Tumor Biology

, Volume 36, Issue 3, pp 2201–2207 | Cite as

Metabolic components and recurrence in early-stage cervical cancer

  • Hee Kyung Ahn
  • Jin Woo Shin
  • Hong Yup Ahn
  • Chan-Yong Park
  • Nak Woo Lee
  • Jae Kwan Lee
  • In Cheol Hwang
Research Article


Epidemiological evidence suggests that the metabolic syndrome (MetS) is associated with increased risk of cervical cancer. However, research on the impact of MetS on prognosis in cervical cancer is lacking. This study investigated the association between MetS and recurrence-free survival (RFS) in patients with early-stage cervical cancer. This is a retrospective study of patients diagnosed with the International Federation of Gynecology and Obstetrics (FIGO) stage I-II cervical cancer in three tertiary hospitals during 2006–2009. Cox proportional hazards model was used to estimate the association between MetS or MetS components and RFS. We were able to evaluate MetS status in 84 patients out of 127. Forty patients had MetS. RFS was not significantly different according to MetS status; however, there was no further event of recurrence in non-MetS group after 2 years from primary surgical treatment. Hypertriglyceridemia (HR 3.67, 95 % CI 1.18–11.43) and impaired fasting glucose (HR 4.30, 95 % CI 1.23–15.03) were independent risk factors for shorter RFS, after adjustment for age, lymph node involvement, tumor involvement of resection margin, parametrial invasion, FIGO stage at diagnosis, and adjuvant treatment. Hypertriglyceridemia and impaired fasting glucose were associated with higher risk of recurrence in patients with early-stage cervical cancer. Prospective validation in large populations and further studies on the impact of MetS treatment in patients with cervical cancer are warranted.


Uterine cervical neoplasms Metabolic syndrome X Hypertriglyceridemia Obesity Hyperglycemia Prognosis 


Conflicts of interest



  1. 1.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90. doi: 10.3322/caac.20107.CrossRefPubMedGoogle Scholar
  2. 2.
    Gray HJ. Primary management of early-stage cervical cancer (IA1-IB) and appropriate selection of adjuvant therapy. J National Compr Cancer Netw : JNCCN. 2008;6(1):47–52.Google Scholar
  3. 3.
    Horn LC, Fischer U, Raptis G, Bilek K, Hentschel B. Tumor size is of prognostic value in surgically treated FIGO stage II cervical cancer. Gynecol Oncol. 2007;107(2):310–5. doi: 10.1016/j.ygyno.2007.06.026.CrossRefPubMedGoogle Scholar
  4. 4.
    Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735–52. doi: 10.1161/CIRCULATIONAHA.105.169404.CrossRefPubMedGoogle Scholar
  5. 5.
    Koren-Morag N, Goldbourt U, Tanne D. Relation between the metabolic syndrome and ischemic stroke or transient ischemic attack: a prospective cohort study in patients with atherosclerotic cardiovascular disease. Stroke. 2005;36(7):1366–71. doi: 10.1161/01.STR.0000169945.75911.33.CrossRefPubMedGoogle Scholar
  6. 6.
    Malik S, Wong ND, Franklin SS, Kamath TV, L'Italien GJ, Pio JR, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004;110(10):1245–50. doi: 10.1161/01.CIR.0000140677.20606.0E.CrossRefPubMedGoogle Scholar
  7. 7.
    Cowey S, Hardy RW. The metabolic syndrome: a high-risk state for cancer? Am J Pathol. 2006;169(5):1505–22. doi: 10.2353/ajpath.2006.051090.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ulmer H, Bjorge T, Concin H, Lukanova A, Manjer J, Hallmans G, et al. Metabolic risk factors and cervical cancer in the metabolic syndrome and cancer project (Me-Can). Gynecol Oncol. 2012;125(2):330–5. doi: 10.1016/j.ygyno.2012.01.052.CrossRefPubMedGoogle Scholar
  9. 9.
    Penaranda EK, Shokar N, Ortiz M. Relationship between metabolic syndrome and history of cervical cancer among a US national population. ISRN Oncol. 2013;2013:840964. doi: 10.1155/2013/840964.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Lacey Jr JV, Swanson CA, Brinton LA, Altekruse SF, Barnes WA, Gravitt PE, et al. Obesity as a potential risk factor for adenocarcinomas and squamous cell carcinomas of the uterine cervix. Cancer. 2003;98(4):814–21. doi: 10.1002/cncr.11567.CrossRefPubMedGoogle Scholar
  11. 11.
    Stocks T, Van Hemelrijck M, Manjer J, Bjorge T, Ulmer H, Hallmans G, et al. Blood pressure and risk of cancer incidence and mortality in the metabolic syndrome and cancer project. Hypertension. 2012;59(4):802–10. doi: 10.1161/HYPERTENSIONAHA.111.189258.CrossRefPubMedGoogle Scholar
  12. 12.
    Einhorn D, Reaven GM, Cobin RH, Ford E, Ganda OP, Handelsman Y, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract. 2003;9(3):237–52.PubMedGoogle Scholar
  13. 13.
    McTiernan A, Irwin M, Vongruenigen V. Weight, physical activity, diet, and prognosis in breast and gynecologic cancers. J Clin Oncol: Off J Am Soc Clin Oncol. 2010;28(26):4074–80. doi: 10.1200/JCO.2010.27.9752.CrossRefGoogle Scholar
  14. 14.
    Tulinius H, Sigfusson N, Sigvaldason H, Bjarnadottir K, Tryggvadottir L. Risk factors for malignant diseases: a cohort study on a population of 22,946 Icelanders. Cancer Epidemiol, Biomark Prev : Publ Am Assoc Cancer Res, Cosponsored by Am Soc Prev Oncol. 1997;6(11):863–73.Google Scholar
  15. 15.
    Ulmer H, Borena W, Rapp K, Klenk J, Strasak A, Diem G, et al. Serum triglyceride concentrations and cancer risk in a large cohort study in Austria. Br J Cancer. 2009;101(7):1202–6. doi: 10.1038/sj.bjc.6605264.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Sowers MR, Randolph Jr J, Jannausch M, Lasley B, Jackson E, McConnell D. Levels of sex steroid and cardiovascular disease measures in premenopausal and hormone-treated women at midlife: implications for the "timing hypothesis". Arch Intern Med. 2008;168(19):2146–53. doi: 10.1001/archinte.168.19.2146.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Nilsen TI, Vatten LJ. Prospective study of colorectal cancer risk and physical activity, diabetes, blood glucose and BMI: exploring the hyperinsulinaemia hypothesis. Br J Cancer. 2001;84(3):417–22. doi: 10.1054/bjoc.2000.1582.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Schoen RE, Tangen CM, Kuller LH, Burke GL, Cushman M, Tracy RP, et al. Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst. 1999;91(13):1147–54.CrossRefPubMedGoogle Scholar
  19. 19.
    Jee SH, Ohrr H, Sull JW, Yun JE, Ji M, Samet JM. Fasting serum glucose level and cancer risk in Korean men and women. JAMA : J Am Med Assoc. 2005;293(2):194–202. doi: 10.1001/jama.293.2.194.CrossRefGoogle Scholar
  20. 20.
    Smith GD, Egger M, Shipley MJ, Marmot MG. Post-challenge glucose concentration, impaired glucose tolerance, diabetes, and cancer mortality in men. Am J Epidemiol. 1992;136(9):1110–4.CrossRefPubMedGoogle Scholar
  21. 21.
    Wideroff L, Gridley G, Mellemkjaer L, Chow WH, Linet M, Keehn S, et al. Cancer incidence in a population-based cohort of patients hospitalized with diabetes mellitus in Denmark. J Natl Cancer Inst. 1997;89(18):1360–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Baur DM, Klotsche J, Hamnvik OP, Sievers C, Pieper L, Wittchen HU, et al. Type 2 diabetes mellitus and medications for type 2 diabetes mellitus are associated with risk for and mortality from cancer in a German primary care cohort. Metabolism. 2011;60(10):1363–71. doi: 10.1016/j.metabol.2010.09.012.CrossRefPubMedGoogle Scholar
  23. 23.
    Hemminki K, Li X, Sundquist J, Sundquist K. Risk of cancer following hospitalization for type 2 diabetes. Oncologist. 2010;15(6):548–55. doi: 10.1634/theoncologist. 2009-0300.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Stocks T, Rapp K, Bjorge T, Manjer J, Ulmer H, Selmer R, et al. Blood glucose and risk of incident and fatal cancer in the metabolic syndrome and cancer project (me-can): analysis of six prospective cohorts. PLoS Med. 2009;6(12):e1000201. doi: 10.1371/journal.pmed.1000201.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Steller MA, Delgado CH, Bartels CJ, Woodworth CD, Zou Z. Overexpression of the insulin-like growth factor-1 receptor and autocrine stimulation in human cervical cancer cells. Cancer Res. 1996;56(8):1761–5.PubMedGoogle Scholar
  26. 26.
    Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Madarnas Y, et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol : Off J Am Soc Clin Oncol. 2002;20(1):42–51.CrossRefGoogle Scholar
  27. 27.
    Huang YF, Shen MR, Hsu KF, Cheng YM, Chou CY. Clinical implications of insulin-like growth factor 1 system in early-stage cervical cancer. Br J Cancer. 2008;99(7):1096–102. doi: 10.1038/sj.bjc.6604661.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Ursin G, Pike MC, Preston-Martin S, 3rd d'Ablaing G, Peters RK. Sexual, reproductive, and other risk factors for adenocarcinoma of the cervix: results from a population-based case–control study (California, United States). Cancer Causes Control : CCC. 1996;7(3):391–401.CrossRefPubMedGoogle Scholar
  29. 29.
    Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38. doi: 10.1056/NEJMoa021423.CrossRefPubMedGoogle Scholar
  30. 30.
    Key TJ, Allen NE, Verkasalo PK, Banks E. Energy balance and cancer: the role of sex hormones. Proc Nutr Soc. 2001;60(1):81–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Louwman WJ, Aarts MJ, Houterman S, van Lenthe FJ, Coebergh JW, Janssen-Heijnen ML. A 50% higher prevalence of life-shortening chronic conditions among cancer patients with low socioeconomic status. Br J Cancer. 2010;103(11):1742–8. doi: 10.1038/sj.bjc.6605949.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2014

Authors and Affiliations

  • Hee Kyung Ahn
    • 1
  • Jin Woo Shin
    • 2
  • Hong Yup Ahn
    • 3
  • Chan-Yong Park
    • 2
  • Nak Woo Lee
    • 4
  • Jae Kwan Lee
    • 4
  • In Cheol Hwang
    • 5
  1. 1.Division of Hematology and Oncology, Department of Internal MedicineGachon University Gil Medical CenterIncheonRepublic of Korea
  2. 2.Department of Obstetrics and GynecologyGachon University Gil Medical CenterIncheonRepublic of Korea
  3. 3.Department of StatisticsDongguk UniversitySeoulRepublic of Korea
  4. 4.Department of Obstetrics and GynecologyKorea University College of MedicineSeoulRepublic of Korea
  5. 5.Department of Family MedicineGachon University Gil Medical CenterIncheonRepublic of Korea

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