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Obesity, diabetes, and race in Type 1 and Type 2 endometrial cancers.

5111 Background: Type1 endometrial cancers (EC) classically occur in obese, Caucasian women and arise in a hyper-estrogenic milieu. In contrast, Type2 EC (i.e. serous and clear cell) behave more aggressively and occur more frequently in African-American (AA) women. Obesity has not been conclusively demonstrated to be a risk factor for Type2 EC, but recent studies are lacking. Given the obesity and diabetes (DM) epidemic and the poorer outcomes in AA with EC, we sought to re-assess whether obesity and DM are associated with both types of EC.


METHODS
An institutional review board approved cross-sectional analysis of all Type1 and Type2 EC diagnosed in a single institution from Jan 2005-Sept 2010 to assess obesity, race and other prognostic factors. Statistical analyses using student t-test, Χ2 test, and multiple logistic regression were performed in STATA 11. Statistical significance was set at p=0.05, with confidence levels of 95%.


RESULTS
Of 881 (691 Type1 and 190 Type2) EC cases, 16.6% of Type1 and 30.2% of Type2 were AA. Of Type1 and Type2 EC, 84.4% and 78.1% were overweight-obese (OvOb) (p=NS); 61.9% and 50.8% were obese (p=0.007). 94.7% of AA patients were OvOb compared to 79.8% of Caucasian patients (p<0.001). AA had a higher mean BMI than Caucasians for Type1 (37.0 v 33.9, p<0.005) and Type2 (34.9 v 30.2, p<0.001) cancers. For Type2 EC, AA had 6.62 times the odds of being OvOB (95CI 1.93, 22.6) as Caucasians. AA race was associated with 2.36 times the odds (95CI 1.58, 3.54) of having Type2 EC compared to Caucasian race after adjusting for OvOb. Overall, 21.6% of EC patients had DM, of which 95.3% were non-insulin dependent. The proportion of DM did not differ between Type1 and Type2 EC (23.1 v 20.5%, p=0.456). More AA patients had DM than Caucasian patients (34.8 v 19.9%, p<0.001). Within Type2 EC, AA had 3.48 times the odds (95CI 1.63, 7.42) of having DM than Caucasians. Stage, lymphovascular and myometrial invasion did not differ between normal and OvOB, or DM and non-DM patients.


CONCLUSIONS
Despite traditional dogma, the vast majority of both Type I and 2 endometrial cancer patients are overweight and obese and many have diabetes. Thus, strategies to impact obesity may be just as critical for women faced with Type 2 as Type 1 disease.