Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
J Natl Cancer Inst Monogr. 2023 May 4;2023(61):49-55. doi: 10.1093/jncimonographs/lgad012.
Obesity is a known risk factor for developing endometrial cancer. However, the association of obesity with endometrial cancer (EC) outcomes has not been clearly established. This study examined how outcomes in women with early stage EC vary with body composition measured via computed tomography (CT).
In this retrospective study, patients diagnosed with EC international Federation of Gynecology and Obstetrics stages I-III and available CT scans were included. Automatica software was used to assess the areas of visceral adipose tissue, subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) and skeletal muscle area.
Of 293 patient charts assessed, 199 met eligibility criteria. Median body mass index (BMI) was 32.8 kg/m2 (interquartile range [IQ] = 26.8-38.9); 61.8% had histologic subtype endometrioid carcinoma. Adjusted for age, international Federation of Gynecology and Obstetrics stage, and histologic subtype, a BMI of at least 30 vs less than 30 kg/m2 was associated with lower endometrial cancer-specific survival (ECSS) (hazard ratio [HR] = 2.32, 95% confidence interval [CI] = 1.27 to 4.25) and overall survival (OS) (HR = 2.7, 95% CI = 1.35 to 5.39). Higher IMAT 75th vs 25th percentile and SAT of at least 225.6 vs less than 225.6 cm2 were associated with lower ECSS (HR = 1.53, 95% CI = 1.1 to 2.13, and HR = 2.57, 95% CI = 1.13 to 5.88) and OS (HR = 1.50, 95% CI = 1.11 to 2.02, and HR = 2.46, 95% CI = 1.2 to 5.01), respectively. The association of visceral adipose tissue (75th vs 25th percentile) with ECSS and OS was not statistically significant (HR = 1.42, 95% CI = 0.91 to 2.22, and HR = 1.24, 95% CI = 0.81 to 1.89).
Higher BMI, IMAT, and SAT were associated with higher mortality from EC and lower OS. A better understanding of the mechanisms underlying these relationships could inform strategies to improve patient outcomes.
肥胖是子宫内膜癌发病的已知危险因素。然而，肥胖与子宫内膜癌（EC）结局的关联尚未明确。本研究通过计算机断层扫描（CT）评估了体成分对早期 EC 女性结局的影响。
本回顾性研究纳入了国际妇产科联合会（FIGO）分期 I-III 期且有 CT 扫描的 EC 患者。采用 AutomatA 软件评估内脏脂肪组织、皮下脂肪组织（SAT）和肌间脂肪组织（IMAT）及骨骼肌面积。
在评估的 293 份病历中，有 199 份符合入选标准。中位 BMI 为 32.8kg/m2（四分位间距 [IQR] = 26.8-38.9）；61.8%为组织学类型子宫内膜样癌。校正年龄、FIGO 分期和组织学类型后，BMI 至少为 30kg/m2 与较低的子宫内膜癌特异性生存率（ECSS）（风险比 [HR] = 2.32，95%置信区间 [CI] = 1.27 至 4.25）和总生存率（OS）（HR = 2.7，95%CI = 1.35 至 5.39）相关。IMAT 第 75 百分位与第 25 百分位相比和 SAT 至少 225.6cm2 与较低的 ECSS（HR = 1.53，95%CI = 1.1 至 2.13，HR = 2.57，95%CI = 1.13 至 5.88）和 OS（HR = 1.50，95%CI = 1.11 至 2.02，HR = 2.46，95%CI = 1.2 至 5.01）相关。内脏脂肪组织（第 75 百分位与第 25 百分位相比）与 ECSS 和 OS 的相关性无统计学意义（HR = 1.42，95%CI = 0.91 至 2.22，HR = 1.24，95%CI = 0.81 至 1.89）。
较高的 BMI、IMAT 和 SAT 与 EC 死亡率增加和 OS 降低相关。更好地了解这些关系背后的机制可能为改善患者结局提供策略。
