p = 0.01) and adiponectin (p = 0.02) were significantly lower in cancer subjects than controls. A significant association was found between elevated triglycerides (TG) and breast cancer [OR (95% CI), 6.1(1.8, 15.6), p = 0.004], as well as elevated ANG II [OR (95% CI), 5.2(1.2, 14.3), p = 0.03]. On the other hand, aPAI and HDL correlated negatively with breast cancer [OR (95% CI), 0.076(0.01, 0.34), p = 0.001; 0.30(0.09, 0.95), p 0.04, respectively]. Conclusion Circulating ANGII and triglycerides were positively associated with early breast cancer. In contrast, HDL-cholesterol correlated negatively with ANG II and aPAI in these patients. This suggests that patients with recently diagnosed breast cancer have biochemical changes consistent with an activated stress response and/or that patients with metabolic syndrome manifestations have a higher risk of developing this disease.
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Affiliation(s)
- Majed S Alokail
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia (KSA)
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Ronco AL, De Stefani E, Deneo-Pellegrini H, Quarneti A. Diabetes, overweight and risk of postmenopausal breast cancer: a case-control study in Uruguay. Asian Pac J Cancer Prev 2012; 13:139-46. [PMID: 22502657 DOI: 10.7314/apjcp.2012.13.1.139] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Obese postmenopausal women increase their risk of developing breast cancer (BC), in particular if they display an android-type pattern of adiposity, which is also associated to increased risks of diabetes mellitus, hypertension and cardiovascular disease. In order to explore the associations among anthropometry (body mass index, body composition, somatotype), some specific items of medical history (diabetes, hypertension, dislypidemias, hyperuricemia) and the risk of BC in Uruguayan women, a case-control study was carried out between 2004-2009 at our Oncology Unit. 912 women of ages between 23-69 years (367 new BC cases and 545 non hospitalized, age-matched controls with a normal mammography) were interviewed. Twenty body measurements were taken in order to calculate body composition and somatotype. Patients were queried on socio-demographics, reproductive history, family history of cancer, a brief food frequency questionnaire and on personal history of diabetes, dislypidemias, hyperuricemia, hypertension and gallbladder stones. Uni- and multivariate analyses were done, generating odds ratios (ORs) as an expression of relative risks. A personal history of diabetes was positively associated to BC risk (OR=1.64, 95% CI 1.00-2.69), being higher among postmenopausal women (OR=1.92, 95% CI 1.04-3.52). The risks of BC for diabetes in postmenopausal women with overweight combined with dislypidemia (OR=9.33, 95% CI 2.10-41.5) and high fat/muscle ratio (OR=7.81, 95% CI 2.01-30.3) were significantly high. As a conclusion, a personal history of diabetes and overweight was strongly associated to BC. The studied sample had a subset of high-risk of BC featured by postmenopausal overweight and diabetic women, who also had a personal history of hypertension and/or dyslipidemia. The present results could contribute to define new high risk groups and individuals for primary as well as for secondary prevention, since this pattern linked to the metabolic syndrome is usually not considered for BC prevention.
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Affiliation(s)
- Alvaro L Ronco
- Oncology and Radiotherapy Unit, Pereira Rossell Women's Hospital, Montevideo, Uruguay.
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Lin CC, Li CI, Liu CS, Lin WY, Chen CC, Yang SY, Lee CC, Li TC. Annual fasting plasma glucose variation increases risk of cancer incidence and mortality in patients with type 2 diabetes: the Taichung Diabetes Study. Endocr Relat Cancer 2012; 19:473-83. [PMID: 22544890 DOI: 10.1530/erc-12-0038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The study aims to examine whether the annual variations in fasting plasma glucose (FPG) measurements, represented by the coefficient of variation (CV), predict cancer incidence and mortality in the subsequent years independent of traditional risk factors of type 2 diabetic patients. A computerized database of patients with type 2 diabetes of 30 years old and older (n=4805) enrolled in the Diabetes Care Management Program of a medical center before 2006 was analyzed using a time-dependent Cox's proportional hazards regression model. The mortality rates for the first, second, and third tertiles of the first annual FPG-CV were 8.64, 12.71, and 30.82 per 1000 person-years respectively. After adjusting for mean FPG, HbA1c, and other risk factors, the annual FPG-CV was independently associated with cancer incidence, cancer mortality, and cancer incidence or mortality, and the corresponding hazard ratios for the third vs first tertile of the annual FPG-CV were 3.03 (1.98, 4.65), 5.04 (2.32, 10.94), and 2.86 (1.91, 4.29) respectively. The annual variation in FPG was a strong predictor of cancer incidence and mortality in type 2 diabetic patients; therefore, glucose variation may be important in the clinical practice of care management and cancer prevention.
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Affiliation(s)
- Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Cardiometabolic factors and breast cancer risk in U.S. black women. Breast Cancer Res Treat 2012; 134:1247-56. [PMID: 22710709 DOI: 10.1007/s10549-012-2131-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 06/04/2012] [Indexed: 10/28/2022]
Abstract
Previous studies have suggested that metabolic syndrome may be associated with an increased risk of breast cancer, particularly in postmenopausal women, but U.S. black women have not been assessed. We examined the associations of abdominal obesity, type 2 diabetes, hypertension, and high cholesterol individually and in combination with breast cancer incidence in the Black Women's Health Study. By means of Cox regression models, we estimated incidence rate ratios (IRR) and 95 % confidence intervals (CI) for the associations of baseline and time-dependent values of self-reported abdominal obesity, type 2 diabetes, hypertension, and high cholesterol with breast cancer incidence. During 516,452 person years of follow-up (mean years = 10.5; standard deviation = 2.9) from 1995 to 2007, 1,228 breast cancer cases were identified. After adjustment for age, education, body mass index at age 18, physical activity, and individual cardiometabolic factors, neither individual nor combinations of cardiometabolic factors were associated with breast cancer incidence overall; the multivariable IRR was 1.04 (95 % CI 0.86-1.25) for the combination of ≥3 factors relative to the absence of all factors, and 1.17 (0.85-1.60) for having all four factors. Among postmenopausal women, however, the comparable IRRs were 1.23 (0.93-1.62) and 1.63 (1.12-2.37), respectively. Our findings provide some support for an association between cardiometabolic factors and breast cancer incidence among postmenopausal U.S. black women.
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Reeves KW, McLaughlin V, Fredman L, Ensrud K, Cauley JA. Components of metabolic syndrome and risk of breast cancer by prognostic features in the study of osteoporotic fractures cohort. Cancer Causes Control 2012; 23:1241-51. [PMID: 22661101 DOI: 10.1007/s10552-012-0002-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 05/18/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Metabolic syndrome (MetS) and most of its components have been previously associated with increased breast cancer risk. We hypothesized that increasing number of MetS components would be positively associated with breast cancer risk. METHODS Data were obtained from the Study of Osteoporotic Fractures, a prospective cohort of women aged ≥65 enrolled between 1986 and 1988 and still being followed prospectively (n = 8,956). MetS components evaluated at baseline were elevated waist circumference, hypertension, and diabetes. Data were not available on hyperlipidemia. Incident breast cancers were confirmed by pathology report. We compared women with 0, 1, and 2 or 3 MetS components. We used Cox proportional hazards regression to calculate associations for breast cancer overall and classified by prognostic features. RESULTS At baseline, 28.8 % of participants had 2 or 3 MetS components. Over an average follow-up of 14.4 years, 551 breast cancer cases were identified. Compared to those with no components, women with 2 or 3 components had increased breast cancer risk (hazard ratio (HR), 1.30; 95 % confidence interval (CI), 1.01-1.68) and increased risk of ER+ (HR, 1.48; 95 % CI, 1.09-2.03) and PR+ (HR, 1.56; 95 % CI, 1.10-2.20) cancer, adjusting for age, hormone use, and family history of breast cancer. These results became attenuated and not statistically significant when additionally adjusted for body mass index. CONCLUSIONS MetS is associated with increased postmenopausal breast cancer risk, especially for ER+ and PR+ cancers, though this effect may not be independent of the effect of body mass index. Managing the components of MetS could be efficacious for breast cancer risk reduction.
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Affiliation(s)
- Katherine W Reeves
- Division of Biostatistics and Epidemiology, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA 01003, USA.
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Choi CH, Park YA, Choi JJ, Song T, Song SY, Lee YY, Lee JW, Kim TJ, Kim BG, Bae DS. Angiotensin II type I receptor and miR-155 in endometrial cancers: synergistic antiproliferative effects of anti-miR-155 and losartan on endometrial cancer cells. Gynecol Oncol 2012; 126:124-31. [PMID: 22525818 DOI: 10.1016/j.ygyno.2012.04.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 04/11/2012] [Accepted: 04/16/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE MicroRNA-155 (miR-155) is one of the micro RNAs (miRNA) most consistently involved in neoplastic diseases, and it is known to repress the angiotensin II type 1 receptor (AGTR1). The aim of the present study was to evaluate the expressions of miR-155 and AGTR1, and to clarify the potential efficacy of anti-miR-155, alone and in combination with AGTR1 blocker losartan in endometrial cancers. METHODS Expressions of miR-155 and AGTR1 were evaluated using real-time PCR and immunohistochemistry. And the MTT assay was performed in endometrial cancer cells following anti-miR-155 and AGTR1 blocker (losartan) treatment, alone and in combination. RESULTS miR-155 was over-expressed and AGTR1 was underexpressed in endometrial carcinoma tissues. AGTR1 immunoreactivity was found in six of ten (60.0%) normal endometrium, 11 of 14 (78.6%) endometrial hyperplasia, and 27 of 62 (43.5%) endometrial carcinoma tissues (P=0.051), and patients with AGTR1 expression showed trend towards improved survival after multivariate analysis (P=0.08). We checked that abolishing the function of miR-155 and AGTR1 by anti-miR-155 or losartan inhibited cell survival of endometrial carcinoma cells, respectively, and furthermore, combined treatment showed synergistic effects. CONCLUSIONS In this study, we characterized the expressions of miR-155 and AGTR1 in endometrial tissues. The combined treatment with anti-miR-155 and losartan has a synergistic antiproliferative effect and an improved understanding is required to clarify whether miR-155 and AGTR1 can be used as a novel therapeutic target in endometrial cancer.
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Affiliation(s)
- Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Risk factors to predict the incidence of surgical adverse events following open or laparoscopic surgery for apparent early stage endometrial cancer: results from a randomised controlled trial. Eur J Cancer 2012; 48:2155-62. [PMID: 22503396 DOI: 10.1016/j.ejca.2012.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/12/2012] [Accepted: 03/12/2012] [Indexed: 11/23/2022]
Abstract
AIMS To identify risk factors for major adverse events (AEs) and to develop a nomogram to predict the probability of such AEs in patients who have surgery for apparent early stage endometrial cancer. METHODS We used data from 753 patients who were randomised to either total laparoscopic hysterectomy or total abdominal hysterectomy in the LACE trial. Serious adverse events that prolonged hospital stay or postoperative adverse events (using common terminology criteria 3+, CTCAE V3) were considered major AEs. We analysed pre-surgical characteristics that were associated with the risk of developing major AEs by multivariate logistic regression. We identified a parsimonious model by backward stepwise logistic regression. The six most significant or clinically important variables were included in the nomogram to predict the risk of major AEs within 6weeks of surgery and the nomogram was internally validated. RESULTS Overall, 132 (17.5%) patients had at least one major AE. An open surgical approach (laparotomy), higher Charlson's medical co-morbidities score, moderately differentiated tumours on curettings, higher baseline Eastern Cooperative Oncology Group (ECOG) score, higher body mass index and low haemoglobin levels were associated with AE and were used in the nomogram. The bootstrap corrected concordance index of the nomogram was 0.63 and it showed good calibration. CONCLUSIONS Six pre-surgical factors independently predicted the risk of major AEs. This research might form the basis to develop risk reduction strategies to minimise the risk of AEs among patients undergoing surgery for apparent early stage endometrial cancer.
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