子宫内膜癌手术绝经与非酒精性脂肪性肝病风险增加
Surgical menopause and increased risk of nonalcoholic fatty liver disease in endometrial cancer.
作者信息
Matsuo Koji, Gualtieri Marc R, Cahoon Sigita S, Jung Carrie E, Paulson Richard J, Shoupe Donna, Muderspach Laila I, Wakatsuki Akihiko, Wright Jason D, Roman Lynda D
机构信息
1Division of Gynecologic Oncology, University of Southern California, Los Angeles, CA 2Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 3Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 4Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan 5Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY.
出版信息
Menopause. 2016 Feb;23(2):189-96. doi: 10.1097/GME.0000000000000500.
OBJECTIVE
Our objective was to examine risk factors associated with development of nonalcoholic fatty liver disease (NAFLD) among women with endometrial cancer who underwent surgical staging with or without oophorectomy.
METHODS
This is a retrospective study that evaluated endometrial cancer cases that underwent surgical staging (n = 666) and endometrial hyperplasia cases that underwent hysterectomy-based treatment (n = 209). This study included 712 oophorectomy cases and 163 nonoophorectomy cases. Archived records were reviewed for participant demographics, medical comorbidities, operative notes, histology results, and radiology reports for NAFLD. Cumulative risks of NAFLD after surgical operation were correlated to demographics and medical comorbidities.
RESULTS
The cumulative prevalence of NAFLD in 875 women with endometrial tumor was 14.1%, 20.5%, and 38.4% at 1, 2, and 5 years after surgical operation, respectively. On multivariate analysis, after controlling for age, ethnicity, body mass index, medical comorbidities, tumor type, hormonal treatment pattern, and oophorectomy status, age younger than 40 years (2-y cumulative prevalence, 26.6% vs 16.8%; hazard ratio [HR], 1.85; 95% CI, 1.27-2.71; P = 0.001) and age 40 to 49 years (2-y cumulative prevalence, 23.1% vs 16.8%; HR, 1.49; 95% CI, 1.08-2.04; P = 0.015) remained significant predictors for developing NAFLD after surgical operation compared with age 50 years or older. Oophorectomy was an independent predictor for increased risk of NAFLD (20.9% vs 15.9%; HR, 1.70; 95% CI, 1.01-2.86; P = 0.047). In addition, NAFLD was significantly associated with postoperative development of diabetes mellitus (39.2% vs 15.3%; HR, 2.26; 95% CI, 1.52-3.35; P < 0.0001) and hypercholesterolemia (34.3% vs 17.5%; HR, 1.71; 95% CI, 1.12-2.63; P = 0.014).
CONCLUSIONS
Oophorectomy in young women with endometrial cancer significantly increases the risk of NAFLD. This is associated with development of diabetes mellitus and hypercholesterolemia after oophorectomy.
目的
我们的目的是研究在接受或未接受卵巢切除术进行手术分期的子宫内膜癌女性中，与非酒精性脂肪性肝病（NAFLD）发生相关的危险因素。
方法
这是一项回顾性研究，评估了接受手术分期的子宫内膜癌病例（n = 666）和接受子宫切除术治疗的子宫内膜增生病例（n = 209）。本研究包括712例卵巢切除术病例和163例非卵巢切除术病例。查阅存档记录，了解参与者的人口统计学信息、合并症、手术记录、组织学结果以及NAFLD的放射学报告。手术操作后NAFLD的累积风险与人口统计学和合并症相关。
结果
875例患有子宫内膜肿瘤的女性中，NAFLD的累积患病率在手术后1年、2年和5年分别为14.1%、20.5%和38.4%。多因素分析显示，在控制年龄、种族、体重指数、合并症、肿瘤类型、激素治疗模式和卵巢切除术状态后，与50岁及以上相比，年龄小于40岁（2年累积患病率，26.6%对16.8%；风险比[HR]，1.85；95%置信区间[CI]，1.27 - 2.71；P = 0.001）和40至49岁（2年累积患病率，23.1%对16.8%；HR，1.49；95% CI，1.08 - 2.04；P = 0.015）仍然是手术后发生NAFLD的显著预测因素。卵巢切除术是NAFLD风险增加的独立预测因素（20.9%对15.9%；HR，1.70；95% CI，1.01 - 2.86；P = 0.047）。此外，NAFLD与术后糖尿病的发生显著相关（39.2%对15.3%；HR，2.26；95% CI，1.52 - 3.35；P < 0.0001）和高胆固醇血症（34.3%对17.5%；HR，1.71；95% CI，1.12 - 2.63；P = 0.014）。
结论
年轻子宫内膜癌女性进行卵巢切除术会显著增加NAFLD的风险。这与卵巢切除术后糖尿病和高胆固醇血症的发生有关。
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