title: Surgical menopause and increased risk of nonalcoholic fatty liver disease in endometrial cancer.
abstract: OBJECTIVE
  Our objective was to examine risk factors associated with development of nonalcoholic fatty liver disease (NAFLD) among women with endometrial cancer who underwent surgical staging with or without oophorectomy.
  
  
  METHODS
  This is a retrospective study that evaluated endometrial cancer cases that underwent surgical staging (n = 666) and endometrial hyperplasia cases that underwent hysterectomy-based treatment (n = 209). This study included 712 oophorectomy cases and 163 nonoophorectomy cases. Archived records were reviewed for participant demographics, medical comorbidities, operative notes, histology results, and radiology reports for NAFLD. Cumulative risks of NAFLD after surgical operation were correlated to demographics and medical comorbidities.
  
  
  RESULTS
  The cumulative prevalence of NAFLD in 875 women with endometrial tumor was 14.1%, 20.5%, and 38.4% at 1, 2, and 5 years after surgical operation, respectively. On multivariate analysis, after controlling for age, ethnicity, body mass index, medical comorbidities, tumor type, hormonal treatment pattern, and oophorectomy status, age younger than 40 years (2-y cumulative prevalence, 26.6% vs 16.8%; hazard ratio [HR], 1.85; 95% CI, 1.27-2.71; P = 0.001) and age 40 to 49 years (2-y cumulative prevalence, 23.1% vs 16.8%; HR, 1.49; 95% CI, 1.08-2.04; P = 0.015) remained significant predictors for developing NAFLD after surgical operation compared with age 50 years or older. Oophorectomy was an independent predictor for increased risk of NAFLD (20.9% vs 15.9%; HR, 1.70; 95% CI, 1.01-2.86; P = 0.047). In addition, NAFLD was significantly associated with postoperative development of diabetes mellitus (39.2% vs 15.3%; HR, 2.26; 95% CI, 1.52-3.35; P < 0.0001) and hypercholesterolemia (34.3% vs 17.5%; HR, 1.71; 95% CI, 1.12-2.63; P = 0.014).
  
  
  CONCLUSIONS
  Oophorectomy in young women with endometrial cancer significantly increases the risk of NAFLD. This is associated with development of diabetes mellitus and hypercholesterolemia after oophorectomy.
authors.affiliation: 1Division of Gynecologic Oncology, University of Southern California, Los Angeles, CA 2Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 3Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 4Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan 5Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
authors.forename: Marc R
authors.initials: MR
authors.lastname: Gualtieri
authors.forename: Sigita S
authors.initials: SS
authors.lastname: Cahoon
authors.forename: Carrie E
authors.initials: CE
authors.lastname: Jung
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Paulson
authors.forename: Donna
authors.initials: D
authors.lastname: Shoupe
authors.forename: Laila I
authors.initials: LI
authors.lastname: Muderspach
authors.forename: Akihiko
authors.initials: A
authors.lastname: Wakatsuki
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Roman
mesh_terms: D018450:Disease Progression; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008594:Menopause, Premature; D065626:Non-alcoholic Fatty Liver Disease / Q000209:etiology*; D009765:Obesity / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors