Bariatric Surgery and Longitudinal Cancer Risk
Pei‐Wen LimChee-Chee H. StuckyNabil WasifDavid A. EtzioniKristi L. HaroldJames A. MaduraZhi Ven Fong
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Abstract:
Cancer is one of the leading causes of death in the United States, with the obesity epidemic contributing to its steady increase every year. Recent cohort studies find an association between bariatric surgery and reduced longitudinal cancer risk, but with heterogeneous findings.Keywords:
Longitudinal Study
New reliable approaches to stratify patients with endometrial cancer into risk categories are highly needed. We have recently demonstrated that DJ-1 is overexpressed in endometrial cancer, showing significantly higher levels both in serum and tissue of patients with high-risk endometrial cancer compared with low-risk endometrial cancer. In this experimental study, we further extended our observation, evaluating the role of DJ-1 as an accurate serum biomarker for high-risk endometrial cancer. A total of 101 endometrial cancer patients and 44 healthy subjects were prospectively recruited. DJ-1 serum levels were evaluated comparing cases and controls and, among endometrial cancer patients, between high- and low-risk patients. The results demonstrate that DJ-1 levels are significantly higher in cases versus controls and in high- versus low-risk patients. The receiver operating characteristic curve analysis shows that DJ-1 has a very good diagnostic accuracy in discriminating endometrial cancer patients versus controls and an excellent accuracy in distinguishing, among endometrial cancer patients, low- from high-risk cases. DJ-1 sensitivity and specificity are the highest when high- and low-risk patients are compared, reaching the value of 95% and 99%, respectively. Moreover, DJ-1 serum levels seem to be correlated with worsening of the endometrial cancer grade and histotype, making it a reliable tool in the preoperative decision-making process.
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Studies on alcohol intake in relation to endometrial cancer risk have produced inconsistent results. For a meta-analysis, we identified cohort studies of alcohol and endometrial cancer by a literature search of Pub-Med and Embase up to 1 March 2010 and by searching the reference lists of relevant articles. Seven cohort studies, including 1 511 661 participants and 6086 endometrial cancer cases, were included in the dose–response random-effect meta-regression model. Compared with non-drinkers, women drinking less than 1 drink of alcohol (13 g of ethanol) per day had a lower risk for endometrial cancer; this risk was lower by 4% (95% confidence interval (95% CI): 0.93–1.00) for consumption up to 0.5 drink per day and by 7% (95% CI: 0.85–1.02) for consumption up to 1 drink. However, we found evidence of an increased risk for endometrial cancer for intakes higher than two alcoholic drinks per day: compared with non-drinkers, the risk was higher by 14% (95% CI: 0.95–1.36) for 2–2.5 drinks per day and by 25% (95% CI: 0.98–1.58) for >2.5 drinks per day. Our meta-analysis indicates a possible J-shaped relationship between alcohol intake and endometrial cancer risk.
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Objective To detect the expression and role of PTTG mRNA in human colorectal cancer.Methods The expression of PTTG mRNA was evaluated in 12 normal colorectal tissues,20 colorectal adenoma tissues and 44 colorectal cancer tissues by RT-PCR.Results The expression of PTTG mRNA in colorectal cancer was significantly higher than that in colorectal adenoma and normal colorectal tissues.The PTTG mRNA expression in the Dukes C,D colorectal cancer was higher than that in the Dukes A,B cancer(P0.05).The expression in the colorectal cancer with lymph node metastasis was higher than that in the cancer without lymph node metastasis(P0.05).Conclusion The expression of PTTG mRNA increases in colorectal cancer,and is related with cell differentiation and metastasis.The abnormal expression of PTTG probably participates in genesis and development of colorectal cancers.
Colorectal adenoma
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Endometrial cancer is the most common gynecological cancer affecting post-menopausal women. It has been well documented that old age, estrogen overexposure, obesity and physical inactivity are major risk factors contributing to the development of endometrial cancer. Increased physical activity or exercise can alleviate disease- and treatment-related symptoms and improve quality of life of cancer patients during and after treatment. However, few studies have been focused the effects of physical exercise for patients that were treated for endometrial cancer. This paper aims to provide an over view of the course and treatment of endometrial cancer, cancer- and treatment-related symptoms, and the effects of physical exercise.
Physical exercise
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Endometrial cancer is the fifth most common cancer diagnosed in women in developed countries. This research used genetics to assess relationships between endometrial cancer and, previously identified and novel, risk factors. This work brings new insights by providing evidence that HDL and LDL cholesterol levels are linked to endometrial cancer risk. Further, I have shown that two gynaecological diseases, which are comorbid with endometrial cancer, also share genetic risk architecture with endometrial cancer. This work also advances the understanding of biological mechanisms of endometrial cancer by identifying candidate susceptibility genes.
Epidemiology of cancer
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Longitudinal Study
Framingham Heart Study
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Objective Diabetes mellitus is a common condition often associated with an ageing population. However, only few longitudinal studies in China have investigated the incidence of diabetes and identified its risk factors. Therefore, this study aimed to investigate the incidence and risk factors of diabetes in Chinese people aged ≥45 years using the harmonised China Health and Retirement Longitudinal Study (CHARLS) data. Design A dynamic cohort study. Setting The harmonised CHARLS 2011–2018. Participants 19 988 adults aged ≥45 years. Primary outcome measure Incident diabetes from 2011 to 2018. Results The harmonised CHARLS is a representative longitudinal survey of people aged ≥45 years. Using data extracted from the harmonised CHARLS, we calculated the incidence of diabetes and used a competing risk model to determine risk factors of diabetes. In 2011–2013, 2013–2015, 2015–2018, the crude incidence of diabetes among middle-aged and older people in China was 1403.21 (1227.09 to 1604.19), 1673.22 (1485.73 to 1883.92) and 3919.83 (3646.01 to 4213.30) per 100 000 person‐years, respectively, with a significant increasing trend. There were no geographical variations in the incidence of diabetes. Age, obesity and alcohol consumption were associated with an increased risk of incident diabetes. Conclusion The incidence of diabetes increased annually, without any geographical differences. Age, obesity and alcohol consumption were found to be risk factors for incident diabetes.
Longitudinal Study
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Key content Of the 20 most common tumour types, endometrial cancer has the strongest association with obesity. Endometrial cancer should be considered in young, obese women with irregular or heavy menstrual bleeding. To reduce the risk of postoperative complications, surgery for endometrial cancer should be performed using minimal access techniques whenever possible. For women who are unfit for, or who decline, surgery, alternative treatments include progestins or radiotherapy, but these have lower efficacy and are associated with a higher risk of disease relapse. Obesity is associated with reduced overall survival following endometrial cancer because of increased cardiovascular mortality; it may also affect disease‐specific survival. Learning objectives To further understanding of the mechanisms through which obesity drives endometrial carcinogenesis. To improve understanding of the potential difficulties associated with the management of endometrial cancer in obese women. To increase knowledge of alternative treatment options for women who are unfit for, or who decline, standard endometrial cancer management. Ethical issues The number of young, premenopausal women with endometrial cancer is increasing – how should these women be managed? Should super‐obese women with endometrial cancer only be treated in cancer centres? After treating a woman's endometrial cancer, how should she be counselled her about her weight and cardiovascular disease risk?
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