Prospective cohort study of metabolic syndrome and endometrial cancer survival

Abstract

Background: Metabolic syndrome has been previously associated with increased endometrial cancer risk, but the relationship with metabolic syndrome and endometrial cancer survival remains unclear. Objectives: To determine the associations between metabolic syndrome using the harmonized criteria with disease-free survival, overall survival, endometrial cancer-specific survival and time to recurrence among endometrial cancer survivors. Second, to determine the association between the number of metabolic syndrome components as well as each individual metabolic syndrome component with these prognostic outcomes. Methods: A prospective cohort of 540 endometrial cancer survivors diagnosed between 2002 and 2006 participated in the Alberta Endometrial Cancer Cohort and were followed until death or March 20, 2019. Baseline in-person interviews, direct anthropometric measurements and fasting blood samples were used to assess metabolic syndrome. Recurrence and survival data were obtained via medical chart abstraction and vital status updates. Results: Compared to endometrial cancer survivors without metabolic syndrome, survivors with metabolic syndrome had worse overall survival when assessed with the harmonized criteria. Of the individual metabolic syndrome components, only waist circumference was associated with recurrence and survival outcomes. Lifetime recreational physical activity prior to diagnosis was observed to modify the associations between metabolic syndrome and its components with overall survival and disease-free survival. Conclusion: The metabolic syndrome, especially waist circumference, was associated with worse overall and disease-free survival among endometrial cancer survivors. Future research should aim to confirm these results and improve our understanding of the role lifestyle factors iii such as physical activity have in the association between metabolic syndrome and endometrial cancer survivors' prognosis. iv Preface Chapter Four includes the main manuscript from this thesis which addresses the association between metabolic syndrome and its components defined by harmonized criteria with disease-free survival, overall survival, endometrial cancer-specific survival and recurrence among endometrial cancer survivors from the Alberta Endometrial Cancer Cohort Study. For this manuscript Renee Kokts-Porietis led the formal analysis and interpretation of data, as well as drafting, writing, reviewing and editing of the manuscript. All authors were involved in conceptualization and provided critical review of this manuscript. Kerry Courneya, Linda Cook and Christine Friedenreich were involved in the funding acquisition, methodology, investigation and project administration of the larger project. Finally, Jessica McNeil, Gregg Nelson and Christine Friedenreich provided supervision and guidance to Renee Kokts-Porietis at each stage of the project.

Obesity and mortality among endometrial cancer survivors: A systematic review and meta‐analysis

“…Briefly, study populations were predominantly white, over 60 years of age, diagnosed with Type I endometrial cancer and had FIGO stage I. Most of studies were conducted in Europe ( n = 20) 12,13,15,18,21,22,27,43–55 and North America ( n = 18) 19,20,23–26,56–67 . The remaining studies were conducted in Asia ( n = 4), 14,68–70 Oceania ( n = 2), 17,71 and South America ( n = 1) 72 .…”

“…Only Martra et al 16 included participants from more than one location (USA and Italy). Excess body fat was evaluated by BMI in 45 studies; visceral and subcutaneous‐fat area, volume, or percentage from CT/MRI scans in five studies 43,44,50,51,65 ; and waist circumference in three studies 43,51,66 . Direct measurements were used in elven studies (BMI n = 10; WC n = 3, Volumetric CT/MRI variables n = 5) 14,18,19,21,43,44,46,50,51,56,65,66,72 .…”

“…Excess body fat was evaluated by BMI in 45 studies; visceral and subcutaneous‐fat area, volume, or percentage from CT/MRI scans in five studies 43,44,50,51,65 ; and waist circumference in three studies 43,51,66 . Direct measurements were used in elven studies (BMI n = 10; WC n = 3, Volumetric CT/MRI variables n = 5) 14,18,19,21,43,44,46,50,51,56,65,66,72 . The duration of follow‐up time ranged from a median of 1.1 to 14.2 years (≥5 years; n = 21).…”

“…One study noted a negative relationship between BMI and endometrial cancer‐specific mortality 55 . Of the three studies that assessed waist circumference at the time of diagnosis, only one noted an association with increased all‐cause mortality 66 . Two of the five studies that used CT/MRI scans to assess endometrial cancer survivor's body composition observed greater endometrial cancer‐specific mortality with higher percent visceral fat after adjustment 43,50 …”

Risk factors of endometrial cancer in patients with endometrial hyperplasia: implication for clinical treatments

“…Previous studies [7,8] have shown that it's very common that EH and EC can coexist in patients. The risk of endometrial dysplasia combined with endometrial cancer is as high as 25.76 to 59.22% [9,10]. Clinically, there is a certain missed diagnosis rate in the diagnosis of EC [11].…”