Impact of Type 2 Diabetes Mellitus on Endometrial Cancer Survival: A Prospective Database Analysis

Abstract

PurposeType 2 diabetes mellitus (T2DM) is an established risk factor for endometrial cancer but its impact on endometrial cancer survival outcomes is unclear. The aim of this study was to investigate whether pre-existing T2DM impacts survival outcomes in endometrial cancer.Patients and MethodsWomen diagnosed with endometrial cancer were recruited to a single centre prospective cohort study. Relevant sociodemographic and clinico-pathological data were recorded at baseline. T2DM status was based on clinical and biochemical assessment, verified by general practitioner records and analysed in relation to overall, cancer-specific and recurrence-free survival using Kaplan-Meier estimation and multivariable Cox-regression.ResultsIn total, 533 women with median age and BMI of 66 years (Interquartile range (IQR), 56, 73) and 32kg/m2 (IQR 26, 39) respectively, were included in the analysis. The majority had low-grade (67.3%), early-stage (85.1% stage I/II), endometrial cancer of endometrioid histological phenotype (74.7%). A total of 107 (20.1%) had pre-existing T2DM. Women with T2DM had a two-fold increase in overall mortality (adjusted HR 2.07, 95%CI 1.21-3.55, p=0.008), cancer-specific mortality (adjusted HR 2.15, 95% CI 1.05-4.39, p=0.035) and recurrence rates (adjusted HR 2.22, 95% CI 1.08-4.56, p=0.030), compared to those without, in multivariable analyses.ConclusionT2DM confers an increased risk of death in endometrial cancer patients. Well-designed longitudinal studies with large sample sizes are now needed to confirm these findings.

Risk Assessment of Type 2 Diabetes and Women Cancer in Egypt

“…Our results align with various other studies [18,22,23,25], which demonstrate a strong association between an increased risk of malignancy and higher BMI, particularly among diabetic women.…”

Short-Term Outcome of Robotic versus Laparoscopic Hysterectomy for Endometrial Cancer in Women with Diabetes: Analysis of the US Nationwide Inpatient Sample

“…The findings of that study were consistent with an earlier review and meta-analysis (2007), showing that diabetes was associated with a 72% increased risk for EC [9,10]. Another larger population-based study emphasized that women with EC and type 2 diabetes mellitus (T2DM) had a twofold higher overall mortality rate, cancer-specific mortality rate, and recurrence rate compared to those without T2DM [11]. In addition, diabetes is also a well-known adverse prognostic factor for short-term outcomes after most surgical procedures, increasing the risk for postoperative complications and reoperations [12,13].…”

“…Nevertheless, a meta-analysis of six cohort studies provided inconclusive evidence for establishing a definitive link between diabetes and EC-specific mortality [26]. More recent studies have indicated a two-fold increase in EC-specific mortality among patients with type 2 diabetes mellitus (T2DM) compared to those without [11,27].…”

Diabetes and the social, biologic, and behavioral determinants of endometrial cancer in the United States

“…Our analysis revealed that women with diabetes had almost double the estimated risk of endometrial cancer compared to women without diabetes. This detected association could be attributed to hyperinsulinemia in type 2 diabetes that contributes to elevated estrogen levels and consequently the development of endometrial cancer [ 5 , 9 ]. Our result is consistent with previous findings which reported an increased risk of endometrial cancer among diabetic women with risk ratios ranging between 1.7 and 2.1 [ 7 – 15 ].…”