Abstract
ObjectiveTo explore the effects of metabolic syndrome (MetS) on the prognosis of endometrial cancer (EC) and to identify key components of MetS associated with EC.MethodsA total of 506 patients surgically diagnosed with EC were analyzed in this study. These patients were diagnosed with EC in the Department of Obstetrics and Gynecology at the People’s Hospital of Peking University between 2010 and 2016. The follow-up time was cut off at December 2019. MetS was characterized based on standards provided by the Chinese Diabetes Society in 2004.ResultsAmong the 506 EC patients analyzed, 153 patients were diagnosed with MetS. MetS patients were more likely to be older and postmenopausal. MetS was positively related to tumor grade, stage, LNM, LVSI, and MI. The univariate analysis showed that MetS was closely related to the OS (HR = 2.14; P = 0.032) and RFS (HR = 1.80; P = 0.045) of EC patients. K–M analysis also indicated that EC patients with MetS had shorter OS and RFS than EC patients without MetS. More specifically, patients that had ≥3 components showed a worse outcome compared with patients only having 0 or 1–2 components (P <0.05). In the multivariate-adjust model, after adjusting for age, histotype, tumor grade, and stage, HDL-C was found to be associated with increased risk of death related to EC (HR = 2.2, P = 0.034). However, MetS did not significantly correlate with this. ROC analysis revealed that the area under the ROC curve of combined factors (HDL-C + grade + stage) was better than traditional stage or grade at 1-, 3-, and 5-year survival rates. From this, a nomogram based on HDL-C, grade, and stage was constructed to predict survival of EC patients. Calibration curve analysis and decision curve analysis (DCA) showed the nomogram we constructed could better predict the survival of EC patients.ConclusionMetS is closely related to poor prognosis in EC patients. The prevalence of individual MetS components increase with worse outcomes in EC patients. A nomogram based on HDL-C, grade, and stage has good ability to predict survival of EC patients.
Highlights
Endometrial cancer (EC) is one of the most common gynecological malignancies
To evaluate the association between metabolic syndrome (MetS) and EC, we firstly explored the association between MetS and clinicopathological characteristics of EC patients
Cox multivariate analysis showed associations between MetS and its components and overall survival (OS) or recurrence-free survival (RFS) after adjusting for basic factors (Tables 4, 5). These results indicated that dyslipidemia and HDL-C
Summary
The latest cancer statistics from the SEER data showed that the estimated new EC cases in the United States increased by 66,570, and the estimated deaths increased by 12,940 in 2021, and the incidence rate was fourth among female malignant tumors and sixth in terms of deaths [1, 2]. With lifestyle changes and the increased incidence of metabolic diseases (obesity, diabetes, and hypertension), the incidence and mortality rates of EC has been increasing worldwide. This EC incidence rate is expected to increase to 42.13 cases per 100,000 in the United States by 2030 [3].
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