Carcinoma De Endometrio

ABSTRACT

Endometrial cancer incidence is increasing in industrialized countries. High body mass index (BMI, kg x meters square) is associated with worse prognosis for many diseases. We investigate if BMI is related to clinical-pathological characteristics in primary tumor, and disease outcome in endometrial cancer.

PATIENTS AND METHODS: In total, 147 women primarily treated for endometrialcarcinoma at Instituto Nacional de Cancerología during 2000-2005 were studied. Body mass index was available for all patients and related to comprehensive clinical and histopathological data.

RESULTS: High BMI was related with endometrioid histology, low/intermediate grade and overweight/obese women had the same survival than normal/underweight women. In survival analysis adjusting for age,histological subtype, and grade, BMI showed no independent prognostic impact.

CONCLUSION: High BMI was significantly associated with markers of non-aggressive disease and women with high BMI had the same survival time in univariate analysis.
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KEYWORDS
Endometrial carcinoma, endometrioid adenocarcinoma, Body Mass Index, obesity, female cancer.



INTRODUCTION

Endometrial carcinoma isthe most common gynecological malignancy in industrialized countries (1), and the incidence has been increasing over the last decades. Obesity is a known risk factor for disease development with a higher risk according increasing body mass index (BMI, kg/square meters) (2). Has recently been shown that morbidly obese women (BMI >40) have a six-fold increase in risk of disease development,including cancer (3). This is presumably related to unopposed estrogen exposure. After menopause, the ovaries and adrenal glands continue to produce androstenedione, which is converted to estrone in adipose tissue by the aromatase enzyme. This weaker oestrogen may stimulate chronic endometrial proliferation and cancer development after menopause (4). Tumours arising in such hyper-estrogenic environmentare typically type I endometrial carcinomas, characterized by endometrioid histology, low histological grade (grade 1 or 2), hormone receptor-positive status, PTEN mutation, microsatellite instability and good prognosis. In contrast, tumors of type II are typically not estrogen driven, have non-endometrioid histology (serous or clear cell), are high grade (grade 3 or 4) and show loss of hormonereceptors, TP53 mutations and poor prognosis (5). However, the prognostic value of the distinction between type I and type II endometrial cancer is limited, as up to 20% of type I endometrial cancers recur and 50% of type II cancers do not (6). Diagnostic accuracy and reproducibility of histological subtyping is a challenge. Therefore, there is need for new prognostic markers.

On the otherhand, it is well established that obesity gives higher risk for endometrial cancer, studies relating BMI to clinical and histopathological markers and survival are scarce, and contradictive (7-12). In addition, the Mexican people have a very high prevalence and incidence of obesity in some studies the highest in the world and this could be much, but because if we apply the recommendations made forthe determination of obesity in our population, the number must be much higher. These amendments are based on racial differences in the Mexican population from other populations, the criteria of obesity in our population are different in two points to the established worldwide, and this is due to the formation of our population. The criteria for short stature ( 27, overweight of 25-27 and normal aBMI under 25 (13). On this background, we investigated the relationship between BMI and a number of clinical and histopathological data correlated with survival in a series of 147 endometrial carcinomas.

MATERIAL AND METHOD

Patients

This series includes 147 consecutive women treated by endometrioid carcinoma in the Instituto Nacional de Cancerología during the period 2000 to 2005. Our...