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Longitudinal analysis of cancer-associated biomarkers within weight loss intervention for endometrial cancer survivors with obesity
Abstracts / Gynecologic Oncology 137 (2015) 2–91
216 — Poster Session Is hypothyroidism a risk factor for types of uterine cancer? C.C. Warda, M.S. Shahinb, M.I. Edelsonb. aUniversity of Iowa Hospitals and Clinics, Iowa City, IA, USA, bHanjani Institute for Gynecologic Oncology, Abington Memorial Hospital, Abington, PA, USA Objectives: Endometrial cancers are considered to be hormone-driven. Thyroid status may influence the tumorigenesis of these cancers, but epidemiologic studies have failed to show a significant relationship. No known study has evaluated the incidence of specific types of gynecologic cancers in patients with thyroid disease. This study explored if there is a risk of a certain type of uterine cancer related to hypothyroidism. Methods: We conducted a retrospective cohort study of 600 patients with uterine cancer. We evaluated age, parity, body mass index, diagnosis of thyroid disease, and histologic type of uterine cancer. Chi square and multivariate analysis were used to examine the relationship between hypothyroidism and types of uterine cancers. Results: Nineteen percent of the patients (116) had hypothyroidism, and those without hypothyroidism were used as the control group. Types of cancer were divided into endometrioid, serous, clear cell, carcinosarcoma, and sarcomas, and we compared those with and without hypothyroidism. Seventy-six percent of both groups had endometrioid adenocarcinoma, 21% of the hypothyroid group and 8% without hypothyroidism had serous adenocarcinoma, 0% of hypothyroid patients and 8% without hypothyroidism had clear cell histology, 2% of the hypothyroid patients and 3% of the nonhypothyroid patients had carcinosarcoma, and 1% of the hypothyroid group and 3% of the nonhypothyroid group had sarcoma. Among those with serous adenocarcinoma, 38.5% had hypothyroidism (OR 3.04, 95% CI 1.9–5.3, P = 0.000), and fewer patients than expected in the carcinosarcoma (4%, P = 0.013) and clear cell groups (0%, P = 0.032) had hypothyroidism. There were no significant differences in age, parity, or body mass index. Conclusions: Hypothyroidism may be an independent risk factor for histologic type of endometrial cancer. There is no increased risk for endometrioid adenocarcinoma, but unexpectedly a significantly increased risk for serous adenocarcinoma and significantly decreased risk for both clear cell adenocarcinoma and carcinosarcoma in patients with hypothyroidism. doi:10.1016/j.ygyno.2015.01.218
217 — Poster Session Longitudinal analysis of cancer-associated biomarkers within weight loss intervention for endometrial cancer survivors with obesity A.F. Haggertya, G. Raggiob, J. Spitzera, J. Boyerc, D.B. Sarwera, C. Chud, K. Allisona. aUniversity of Pennsylvania, Philadelphia, PA, USA, bUniversity of Pennsylvania Health System, Philadelphia, PA, USA, cPerelman School of Medicine, USA, dFox Chase Cancer Center, Philadelphia, PA, USA Objectives: Obesity significantly increases the relative risk of the development of both endometrial hyperplasia and cancer. Cancerassociated biomarker levels may be altered after weight loss in this patient population, hypothetically affecting inflammation or host factors that may relate to oncogenesis. The objective of this study was to longitudinally evaluate biomarker changes in women with endometrial cancer/hyperplasia participating in a novel technologybased weight loss intervention. Methods: Women age N18 years with obesity (body mass index ≥30) and histologically confirmed endometrial hyperplasia or type I endometrial cancer were randomized 1:1 to a technology-based delivery of a 6month weight loss and lifestyle intervention via either telemedicine or text messaging in which 90% of participants successfully lost weight.
89
Serum samples from participants were obtained pre- and post-intervention. Bead-based xMAP enzyme-linked immunosorbent assays were used to observe sera levels of cytokines interleukin (IL)-8, IL-6, IL-1 beta, IL-2, IL-7, vascular endothelial growth factor (VEGF), adipokine, and insulinlike growth factor binding protein (IGFBP). Paired t-tests were used to examine the difference between changes in biomarker expression. Results: Mean serum levels of IL-2 demonstrated a significant difference pre- and postintervention, and there was a decrease in the level of IL-1 beta that trended toward significance. The levels of IGFBP, VEGF, IL-6, and IL-8 increased and the levels of adiponectin and IL-7 increased, although these changes did not demonstrate statistical significance in the pilot data. (See Table 1.) Conclusions: In this pilot study, changes in expression of IL-2 were affected by participation in a novel technology-based weight loss intervention. Our results warrant further study in a larger trial to test the impact of weight loss on cancer-related biomarkers. Table 1 Mean levels of biomarkers at baseline and end of intervention, mean (SD). Biomarker
Baseline (n = 21)(pg/mL)
6 months (n = 18)(pg/mL)
P valuea
IGFBP Adiponectin VEGF IL-1 beta IL-2 IL-6 IL-7 IL-8
140.63 (215.81) 9,326,925 (6,429,249) 1778.0 (2764.0) 18.78 (75.61) 27.15 (112.65) 28.35 (81.35) 5.58 (103.69) 287.1 (728.18)
109.61 1,060,007 1635.93 7.58 5.18 16.21 8.85 272.83
0.689 0.238 0.57 0.0554 0.0495 0.3844 0.4611 0.8866
a
(97.9) (6,769,987) (2654.95) (14.38) (7.97) (30.37) (18.24) (813.34)
P b 0.05 considered statistically significant.
doi:10.1016/j.ygyno.2015.01.219 218 — Poster Session Operative outcomes for women undergoing robotic-assisted hysterectomy in the treatment of endometrial cancer: A Washington State population-based study, 2008–2011 T.L. Beck, M.A. Schiff, B.A. Goff, R.R. Urban. University of Washington Medical Center, Seattle, WA, USA Objectives: While some studies have shown that hospital size and surgeon volume affect patient operative outcomes, data are limited regarding robotic-assisted (RA) surgery outcomes, especially in population-based studies. We sought to identify factors that affect outcomes for women undergoing RA surgery for endometrial cancer (EC). Methods: We performed a population-based retrospective cohort study using the Comprehensive Hospital Abstract Reporting System to identify EC patients managed with RA surgery in Washington State from 2008 to 2011. Regression analyses were used to assess length of stay (LOS), readmissions, and complications by hospital size, RA surgical volume, and surgeon group RA volume. All analyses were adjusted for year of surgery, lymphadenectomy (LND), and patients' Charlson Comorbidity Index (CCI). Results: We identified 1003 women with EC managed with RA surgery by 12 surgeon groups at 17 hospitals. One-third of patients were obese, 74% were older than age 55 years, and 8.6% had a CCI ≥ 2. More patients were treated at high- vs. low-volume hospitals (73.2% vs. 26.8%), large vs. small hospitals (72.3% vs. 27.7%), and by high- vs. low-volume surgeon groups (79.9% vs. 20.1%). LND was performed in 53% of patients. Mean LOS was 1 day (range, 1– 26 days) and did not vary by hospital size or group volume. The 90day readmission rate was 8.1%, the rate of major complications was 9.0%, and the rate of minor complications was 10.8%. These did not vary by hospital or surgeon factors. We identified four very lowvolume groups performing b10 cases/year in at least 3 study years. Of these, three groups did not have a gynecologic oncologist. These surgeon groups contributed a small total number of RA cases but had major complication rates of up to 20%.
216 — Poster Session Is hypothyroidism a risk factor for types of uterine cancer? C.C. Warda, M.S. Shahinb, M.I. Edelsonb. aUniversity of Iowa Hospitals and Clinics, Iowa City, IA, USA, bHanjani Institute for Gynecologic Oncology, Abington Memorial Hospital, Abington, PA, USA Objectives: Endometrial cancers are considered to be hormone-driven. Thyroid status may influence the tumorigenesis of these cancers, but epidemiologic studies have failed to show a significant relationship. No known study has evaluated the incidence of specific types of gynecologic cancers in patients with thyroid disease. This study explored if there is a risk of a certain type of uterine cancer related to hypothyroidism. Methods: We conducted a retrospective cohort study of 600 patients with uterine cancer. We evaluated age, parity, body mass index, diagnosis of thyroid disease, and histologic type of uterine cancer. Chi square and multivariate analysis were used to examine the relationship between hypothyroidism and types of uterine cancers. Results: Nineteen percent of the patients (116) had hypothyroidism, and those without hypothyroidism were used as the control group. Types of cancer were divided into endometrioid, serous, clear cell, carcinosarcoma, and sarcomas, and we compared those with and without hypothyroidism. Seventy-six percent of both groups had endometrioid adenocarcinoma, 21% of the hypothyroid group and 8% without hypothyroidism had serous adenocarcinoma, 0% of hypothyroid patients and 8% without hypothyroidism had clear cell histology, 2% of the hypothyroid patients and 3% of the nonhypothyroid patients had carcinosarcoma, and 1% of the hypothyroid group and 3% of the nonhypothyroid group had sarcoma. Among those with serous adenocarcinoma, 38.5% had hypothyroidism (OR 3.04, 95% CI 1.9–5.3, P = 0.000), and fewer patients than expected in the carcinosarcoma (4%, P = 0.013) and clear cell groups (0%, P = 0.032) had hypothyroidism. There were no significant differences in age, parity, or body mass index. Conclusions: Hypothyroidism may be an independent risk factor for histologic type of endometrial cancer. There is no increased risk for endometrioid adenocarcinoma, but unexpectedly a significantly increased risk for serous adenocarcinoma and significantly decreased risk for both clear cell adenocarcinoma and carcinosarcoma in patients with hypothyroidism. doi:10.1016/j.ygyno.2015.01.218
217 — Poster Session Longitudinal analysis of cancer-associated biomarkers within weight loss intervention for endometrial cancer survivors with obesity A.F. Haggertya, G. Raggiob, J. Spitzera, J. Boyerc, D.B. Sarwera, C. Chud, K. Allisona. aUniversity of Pennsylvania, Philadelphia, PA, USA, bUniversity of Pennsylvania Health System, Philadelphia, PA, USA, cPerelman School of Medicine, USA, dFox Chase Cancer Center, Philadelphia, PA, USA Objectives: Obesity significantly increases the relative risk of the development of both endometrial hyperplasia and cancer. Cancerassociated biomarker levels may be altered after weight loss in this patient population, hypothetically affecting inflammation or host factors that may relate to oncogenesis. The objective of this study was to longitudinally evaluate biomarker changes in women with endometrial cancer/hyperplasia participating in a novel technologybased weight loss intervention. Methods: Women age N18 years with obesity (body mass index ≥30) and histologically confirmed endometrial hyperplasia or type I endometrial cancer were randomized 1:1 to a technology-based delivery of a 6month weight loss and lifestyle intervention via either telemedicine or text messaging in which 90% of participants successfully lost weight.
89
Serum samples from participants were obtained pre- and post-intervention. Bead-based xMAP enzyme-linked immunosorbent assays were used to observe sera levels of cytokines interleukin (IL)-8, IL-6, IL-1 beta, IL-2, IL-7, vascular endothelial growth factor (VEGF), adipokine, and insulinlike growth factor binding protein (IGFBP). Paired t-tests were used to examine the difference between changes in biomarker expression. Results: Mean serum levels of IL-2 demonstrated a significant difference pre- and postintervention, and there was a decrease in the level of IL-1 beta that trended toward significance. The levels of IGFBP, VEGF, IL-6, and IL-8 increased and the levels of adiponectin and IL-7 increased, although these changes did not demonstrate statistical significance in the pilot data. (See Table 1.) Conclusions: In this pilot study, changes in expression of IL-2 were affected by participation in a novel technology-based weight loss intervention. Our results warrant further study in a larger trial to test the impact of weight loss on cancer-related biomarkers. Table 1 Mean levels of biomarkers at baseline and end of intervention, mean (SD). Biomarker
Baseline (n = 21)(pg/mL)
6 months (n = 18)(pg/mL)
P valuea
IGFBP Adiponectin VEGF IL-1 beta IL-2 IL-6 IL-7 IL-8
140.63 (215.81) 9,326,925 (6,429,249) 1778.0 (2764.0) 18.78 (75.61) 27.15 (112.65) 28.35 (81.35) 5.58 (103.69) 287.1 (728.18)
109.61 1,060,007 1635.93 7.58 5.18 16.21 8.85 272.83
0.689 0.238 0.57 0.0554 0.0495 0.3844 0.4611 0.8866
a
(97.9) (6,769,987) (2654.95) (14.38) (7.97) (30.37) (18.24) (813.34)
P b 0.05 considered statistically significant.
doi:10.1016/j.ygyno.2015.01.219 218 — Poster Session Operative outcomes for women undergoing robotic-assisted hysterectomy in the treatment of endometrial cancer: A Washington State population-based study, 2008–2011 T.L. Beck, M.A. Schiff, B.A. Goff, R.R. Urban. University of Washington Medical Center, Seattle, WA, USA Objectives: While some studies have shown that hospital size and surgeon volume affect patient operative outcomes, data are limited regarding robotic-assisted (RA) surgery outcomes, especially in population-based studies. We sought to identify factors that affect outcomes for women undergoing RA surgery for endometrial cancer (EC). Methods: We performed a population-based retrospective cohort study using the Comprehensive Hospital Abstract Reporting System to identify EC patients managed with RA surgery in Washington State from 2008 to 2011. Regression analyses were used to assess length of stay (LOS), readmissions, and complications by hospital size, RA surgical volume, and surgeon group RA volume. All analyses were adjusted for year of surgery, lymphadenectomy (LND), and patients' Charlson Comorbidity Index (CCI). Results: We identified 1003 women with EC managed with RA surgery by 12 surgeon groups at 17 hospitals. One-third of patients were obese, 74% were older than age 55 years, and 8.6% had a CCI ≥ 2. More patients were treated at high- vs. low-volume hospitals (73.2% vs. 26.8%), large vs. small hospitals (72.3% vs. 27.7%), and by high- vs. low-volume surgeon groups (79.9% vs. 20.1%). LND was performed in 53% of patients. Mean LOS was 1 day (range, 1– 26 days) and did not vary by hospital size or group volume. The 90day readmission rate was 8.1%, the rate of major complications was 9.0%, and the rate of minor complications was 10.8%. These did not vary by hospital or surgeon factors. We identified four very lowvolume groups performing b10 cases/year in at least 3 study years. Of these, three groups did not have a gynecologic oncologist. These surgeon groups contributed a small total number of RA cases but had major complication rates of up to 20%.