Metabolic syndrome was tied closely to poor prognosis among patients with endometrial cancer, according to a study published in Frontiers in Endocrinology. For the retrospective study—conducted at a single center in China between 2010 and 2016—researchers aimed to determine the impact of metabolic syndrome (MetS) on prognosis in endometrial cancer, as well as important elements of MetS associated with endometrial cancer. Of the 506 patients included in the study, more than one-half (56.52%) were aged 55 and older and were of post-menopausal status (63.60%). Most patients (79.40%) had stage I disease.
The study team examined MetS clinical data, clinicopathologic characteristics, and general patient information for all participants. Specifically, MetS was evaluated according to the 2004 Chinese Diabetes Society standard, which notes that three or more of the following conditions must be present in a patient: 1) BMI ≥25.0 kg/m2; 2) fasting blood glucose ≥6.1 mmol/L and (or) 2-hour plasma glucose of ≥7.8 mmol/L, or (and) those diagnosed as diabetic and being treated; 3) blood pressure ≥140/90 mmHg or (and) those diagnosed as having hypertension and being treated; and 4) fasting triglycerides ≥1.69 mmol/L and/or HDL-C <0.9 mmol/L for men and <1.0 mmol/L for women. They also described recurrence and survival status for all patients and determined overall survival (OS) and recurrence-free survival (RFS) times. December 2019 was selected as the cut-off point for follow-up.
More than one-quarter of patients studied (30.20%) had MetS. Among all patients, 39.70% had hyperglycemia and 56.30% had a BMI of ≥25 kg/m2. In addition, 41.30% had hypertension and 49.60% had dyslipidemia. Per the different elements of MetS, patients with endometrial cancer were grouped in the following structure: zero elements (73 cases; 14.4%), one to two elements (280 cases; 55.3%), and three or more elements (153 cases; 30.2%). Regarding lymph nodes, 11.1% had lymph node metastasis (LNM), 17.2% were positive for lymph-vascular space invasion (LVSI), and 33.4% had deep myometrial infiltration (MI).
Examination of the link between MetS and clinicopathological characteristics demonstrated that patients with MetS were older (≥55 years; 71.24% vs 50.14%, P<0.05) and more often postmenopausal (72.55% vs 59.77%; P<0.05) than patients without MetS. Patients with MetS more often had high-grade (2-3) and advanced-stage (II-IV) disease than those without MetS (30.72% vs 20.40% and 33.99% vs 14.73%, respectively; P<0.05). Further, patients with MetS had higher positivity rates for LNM, LVSI, and deep MI proportion (25.98% vs 7.85%, 24.84% vs 13.88%, and 44.44% vs 28.61%, respectively; P<0.05). These findings indicate that patients with endometrial cancer and MetS have greater tumor aggressiveness, the researchers noted.
Study results also showed that MetS was closely linked with OS (HR=2.14; 95% CI, 1.07-4.28) and RFS (HR=1.80; 95% CI, 1.0-3.3). There was a significant correlation between OS and dyslipidemia (HR=3.20; 95% CI, 1.44–7.12) and HDL-C <1.0 mmol/L (HR=3.24; 95% CI, 1.62-6.49), as well as recurrence. Univariate analysis showed that age, histotype, tumor grade, and tumor stage were associated with OS and RFS.
While the mechanism underlying MetS in the promotion of endometrial cancer is unknown, it may be related to long-term hyperglycemia, obesity, dyslipidemia, insulin, and inflammatory cytokines, according to the researchers. Further, they noted that the study results indicate that improving MetS may improve prognosis for patients with endometrial cancer.
