The impact of metabolic syndrome on the clinical profile and tumor characteristics of endometrial carcinoma

Authors

  • Tawfik A. Tawfik Department of Obstetrics and Gynaecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
  • Bassma M. Elsabaa Department of Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
  • Dalia A. El-Neily Department of Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
  • Sally S. El-Tawab Department of Obstetrics and Gynaecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
  • Heba A. Ebrahim Department of Obstetrics and Gynaecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20163831

Keywords:

Allred score, Endometrial cancer, Estrogen receptors, Hyperinsulinemia, Metabolic syndrome

Abstract

Background: The objective is to study the influence of different components of metabolic syndrome on clinical behavior and tumor characteristics of endometrial cancer cases and to evaluate if metformin usage affects the stage and grade of endometrial cancer.

Methods: 60 women attending the gynecological oncology clinic at El Shatby Maternity University Hospital, after being diagnosed as endometrial carcinoma, were recruited in the study. Serum samples were collected to detect insulin level and lipid profile, and then allocated into two groups according to metabolic syndrome existence. After the recommended surgery, and the routine histopathological diagnosis followed by histopathological chemilumeniscence technique to detect staining intensity, percentage of estrogen receptors ER, and score out of 8 according to Allred score.

Results: Endometrial cancer EC patients with metabolic syndrome had a significantly higher age, higher FIGO stages, and higher grade compared to EC without metabolic syndrome (p˂0.05). There was no statically significant difference between both groups in estrogen receptors scoring. HDL was an important factor affecting grade of EC patients, as when HDL decreased by one mg/dl, the grade increased by 0.033% (P=0.030, OR=0.899, OR adjusted=0.826), Insulin level was found to be an important factor affecting stage as when insulin level increased by one Uiu/ml, the stage increased by1.091% (p=<0.001, OR=1.064, OR adjusted=1.091).

Conclusions: Hyperinsulinemia was the most important factor affecting aggressiveness of the tumor as regards stage and risk group classification. Metformin failed to show a protective effect against endometrial cancer progression.

References

Hoffman B, Schaffer JO, Halvorson JI, Bradshaw KD. In Endometrial Cancer. Williams Gynecology: Chapter 33, Cunningham FG (eds), (2nd ed) McGraw-Hill, ISBN 2012; 978.

Kong A, Johnson N, Kitchener HC, Lawrie TA. Gynecological Cancer Group. Adjuvant radiotherapy for stage I endometrial cancer. Cochrane Database of Systematic Reviews. 2012.

Kaaks R, Lukanova A, Kurzer MS. Obesity endogenous hormones and endometrial cancer risk a synthetic review. Cancer Epidem BioPrev. 2002;11:1531-43.

Berstein LM, Tchernobrovkina AE, Gamajunova VB. Tumor estrogen content and clinic morphological and endocrine features of endometrial cance. J Cancer Res Clin Oncol. 2003;129:245-9.

Weiderpass E, Persson I, Adami HO, Magnusson C, Lindgren A, Baron JA. Body size in different periods of life diabetes mellitus hypertension and risk of postmenopausal endometrial cancer (Sweden). In: Cancer Causes Control. 2000;11:185-92.

Anderson KE, Anderson E, Mink PJ, Hong CP, Kushi LH, Sellers TA, et al. Diabetes and endometrial cancer in the Iowa women's health study. Cancer Epidemiol Biomarkers Prev. 2001;10:611-9.

Aguilar-Salinas CA, Rojas R, Go´mez-Pe´rez FJ, et al. The metabolic syndrome: a concept hard to define. Arch Med Res. 2005;36(3):223-31.

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640-5.

Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. CA: A Cancer Journal for Clinicians. 2010;60(4):207-21.

Johnson JA, Carstensen B, Witte D, Bowker SL, Lipscombe L, Renehan AG. Diabetes and cancer (1): evaluating the temporal relationship between type 2diabetes and cancer incidence. Diabetologia. 2012;55(6):1607-18.

Renehan AG, Yeh HC, Johnson JA, Wild SH, Gale EA, Moller H. Diabetes andcancer (2): evaluating the impact of diabetes on mortality in patients withcancer. Diabetologia. 2012;55(6):1619-32.

Bjorge T, Stocks T, Lukanova A, Tretli S, Selmer R, Manjer J, et al. Metabolic syndrome and endometrial carcinoma. Am J Epidemiol. 2010;171:892-2.

Birks JW (Ed.), Chemilumeniscence and Photochemical Reaction Detection in Chromatography, VCH Verlag Weinhein, Germany, 1989.

Strom BL, Schinnar R, Weber AL, Bunin G, Berlin JA, Baumgarten M, et al. Case-control study of postmenopausal hormone replacement therapy and endometrial cancer. Am J Epidemiol. 2006;164(8):775-86.

Ko EM, Walter P, Clark L, Havrilesky LJ, Alvarez Secord A, et al. Redefining obesity, diabetes, and race in type I and type II endometrial cancers. In: Oncologists SG, (ed). Society of Gynecologic Oncologists Annual Meeting for Women's Cancer. Los Angeles: Society of Gynecologic Oncologists. 2013;130(1):83.

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.

Lentz GM, lobo RA, Gershenson DM. Endometrial cancer. In: Zaino RJ, Diehl SJ, Gajewski WH (eds.). Katz Comprehensive Gynecology. 5thed. Philadelphia: Mosby Elsevier; 2007:464-70.

Dashti SG, Chau R, Ouakrim DA, Buchanan DD, Clendenning M, Young JP, et al. Female Hormonal Factors and the Risk of Endometrial Cancer in Lynch Syndrome. JAMA. 2015;314(1):61-71.

Jhang H, Chuang L, Visintainer P, Ramaswamy G. CA 125 levels in the preoperative assessment of advanced-stage uterine cancer. Am J Obstet Gynecol. 2003;188(5):1195-7.

Jongen V, Briet J, de Jong R, ten Hoor K, Boezen M, van der Zee A, et al. Expression of estrogen receptor-alpha and -beta and progesterone receptor-A and -B in a large cohort of patients with endometrioid endometrial cancer. Gynecol Oncol. 2009;112(3):537-42.

Steiner E, Eicher O, Sagemüller J, Schmidt M, Pilch H, Tanner B, et al. Multivariate independent prognostic factors in endometrial carcinoma: a clinicopathologic study in 181 patients: 10 years’ experience at the Department of Obstetrics and Gynecology of the Mainz University. Int J Gynecol Cancer. 2003;13(2):197-203.

Zandersa M, Dorry B, Liza N, Van S, Lonneke V, Harm R, et al. Effect of diabetes on endometrial cancer recurrence and survival . Maturitas. 2013;74:37-43.

Mu N, Zhu Y, Wang Y, Zhang H, Xue F. Insulin resistance: a significant risk factor of endometrial cancer. Gynecol Oncol. 2012;125:751-7.

Arcidiacono B, Iiritano S, Nocera A, Possidente K, Nevolo MT, Ventura V, et al. Insulin resistance and cancer risk: an overview of the pathogenetic mechanisms. Exp Diabetes Res. 2012;789174.

Zhang Y, Liu Z, Yu X, Zhang X, Lü S, Chen X. The association between metabolic abnormality and endometrial cancer: a large case–control study in China. Gynecol Oncol. 2010;117(1):41-6.

Giovannucci E, Harlan DM, Archer MC, Bergenstal RM, Gapstur SM, Habel LA, et al. Diabetes and cancer: a consensus report. Diabetes Care. 2010;33:1674-85.

Decensi A, PuntoniM, Goodwin P, Cazzaniga M, Gennari A, Bonanni B, et al. Metformin and cancer risk in diabetic patients: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2010;3:1451-61.

Ratner RE, Christophi CA, Metzger BE, Dabelea D, Bennett PH, Pi-Sunyer X, et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. 2008;93:4774-9.

Becker C, Jick SS, Meier CR, Bodmer M. Metformin and the risk of endometrial cancer: a case–control analysis. Gynecol Oncol. 2013;129:565-9.

Stevens RJ, Ali R, Bankhead CR, Bethel MA, Cairns BJ, Camisasca RP, et al. Cancer outcomes and all-cause mortality in adults allocated to metformin: systematic review and collaborative meta-analysis of randomized clinical trials. Diabetologia. 2012;55:2593-603.

Downloads

Published

2016-12-14

Issue

Section

Original Research Articles