Association Between Metabolic Syndrome and Endometrial Cancer Survival in a SEER-Medicare Linked Database

Am J Clin Oncol. 2020 Jun;43(6):411-417. doi: 10.1097/COC.0000000000000686.


Background: Metabolic syndrome has previously been linked to increased risk of endometrial cancer. This study examines the association between metabolic syndrome and cancer-specific survival (CSS) in early stage and locoregionally advanced endometrial cancer.

Methods: The SEER-Medicare linked database was used to identify a cohort of patients with endometrial cancer between 1992 and 2011 who underwent hysterectomy. Patients with incomplete stage or grade information were excluded. Patients were stratified into early stage (stage I to II) or locoregionally advanced (stage III to IVa) disease. Metabolic syndrome status was determined through Medicare claims 1 year before diagnosis. The relationship between metabolic syndrome and CSS was evaluated using univariable and multivariable Cox proportional hazards regression analyses.

Results: A total of 10,090 patients with endometrial cancer were identified. The mean age was 75 and the majority (91.5%) were white. At diagnosis, 86.6% of patients were early stage and 13.4% were locoregionally advanced. Sixteen percent of patients had metabolic syndrome. On stage stratified multivariable analysis, race, income quartile, year of diagnosis, histopathology, and adjuvant treatment were associated with CSS in early stage disease. Presence of metabolic syndrome was associated with worse CSS in early stage disease (hazard ratio=1.28, 95% confidence interval: 1.09-1.53); this difference did not exist for locoregionally advanced disease (hazard ratio=1.18, 95% confidence interval: 0.93-1.49).

Conclusions: In elderly early stage endometrial cancer patients, metabolic syndrome is associated with worse CSS. Control of metabolic syndrome through lifestyle and pharmacologic therapies may improve cancer prognosis in this population.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Databases, Factual
  • Endometrial Neoplasms / complications*
  • Endometrial Neoplasms / mortality*
  • Endometrial Neoplasms / pathology
  • Female
  • Humans
  • Medicare
  • Metabolic Syndrome / complications*
  • Neoplasm Staging
  • SEER Program
  • Survival Rate
  • United States