Poorer survival of nulliparous women with endometrial carcinoma

Self Cite

supporting

confidence: 63%

Prognostic Impact of Parity in 493 Uterine Sarcoma Patients

Albrektsen

Heuch²,

Wik

et al. 2009

Self Cite

“…12,13 Diagnostic delay among nulliparous women was considered as a possible explanation in these studies, but seems less likely in the present study because the association with parity seemed to be strongest among women with the most favorable prognosis. In 1 previous study that included surgical stage II tumors only, 17 parity was not a significant predictor of disease recurrence.…”

Section: Discussionmentioning

confidence: 58%

“…In women without any pregnancyrelated protection caused by mechanical 9,10 or hormonal mechanisms, 11 a more advanced disease at the time of diagnosis or an earlier age at onset may be expected. In our previous populationbased study of endometrial cancer patients, 12 however, nulliparity was associated with a worse prognosis in analyses adjusted for age at diagnosis and clinical stage, indicating a more aggressive tumor behavior in patients with no childbirths. Similar findings were reported among older women in a smaller study, 13 but the association was considerably weakened in the analysis adjusted for traditional prognostic factors and diagnostic delay, defined as time interval since initial symptoms.…”

mentioning

confidence: 79%

Parity and Time Interval Since Childbirth Influence Survival in Endometrial Cancer Patients

Albrektsen

Heuch

Wik

et al. 2009

Self Cite

Parity and time interval since last birth have been found to be associated with the risk of endometrial cancer, but few previous studies have examined whether these reproductive factors have prognostic impact. We examined this issue among 740 nulliparous and 3355 parous endometrial cancer patients diagnosed in Norway during the period 1961-1999. The mean age at diagnosis was 55.7 years (range, 25-74 years). Hazard ratios (HRs) with 95% confidence intervals were calculated in Cox proportional regression models. Parous women had significantly (P < 0.001) better prognosis than nulliparous women. In analyses adjusted for age at diagnosis, clinical stage, and histological type, the HR for parous versus nulliparous women was 0.68 (95% confidence interval, 0.57-0.82). The prognostic impact of parity was restricted to patients with endometrioid tumors (P = 0.014, test for interaction) and appeared to be most pronounced in women without metastases (P = 0.14, test for interaction). Moreover, the improved prognosis was strongest for women with the shortest time interval since last childbirth. The HRs (nulliparous women as reference) were 0.51, 0.60, and 0.80 for women less than 15, 15 to 24, and 25 years or more since birth (P < 0.001). The observed beneficial effect of pregnancies may be related to a strong exposure to progesterone during pregnancy. However, it is possible that tumors developing in nulliparous and parous women have different biological features. Further knowledge on this issue may provide valuable information that can be used for individualized treatment.

“…Although stage at diagnosis, histologic type, tumor grade, and other pathologic characteristics of the tumor have been shown to importantly influence prognosis after endometrial cancer (3) , modifiable risk factors for endometrial cancer incidence may also impact survival. Studies of endometrial cancer cases have shown that lower overall mortality rates were associated with higher body mass (4,5) and previous exogenous estrogen use (6,7) , but having diabetes (8) and being nulliparous (9,10) were associated with a higher overall mortality; endometrial cancer–specific mortality has not been described in relation to these factors. In cohorts of healthy women, higher body masses (11,12) , diabetes (13,14) , and exogenous estrogen use (15) were all associated with an increased risk of death, and oral contraceptive use was associated with a slightly reduced risk of death (9,16) , although these associations potentially reflect an influence of both incidence and survival.…”

mentioning

confidence: 99%

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

Chia

Newcomb

Trentham‐Dietz³

et al. 2007

113

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.