Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma

Abstract

Objectives: Pregnancy and lactation involve adaptations in immune regulation, but little is known about cross‐cultural variation in inflammatory changes during pregnancy or lactation. Here we report concentrations of C‐reactive protein (CRP) in a large cross‐sectional sample of healthy Filipino women who vary in parity, gestational, and lactational status, and who come from a population previously described as having low CRP. Methods: Fasting plasma CRP was measured among female participants (ages 20.8–22.4 years) in the Cebu Longitudinal Health and Nutrition Survey (n = 822). Results: Median CRP was 0.2 mg/l in nulliparous women and peaked at 2.0 mg/l in women in their 3rd trimester of pregnancy. Parous but post‐partum women had higher CRP compared to nulliparous women, which was largely explained by body composition differences as reflected in waist circumference and skinfold measures. Among post‐partum women with infants, CRP was similar in women who were currently breastfeeding compared to those who were not. Conclusions: At Cebu, women late in gestation have 10‐fold higher C‐reactive protein compared to nulliparous women, with no evidence that lactation is inflammatory. These population‐based findings are similar with findings from prior clinic‐based studies and are consistent with the maternal immunological adaptations initiated during pregnancy. The tendency of human females to spend more time than females of other great apes in gestation rather than lactation suggests that the human life history strategy involved increased time spent by reproductively aged females in a pro‐inflammatory state. Am. J. Hum. Biol., 2013. © 2012Wiley Periodicals, Inc.

Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

“…In a recent study BMI serving as a surrogate for weight related co-morbidities has been shown to significantly confound overall survival. 6 Our findings corroborate the GOG's findings 6 that obese women have superior endometrial cancer-related survival when compared to non-obese women. Among women with endometrioid histopathology, there was a 10 percent higher four-year cancer related (95%) survival in obese women, as compared to overall all-cause mortality (85%).…”

“…A recently reported GOG analysis of prospectively collected graded toxicity data concluded that obese women had higher radiation-related cutaneous and lower gastrointestinal toxicity. 6 Our findings fail to corroborate these observations. However, our results must be viewed as subject to underreporting in the medical record and to observer bias.…”

“…2 Obesity also influences completeness of surgical lymph node staging during surgical laparotomy 3,4 and on radiation-related adverse sequelae. 5,6 Despite recommendations for comprehensive surgical staging by gynecologic oncologists, 7,8 obese women may not undergo surgical staging routinely. Comprehensive staging is difficult and may be hazardous in obese women where adequate exposure of the uterus and pelvic and para-aortic lymph nodes are suboptimal.…”

Same-Day Discharge in Clinical Stage I Endometrial Cancer Patients Treated with Total Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy and Bilateral Pelvic Lymphadenectomy

“…We initially suspected that this condition would adversely impact the patients; interestingly, however, although half of our subjects were obese, this comorbidity did not appear to interfere with discharging them on the same day [20,21]. Nevertheless, we suspect that lower-risk (i.e., nonobese) patients are generally more amenable to same-day discharge.…”

Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment

“…In a retrospective study of women with early endometrial cancer, morbidly obese women had higher mortality rates compared with women with a normal BMI, and 67% of these deaths were a result of noncancerous, obesity-related causes. 7 As rates of obesity among women continue to increase, 8 the incidence of endometrial cancer is expected to increase. A multivariate linear regression model, which accounts for expected changes in obesity, hysterectomy rates, and smoking tobacco, predicts that by the year 2030, the incidence of endometrial cancer will reach 42.13 cases per 100,000 women.…”