title: The complex triad of obesity, diabetes and race in Type I and II endometrial cancers: prevalence and prognostic significance.
abstract: BACKGROUND
  We examined the distribution of obesity, diabetes, and race in Type I and Type II endometrial cancers (EC) and their associations with clinical outcomes.
  
  
  METHODS
  A multi-institutional retrospective analysis of Type I and II EC cases from January 2005 to December 2010 was conducted. Type I (endometrioid), Type II (serous and clear cell), low grade (LG) (grade 1 and 2 endometrioid), and high grade (HG) (grade 3 endometrioid, serous, clear cell) cohorts were compared. Univariate and multivariate analyses were used to determine time-to-recurrence (TTR), recurrence-free survival (RFS), and overall survival (OS).
  
  
  RESULTS
  Type I EC patients were more frequently obese than Type II (66% versus 51%, p<0.0001) and had similar rates of diabetes (25% versus 23%, p=0.69). African-Americans (AA) had higher median BMI than Caucasians in both Type I (p<0.001) and II (p<0.001) ECs, and were twice as likely to have diabetes (p<0.001). In Type I EC, DM was associated with worse RFS and OS in unadjusted and adjusted models (RFS HR 1.38, 95%CI 1.01-1.89; OS HR 1.86, 95%CI 1.30-2.67), but not with TTR. BMI was associated with improved TTR in the adjusted analysis for Type I EC (HR 0.98, 95%CI 0.95-1.0), but not with RFS or OS. There was no association between DM or BMI and outcomes in Type II or HG EC. AA race was not associated with RFS or OS on adjusted analyses in any group.
  
  
  CONCLUSIONS
  Obesity and diabetes are highly prevalent in Type I and II ECs, especially in AA. DM was associated with worse RFS and OS in Type I EC. Neither DM nor BMI was associated with outcomes in Type II or HG EC.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, USA; University of North Carolina Lineberger Comprehensive Cancer Center, USA. Electronic address: Emily.ko@uphs.upenn.edu.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Ko
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, USA.
authors.forename: Paige
authors.initials: P
authors.lastname: Walter
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Clark
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Jackson
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Franasiak
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, USA.
authors.forename: Corey
authors.initials: C
authors.lastname: Bolac
authors.affiliation: Division of Gynecologic Oncology, Duke Cancer Institute, Department of Obstetrics and Gynecology, Duke University Medical Center, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Havrilesky
authors.affiliation: Division of Gynecologic Oncology, Duke Cancer Institute, Department of Obstetrics and Gynecology, Duke University Medical Center, USA.
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, USA.
authors.forename: Dominic T
authors.initials: DT
authors.lastname: Moore
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, USA; University of North Carolina Lineberger Comprehensive Cancer Center, USA.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, USA; University of North Carolina Lineberger Comprehensive Cancer Center, USA.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Bae-Jump
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000208:ethnology* / Q000628:therapy; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D002277:Carcinoma / Q000208:ethnology / Q000473:pathology / Q000628:therapy; D018269:Carcinoma, Endometrioid / Q000208:ethnology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003920:Diabetes Mellitus / Q000208:ethnology*; D016889:Endometrial Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000628:therapy; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000208:ethnology*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data
keywords: Diabetes; Endometrial; Obesity; Race; Type I, II