Obesity, diabetes, and other factors in relation to survival after endometrial cancer diagnosis

Abstract

Endogenous and exogenous sources of estrogen and characteristics altering these hormone levels have been related to endometrial cancer risk; however, their relationship to survival following diagnosis is less clear. In a population-based study, we examined whether mortality after endometrial cancer diagnosis was affected by prediagnosis obesity, diabetes, smoking, oral contraceptive use, parity, or postmenopausal hormone (PMH) use. Eligible women, aged 40-79 years, diagnosed from 1991-1994 with incident invasive endometrial cancer and identified through the Wisconsin statewide mandatory cancer registry were invited to participate. Of 745 eligible cases, 166 women were deceased after 9.3 years of follow-up, with 43 attributable to endometrial cancer, based upon vital records linkage. Hazard rate ratios (HRR) and 95% confidence intervals were adjusted for age at diagnosis, menopausal status, stage of disease, and other exposures of interest. Obese women (body mass index [BMI] >or=30 kg/m(2)) prior to endometrial cancer diagnosis had an increased risk of both all-cause (HRR=1.6, 95% CI 1.0-2.5) and endometrial cancer (HRR=2.0, 95% CI 0.8-5.1) mortality, compared with nonoverweight women (BMI<25 kg/m(2)). Endometrial cancer cases with diabetes also had an increased risk of all-cause mortality compared with nondiabetic women (HRR=1.7, 95% CI 1.1-2.5), although there was no association with endometrial cancer mortality. There were no associations between PMH use, oral contraceptive use, parity, or smoking and mortality from any cause. The results suggest that history of obesity and diabetes may increase risk of mortality after endometrial cancer diagnosis; modification of these characteristics may improve survival after endometrial cancer diagnosis.

The Impact of Race and Comorbidity on Survival in Endometrial Cancer

“…Fewer studies have reported on disease-specific survival: Folsom and colleagues (16) found poorer survival for those with diabetes, as we did, whereas Chia and colleagues (17) found no association.…”

“…In particular, diabetes and hypertension are more prevalent in blacks than in whites (13) and some studies suggest that presence of diabetes is associated with poorer survival in women with endometrial cancer (14)(15)(16)(17). We used the population-based SEER-Medicare database to assess the influence of medical conditions on overall and disease-specific survival in older women with endometrial cancer and to determine whether these factors explained part of the disparity in outcome between blacks and whites.…”

Association of diabetes with survival among cohorts of Indigenous and non-Indigenous Australians with cancer

“…The few findings that are available are inconsistent with worse survival reported for diabetic compared to non-diabetic patients with pancreatic [1], liver [2], breast [3], colorectal [4], and endometrial cancers [5,6], while other studies have shown no association between diabetes and survival for colorectal [7] and lung cancer patients [8]. One study found that diabetic patients with various cancers had better survival than non-diabetic patients with these cancers [9].…”

Exploiting the therapeutic potential of the PI3K-AKT-mTOR pathway in enriched populations of gynecologic malignancies

“…Recently, interest in the anticancer properties of metformin has emerged as epidemiologic studies in patients with breast and prostate cancer have shown a survival advantage in patients taking this medication [55][56][57][58]. Additionally, patients with endometrial cancer who are obese or have diabetes have been shown to have compromised survival and increased recurrence rates [59]. This adverse oncologic outcome associated with metabolic syndrome in patients with endometrial cancer may be a direct result of the metabolic and endocrine effects of obesity.…”