Metabolic Syndrome as a Risk Factor of Endometrial Cancer: A Nationwide Population-Based Cohort Study of 2.8 Million Women in South Korea

HyunA Jo; Se Ik Kim; Wenyu Wang; Aeran Seol; Youngjin Han; Junhwan Kim; In Sil Park; Juwon Lee; Juhwan Yoo; Kyung-Do Han; Yong Sang Song

doi:10.3389/fonc.2022.872995

Metabolic Syndrome as a Risk Factor of Endometrial Cancer: A Nationwide Population-Based Cohort Study of 2.8 Million Women in South Korea

Front Oncol. 2022 Jun 16:12:872995. doi: 10.3389/fonc.2022.872995. eCollection 2022.

Authors

HyunA Jo^{1

2}, Se Ik Kim³, Wenyu Wang^{1

4}, Aeran Seol³, Youngjin Han^{1

2}, Junhwan Kim³, In Sil Park^{1

5}, Juwon Lee^{1

2}, Juhwan Yoo⁶, Kyung-Do Han⁷, Yong Sang Song^{1

2

3}

Affiliations

¹ Cancer Research Institute, College of Medicine, Seoul National University, Seoul, South Korea.
² World Class University (WCU) Biomodulation, Department of Agricultural Biotechnology, Seoul National University, Seoul, South Korea.
³ Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.
⁴ Interdisciplinary Program in Cancer Biology, Seoul National University, Seoul, South Korea.
⁵ Department of Agricultural Biotechnology, Seoul National University, Seoul, South Korea.
⁶ Department of Biomedicine & Health Science, The Catholic University of Korea, Seoul, South Korea.
⁷ Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea.

Abstract

Background: A positive relationship was reported between metabolic syndrome and the risk of endometrial cancer. Studies on the relationship between metabolic syndrome and endometrial cancer have been mainly conducted in post-menopausal women. We aimed to investigate the risk of endometrial cancer according to metabolic syndrome and menopausal status using the Korean nationwide population-based cohort.

Methods: We enrolled 2,824,107 adults (endometrial cancer group; N = 5,604 and control group; N= 2,818,503) from the Korean National Health Insurance Service checkup database from January 1 to December 31, 2009. The median follow-up duration was 8.37 years. Metabolic syndrome was diagnosed as having at least three of the following five components: abdominal obesity, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, raised blood pressure, and hyperglycemia. Multivariate Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) to estimate endometrial cancer risk.

Results: The endometrial cancer risk was higher in the metabolic syndrome group than that in the non-metabolic syndrome group (HR, 1.362; 95% CI, 1.281-1.449). The association between metabolic syndrome and endometrial cancer risk was significant in the premenopausal subgroup (HR, 1.543; 95% CI, 1.39-1.713) and postmenopausal subgroup (HR, 1.306; 95% CI, 1.213-1.407). The incidence of endometrial cancer was more closely related to metabolic syndrome components in the pre-menopausal subgroup than those in the post-menopausal subgroup (for waist circumference, blood pressure, triglycerides and high-density lipoprotein cholesterol, all p for interaction <0.0001 respectively, and for fasting blood glucose, p for interaction 0.0188). The incidence of endometrial cancer positively correlated with the number of metabolic syndrome components (log-rank p <0.0001).

Conclusion: Our large population-based cohort study in Korean women suggests that metabolic syndrome and its accumulated components may be risk factors for endometrial cancer, particularly in the pre-menopausal women.

Keywords: cohort; endometrial cancer; incidence; menopause; metabolic syndrome.