Features of endometrial cancer in patients with 'metabolically healthy' versus 'standard' obesity: The decreasing frequency of metabolically healthy obesity

Abstract

Background: As endometrial cancer (EC) prevalence increases with obesity, we aimed to determine whether EC characteristics depend upon obesity type: 'standard' (SO) or 'metabolically healthy obesity' (MHO). Patients & methods: 258 EC patients were included. Data on anthropometry, blood hormones, lipids and glucose, and tumor features were collected. Results: EC clinicopathologic characteristics and clinical stage correlate differently with BMI and obesity type. BMI is related inversely with tumor grade while SO patients are characterized by a more advanced clinical stage than those with MHO. Besides typical insulin resistance signs, EC patients with SO often display a higher serum leptin/adiponectin ratio compared with MHO patients. Historical data suggest a gradual increase in EC patient height and weight, and a decrease in MHO prevalence. Conclusion: It is currently unknown whether the latter observation reflects the evolution of EC, or obesity alongside the current epidemic. Regardless, the reduced MHO prevalence demonstrates the need for more intensive preventive measures aimed at obesity and obesity-associated conditions, including different EC subtypes. Worldwide prevalence of uterine body or endometrial cancer (EC) has increased notably. Recently, the WHO documented an obesity epidemic in several countries. Concurrently, many studies showed a high (37-66%) obesity rate in EC patients. There is currently no mention of a potentially distinctive correlation of EC with obesity types. In general, these types of obesity can be subdivided into 'standard' (SO; with metabolic disturbances, initially with insulin resistance signs) and 'nonstandard', or metabolically healthy obesity (MHO; without mentioned disturbances). The present paper concludes, first, that EC patients with SO (especially if BMI is ≥30) generally have more advanced tumor stage than patients with MHO. Second, in an EC group (2012-2014) a decrease in MHO frequency versus 1998-2000 group was observed. Altogether, this underlines the need for additional cancer preventive efforts in the obese female population.