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Endocrine

, Volume 45, Issue 1, pp 28–36 | Cite as

Metabolic syndrome and endometrial cancer: a meta-analysis

  • Katherine EspositoEmail author
  • Paolo Chiodini
  • Annalisa Capuano
  • Giuseppe Bellastella
  • Maria Ida Maiorino
  • Dario Giugliano
Meta-Analysis

Abstract

We performed a systematic review and meta-analysis on the association of metabolic syndrome with endometrial cancer. A systematic literature search of electronic databases (Medline, ISI Web of Knowledge and Scopus) was conducted and complemented by cross-referencing to identify studies published before 31 January 2013. Core items of identified studies were independently extracted by two reviewers, and results were summarized by random effects meta-analysis. We identified six studies, which reported on 3,132 cancer cases. Metabolic syndrome was associated with an increased risk of endometrial cancer (RR: 1.89, 95 % CI 1.34–2.67, P < 0.001), with significant heterogeneity among studies (I 2 = 92 %, P < 0.001), but no indication for publication bias in the Egger’s test (P = 0.240). A sensitivity analysis omitting two studies produced no heterogeneity (I 2 = 0 %) and attenuated the association (RR: 1.39, 1.31–1.48, P < 0.001). The risk estimates for any single factor of the syndrome were 2.21 (P < 0.001) for higher values of body mass index and/or waist, 1.81 (P = 0.044) for hyperglycemia, 1.81 (P = 0.024) for higher blood pressure values, and 1.17 (P < 0.001) for high triglyceride levels; there was no significant association with low HDL-cholesterol. Metabolic syndrome is associated with an increased risk of endometrial cancer; among the components of the syndrome, obesity/high waist is that more strongly associated with endometrial cancer.

Keywords

Endometrial cancer Metabolic syndrome Meta-analysis 

Notes

Conflict of interest

None reported.

References

  1. 1.
    G. Plataniotis, M. Castiglione, ESMO Guidelines Working Group, Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 21(Suppl 5), v41–v45 (2010)PubMedCrossRefGoogle Scholar
  2. 2.
    Surveillance, Epidemiology, and End Results (SEER) Program. SEER Database: Incidence—SEER 9 Regs Public-Use. National Cancer Institute, DCCPS, Surveillance Research Program. http://www.seer.cancer.gov/csr/1975_2010/results_single/sect_01_table.01.pdf. Accessed 29 April 2013
  3. 3.
    American Cancer Society, Cancer Facts & Figures 2012 (American Cancer Society, Atlanta, 2012)Google Scholar
  4. 4.
    K.G. Alberti, R.H. Eckel, S.M. Grundy, P.Z. Zimmet, J.I. Cleeman, K.A. Donato, J.C. Fruchart, W.P. James, C.M. Loria, S.S. Smith Jr, International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation; International Atherosclerosis Society, International Association for the Study of Obesity, Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120, 1640–1645 (2009)PubMedCrossRefGoogle Scholar
  5. 5.
    E. Weiderpass, I. Persson, H.O. Adami, C. Magnusson, A. Lindgren, J.A. Baron, Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control 11, 185–192 (2000)PubMedCrossRefGoogle Scholar
  6. 6.
    K.E. Anderson, E. Anderson, P.J. Mink, C.P. Hong, L.H. Kushi, T.A. Sellers, D. Lazovich, A.R. Folsom, Diabetes and endometrial cancer in the Iowa women’s health study. Cancer Epidemiol. Biomarkers Prev. 10, 611–616 (2001)PubMedGoogle Scholar
  7. 7.
    M. Soler, L. Chatenoud, E. Negri, F. Parazzini, S. Franceschi, C. la Vecchia, Hypertension and hormone-related neoplasms in women. Hypertension 34, 320–325 (1999)PubMedCrossRefGoogle Scholar
  8. 8.
    K. Esposito, P. Chiodini, A. Colao, A. Lenzi, D. Giugliano, Metabolic syndrome and risk of cancer. A systematic review and meta-analysis. Diabetes Care 35, 2402–2411 (2012)PubMedCrossRefGoogle Scholar
  9. 9.
    A. Liberati, D.G. Altman, J. Tetzlaff, C. Mulrow, P.C. Gøtzsche, J.P. Ioannidis, M. Clarke, P.J. Devereaux, J. Kleijnen, D. Moher, The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann. Intern. Med. 151, W65–W94 (2009)PubMedCrossRefGoogle Scholar
  10. 10.
    G. Wells, B. Shea, D. O’Connell, J. Peterson, V. Welch, M. Losos, P. Tugwell. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 27 Feb 2013
  11. 11.
    J.P. Higgins, S.G. Thompson, Quantifying heterogeneity in a meta-analysis. Stat. Med. 21, 1539–1558 (2002)PubMedCrossRefGoogle Scholar
  12. 12.
    R. DerSimonian, N. Laird, Meta-analysis in clinical trials. Control. Clin. Trials 7, 177–188 (1986)PubMedCrossRefGoogle Scholar
  13. 13.
    A. Tobias, Assessing the influence of a single study in the meta-analysis estimate. Stata Tech. Bull. 8, 15–17 (1999)Google Scholar
  14. 14.
    H.C. van Houwelingen, L.R. Arends, T. Stijnen, Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat. Med. 21, 589–624 (2002)PubMedCrossRefGoogle Scholar
  15. 15.
    M. Egger, D.G. Smith, Bias in location and selection of studies. BMJ 316, 61–66 (1998)PubMedCrossRefGoogle Scholar
  16. 16.
    A.E. Cust, R. Kaaks, C. Friedenreich, F. Bonnet, M. Laville, A. Tjønneland, A. Olsen, K. Overvad, M.U. Jakobsen, V. Chajès, F. Clavel-Chapelon, M.C. Boutron-Ruault, J. Linseisen, A. Lukanova, H. Boeing, T. Pischon, A. Trichopoulou, B. Christina, D. Trichopoulos, D. Palli, F. Berrino, S. Panico, R. Tumino, C. Sacerdote, I.T. Gram, E. Lund, J.R. Quirós, N. Travier, C. Martínez-García, N. Larrañaga, M.D. Chirlaque, E. Ardanaz, G. Berglund, E. Lundin, H.B. Bueno-de-Mesquita, F.J. van Duijnhoven, P.H. Peeters, S. Bingham, K.T. Khaw, N. Allen, T. Key, P. Ferrari, S. Rinaldi, N. Slimani, E. Riboli, Metabolic syndrome, plasma lipid, lipoprotein and glucose levels, and endometrial cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Endocr. Relat. Cancer 14, 755–767 (2007)PubMedCrossRefGoogle Scholar
  17. 17.
    A. Russo, M. Autelitano, L. Bisanti, Metabolic syndrome and cancer risk. Eur. J. Cancer 44, 293–297 (2008)PubMedCrossRefGoogle Scholar
  18. 18.
    Y. Zhang, Z. Liu, X. Yu, X. Zhang, S. Lü, X. Chen, B. Lü, The association between metabolic abnormality and endometrial cancer: a large case-control study in China. Gynecol. Oncol. 117, 41–46 (2010)PubMedCrossRefGoogle Scholar
  19. 19.
    T. Bjørge, T. Stocks, A. Lukanova, S. Tretli, R. Selmer, J. Manjer, K. Rapp, H. Ulmer, M. Almquist, H. Concin, G. Hallmans, H. JonssoH, P. Stattin, A. Engeland, Metabolic syndrome and endometrial carcinoma. Am. J. Epidemiol. 171, 892–902 (2010)PubMedCrossRefGoogle Scholar
  20. 20.
    C.M. Friedenreich, R.K. Biel, D.C. Lau, I. Csizmadi, K.S. Courneya, A.M. Magliocco, Y. Yasui, L.S. Cook, Case–control Study of the metabolic syndrome and metabolic risk factors for endometrial cancer. Cancer Epidemiol. Biomarkers Prev. 20, 2384–2395 (2011)PubMedCrossRefGoogle Scholar
  21. 21.
    V. Rosato, A. Zucchetto, C. Bosetti et al., Metabolic syndrome and endometrial cancer risk. Ann. Oncol. 22, 884–889 (2011)PubMedCrossRefGoogle Scholar
  22. 22.
    J.J. Schlesselman, Case–control studies. Design, conduct, analysis (Oxford University Press, New York, 1982)Google Scholar
  23. 23.
    S.M. Shoff, P.A. Newcomb, Diabetes, body size, and risk of endometrial cancer. Am. J. Epidemiol. 148, 234–240 (1998)PubMedCrossRefGoogle Scholar
  24. 24.
    E. Salazar-Martinez, E.C. Lazcano-Ponce, G.G. Lira-Lira et al., Case–control study of diabetes, obesity, physical activity and risk of endometrial cancer among Mexican women. Cancer Causes Control 11, 707–711 (2000)PubMedCrossRefGoogle Scholar
  25. 25.
    A.S. Furberg, I. Thune, Metabolic abnormalities (hypertension, hyperglycemia and overweight), lifestyle (high energy intake and physical inactivity) and endometrial cancer risk in a Norwegian cohort. Int. J. Cancer 104, 669–676 (2003)PubMedCrossRefGoogle Scholar
  26. 26.
    R.E. Schmandt, D.A. Iglesias, N.N. Co, K.H. Lu, Understanding obesity and endometrial cancer risk: opportunities for prevention. Am. J. Obstet. Gynecol. 205, 518–525 (2011)PubMedCrossRefGoogle Scholar
  27. 27.
    J.P. Forney, L. Milewich, G.T. Chen, J.L. Garlock, B.E. Schwarz, C.D. Edman, P.C. MacDonald, Aromatization of androstenedione to estrone by human adipose tissue in vitro. Correlation with adipose tissue mass, age, and endometrial neoplasia. J. Clin. Endocrinol. Metab. 53, 192–199 (1981)PubMedCrossRefGoogle Scholar
  28. 28.
    M.J. Gunter, D.R. Hoover, H. Yu, S. Wassertheil-Smoller, J.E. Manson, J. Li, T.G. Harris, T.E. Rohan, X. Xue, G.Y. Ho, M.H. Einstein, R.C. Kaplan, R.D. Burk, J. Wylie-Rosett, M.N. Pollak, G. Anderson, B.V. Howard, H.D. Strickler, A prospective evaluation of insulin and insulin-like growth factor-I as risk factors for endometrial cancer. Cancer Epidemiol. Biomarkers Prev. 17, 921–929 (2008)PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    A.E. Cust, N.E. Allen, S. Rinaldi, L. Dossus, C. Friedenreich, A. Olsen, A. Tjønneland, K. Overvad, F. Clavel-Chapelon, M.C. Boutron-Ruault, J. Linseisen, J. Chang-Claude, H. Boeing, M. Schulz, V. Benet, A. Trichopoulou, A.D. Trichopoulos, D. Palli, F. Berrino, R. Tumino, A. Mattiello, P. Vineis, J.R. Quirós, A. Agudo, M.J. Sánchez, N. Larrañaga, C. Navarro, E. Ardanaz, H.B. Bueno-de-Mesquita, P.H. Peeters, C.H. van Gils, S. Bingham, K.T. Khaw, T. Key, N. Slimani, E. Riboli, R. Kaaks, Serum levels of C-peptide, IGFBP-1 and IGFBP-2 and endometrial cancer risk; results from the European prospective investigation into cancer and nutrition. Int. J. Cancer 120, 2656–2664 (2007)PubMedCrossRefGoogle Scholar
  30. 30.
    A. Lukanova, E. Lundin, A. Micheli, A. Arslan, P. Ferrari, S. Rinaldi, V. Krogh, P. Lenner, R.E. Shore, C. Biessy, P. Muti, E. Riboli, K.L. Koenig, M. Levitz, P. Stattin, F. Berrino, G. Hallmans, R. Kaaks, P. Toniolo, A. Zeleniuch-Jacquotte, Prediagnostic levels of C-peptide, IGF-I, IGFBP -1, -2 and -3 and risk of endometrial cancer. Int. J. Cancer 108, 262–268 (2004)PubMedCrossRefGoogle Scholar
  31. 31.
    S. Kang, J. Song, H. Kang, S. Kim, Y. Lee, D. Park, Insulin can block apoptosis by decreasing oxidative stress via phosphatidylinositol 3-kinase- and extracellular signal-regulated protein kinase-dependent signaling pathways in HepG2 cells. Eur. J. Endocrinol. 148, 147–155 (2003)PubMedCrossRefGoogle Scholar
  32. 32.
    M. Sowers, C. Derby, M.L. Jannausch, J.I. Torrens, R. Pasternak, Insulin resistance, hemostatic factors, and hormone interactions in pre- and perimenopausal women: SWAN. J. Clin. Endocrinol. Metab. 88, 4904–4910 (2003)PubMedCrossRefGoogle Scholar
  33. 33.
    D.L. Roberts, C. Dive, A.G. Renehan, Biological mechanisms linking obesity and cancer risk: new perspectives. Annu. Rev. Med. 61, 301–306 (2010)PubMedCrossRefGoogle Scholar
  34. 34.
    World Cancer Research Fund/American Institute for Cancer Research, Food, nutrition, physical activity, and the prevention of cancer: a global perspective (AICR, Washington, DC, 2007)Google Scholar
  35. 35.
    A.G. Renehan, M. Tyson, M. Egger, R.F. Heller, M. Zwahlen, Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371, 569–578 (2008)PubMedCrossRefGoogle Scholar
  36. 36.
    G.K. Reeves, K. Pirie, V. Beral, J. Green, E. Spencer, D. Bull, Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 335, 1134 (3007)CrossRefGoogle Scholar
  37. 37.
    E. Friberg, N. Orsini, C.S. Mantzoros, A. Wolk, Diabetes mellitus and risk of endometrial cancer: a meta-analysis. Diabetologia 50, 1365–1374 (2007)PubMedCrossRefGoogle Scholar
  38. 38.
    H. Noto, K. Osame, T. Sasazuchi, M. Noda, Substantially increate risk of cancer in patients with diabetes mellitus: a systematic review and meta-analysis of epidemiological evidence in Japan. J. Diabetes Complications 24, 345–353 (2010)PubMedCrossRefGoogle Scholar
  39. 39.
    Z.H. Zhang, P.Y. Su, J.H. Sao, Y.H. Sun, The role of preexisting diabetes mellitus on incidence and mortality of endometrial cancer: a meta-analysis of prospective cohort studies. Int. J. Gynecol. Cancer 23, 294–303 (2013)PubMedCrossRefGoogle Scholar
  40. 40.
    F. Parazzini, E. Negri, C. La Vecchia, P. Bruzzi, A. Decarli, Population attributable risk of endometrial cancer in northern Italy. Eur. J. Cancer Clin. Oncol. 25, 1451–1456 (1989)PubMedCrossRefGoogle Scholar
  41. 41.
    J. Maatela, A. Aromaa, T. Salmi, M. Pohja, M. Vuento, M. Gronroos, The risk of endometrial cancer in diabetic and hypertensive patients: a nationwide record-linkage study in Finland. Ann. Chir. Gynaecol. Suppl. 208, 20–24 (1994)PubMedGoogle Scholar
  42. 42.
    N. Reis, N.K. Beji, Risk factors for endometrial cancer in Turkish women: results from a hospital-based case-control study. Eur. J. Oncol. Nurs. 13, 122–127 (2009)PubMedCrossRefGoogle Scholar
  43. 43.
    C.A. Swanson, N. Potischman, R.J. Barrett, M.L. Berman, R. Mortel, L.B. Twiggs et al., Endometrial cancer risk in relation to serum lipids and lipoprotein levels. Cancer Epidemiol. Biomarkers Prev. 3, 575–581 (1994)PubMedGoogle Scholar
  44. 44.
    K. Lindemann, L.J. Vatten, M. Ellstrom-Engh, A. Eskild, Serum lipids and endometrial cancer risk: results from the HUNT-II study. Int. J. Cancer 124, 2938–2941 (2009)PubMedCrossRefGoogle Scholar
  45. 45.
    D. Seth, H. Garmo, A. Wigertz, L. Holmberg, N. Hammar, I. Junger et al., Lipid profiles and the risk of endometrial cancer in the Swedish AMORIS study. Int. J. Mol. Epidemiol. Genet. 3, 122–133 (2012)PubMedCentralPubMedGoogle Scholar
  46. 46.
    L. Dossus, A. Lukanova, S. Rinaldi, N. Allen, A.E. Cust, S. Becker et al., Hormonal, metabolic, and inflammatory profiles and endometrial cancer risk within the EPIC cohort. A factor analysis. Am. J. Epidemiol. 177(8), 787–799 (2013)PubMedCrossRefGoogle Scholar
  47. 47.
    S.M. Grundy, J.L. Cleeman, S.R. Daniels, K.A. Donato, R.H. Eckel, B.A. Franklin et al., Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112, 2735–2752 (2005)PubMedCrossRefGoogle Scholar
  48. 48.
    K. Esposito, A. Ceriello, D. Giugliano, Diet and the metabolic syndrome. Metab. Syndr. Relat. Disord. 5, 291–296 (2007)PubMedCrossRefGoogle Scholar
  49. 49.
    K. Esposito, C.M. Kastorini, D.B. Panagiotakos, D. Giugliano, Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab. Syndr. Relat. Disord. 9, 1–12 (2011)PubMedCrossRefGoogle Scholar
  50. 50.
    R. Kaaks, A. Lukanova, M.S. Kurzer, Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol. Biomarkers Prev. 11, 1531–1543 (2002)PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Katherine Esposito
    • 4
    Email author
  • Paolo Chiodini
    • 1
  • Annalisa Capuano
    • 2
  • Giuseppe Bellastella
    • 3
  • Maria Ida Maiorino
    • 3
  • Dario Giugliano
    • 3
  1. 1.Department of Medicine and Public HealthSecond University of NaplesNaplesItaly
  2. 2.Department of Experimental MedicineSecond University of NaplesNaplesItaly
  3. 3.Department of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesSecond University of NaplesNaplesItaly
  4. 4.Division of Endocrinology, Diabetes, and Metabolic DiseasesDepartment of Clinical and Experimental Medicine and Surgery, Second University of NaplesNaplesItaly

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