Kyle E. Freese

USA Endometrial Cancer Projections to 2030: should we be concerned?

AIM As the incidence of endometrial cancer (EC) increased considerably since 2007, this study aimed to project the burden of EC to the year 2030. METHODS Multivariate linear regression was used to project EC incidence by modeling trends in EC incidence from 1990 to 2013, while accounting for temporal changes in obesity, hysterectomy and smoking. RESULTS The best-fitting model predicting EC rates included a time effect plus effects for hysterectomy (12-year lag), severe obesity (3-year lag) and smoking (9-year lag). The best-fitting model projected an increase to 42.13 EC cases per 100,000 by the year 2030, a 55% increase over 2010 EC rates. CONCLUSION The projected increase of EC over next 16 years indicates the need for close monitoring of EC trends.

Endometrial histology in severely obese bariatric surgery candidates: an exploratory analysis

BACKGROUND Endometrial pathology risk has been linked to obesity; however, little is known of its prevalence in severely obese women not seeking care for endometrial pathology associated symptoms. This pilot study was designed to explore the frequency and risk factors associated with endometrial pathology in cancer-free, severely obese, bariatric surgery candidates using the Pipelle endometrial sampling technique (SureFlex Preferred Curette, Bioteque America, Inc, New Taipei City, Taiwan). METHODS Twenty-nine severely obese bariatric surgery candidates with intact uteruses and no history of endometrial cancer or endometrial ablation were included in this subanalysis from a larger cohort of 47. Endometrial samples were obtained using a Pipelle endometrial suction curette at a single time point before surgery. Logistic regression was used to assess the relationship between body mass index and endometrial pathology when adjusting for age and race. RESULTS Of the 29 successful biopsies, 8 (27.6%) were classified as abnormal endometrium: 1 was classified as complex atypical hyperplasia, 1 was classified as hyperplasia without atypia, 4 samples were identified with endometrial polyps, and 2 samples were identified with metaplasia. None presented with cancer. Increasing body mass index was significantly associated with higher risk of abnormal endometrium (OR = 1.19, 95% CI [1.03-1.36], P = .01). CONCLUSIONS The findings in this sample suggest that obesity may be associated with increased risk of having undiagnosed endometrial pathology. More thorough examination of relationships between levels of obesity and endometrial pathology are needed to better characterize high cancer risk groups who may benefit from introducing new screening measures.

The role of adipose-derived stem cells in endometrial cancer proliferation

Abstract Background. Obesity has been identified as a key risk factor for the development of endometrial cancer (EC), the most common gynecologic malignancy in the US. We hypothesized that adipose tissue from EC patients secretes higher levels of cancer-promoting factors than healthy adipose tissue and promotes tumor cell growth. Methods. In this study, we generated conditioned media from adipose-derived stem cells (ASCs), an important regenerative cell population within adipose tissue. ASCs were isolated from adipose tissue from two EC patients undergoing hysterectomies and four cancer free control patients undergoing elective abdominoplasties. Ishikawa cells were then cultured for 48 hours in ASC-conditioned media (ASC-CM). Study outcomes included cancer cell proliferation rates and angiogenic factor secretion from cancer cells. Results. Our results indicate that ASC-conditioned media significantly increased Ishikawa cell proliferation rate when compared to control Ishikawa culture conditions (p = 0.002). Though not significant, Ishikawa proliferation with conditioned media from EC ASCs was higher than proliferation in conditioned media from control ASCs. Additionally, we found that Ishikawa cells secreted almost 10 % more vascular endothelial growth factor (VEGF) when cultured in EC ASC-CM as compared to Ishikawa cells cultured in healthy (cancer free control) ASC-CM. These results indicate that ASC paracrine factors may positively increase cancer cell growth rate and potentially enhance tumor angiogenesis. Conclusions. Our findings support the hypothesis that adipose tissue is an important source of secreted factors, which increase the rate of EC cell growth. This study provided preliminary evidence that ASCs may be an important parameter to evaluate in relation to EC development.

An Exploratory Investigation of Links Between Changes in Adipokines and Quality of Life in Individuals Undergoing Weight loss Interventions: Possible Implications for Cancer Research

OBJECTIVE Obesity has been linked to a wide spectrum of malignancies, with the strongest association demonstrated for endometrial cancer. Although the mechanisms are not yet entirely clear, a number of risk biomarkers have been proposed, including altered adipokines. Systemic levels of these adipose derived molecules have also been linked in prior research to self-reported quality of life (QOL). The study objective was to examine the hypothesis that adipokine changes during intentional weight loss may be associated with changes in QOL. METHODS Fifty-two female participants were selected from two behavioral weight loss trials (SMART and PREFER) on the basis of achieving successful weight loss at 6month assessment, availability of blood samples and completion of standard SF-36 QOL questionnaires. Levels of adiponectin, leptin, and resistin were measured using xMAP immunoassays. Changes in QOL were examined using linear regression models in relation to pre- and post-intervention changes in biomarker levels and BMI. RESULTS Significant changes between pre- and post-intervention were observed for leptin. Controlling for baseline BMI, leptin was the only biomarker that predicted change in QOL (Physical Component Scale, PCS). Linear regression models demonstrated that leptin continued to be a significant predictor of change in PCS when other possible predictor variables were included in the model. CONCLUSIONS This study is among the first to demonstrate that changes in PCS may be regulated by levels of both metabolic variables and adipokines. An improved understanding of biological mechanisms associated with weight loss and the role of QOL may help guide preventive strategies for obesity-associated cancers.

Assessment of hot flushes and vaginal dryness among obese women undergoing bariatric surgery

ABSTRACT Objective Menopausal symptoms are associated with a negative impact on the quality of life, leading women to seek medical treatment. Obesity has been linked to higher levels of menopausal symptoms such as hot flushes. This assessment will explore whether the prevalence and bother of hot flushes and vaginal dryness change from pre- to post-bariatric surgery among obese midlife women. Methods This study is a longitudinal analysis of data from 69 women (ages 35–72 years) undergoing bariatric surgery with reported reproductive histories and menopausal symptoms at preoperative and 6-month postoperative visits. Prevalence of and degree of bother of hot flushes and vaginal dryness at pre- and post-surgery were compared using McNemar’s test and Wilcoxon signed-rank test. Results The reported degree of bother of symptoms associated with hot flushes decreased from pre- to post-surgery (p < 0.01). There was no significant change in the prevalence of hot flushes or vaginal dryness in the overall study sample. Conclusions The degree of bother of symptoms associated with hot flushes among midlife women may decrease after bariatric surgery. These results highlight important secondary gains, including less bothersome menopausal symptoms, for women who choose bariatric surgery for weight loss.

Obesity, lymphadenectomy and survival outcomes in intermediate to high-risk, early-stage endometrial cancer patients

AIM Lymphadenectomy or lymph node dissection is a topic of controversy in endometrial cancer (EC) treatment. MATERIALS & METHODS Associations between lymph node dissections and clinical factors were retrospectively examined in obese, endometrioid endometrial cancer patients with early-stage disease between 1995 and 2005. Overall, EC-specific and recurrence-free survival were also evaluated. RESULTS Out of 192 patients, 61 (32%) did not have a lymph node examination, 55 (29%) had less than ten lymph nodes removed and 76 (39%) had ≥10 removed. Lymph node dissection count was not significantly associated with overall, EC-specific or recurrence-free survival. CONCLUSION Analysis revealed no significant associations between ≥10 dissected lymph nodes and survival outcomes among obese, EC patients, which supports the need for additional investigation of the merit of lymphadenectomy among these patients.

The Central Asian Journal of Global Health to Increase Scientific Productivity

The WHO Collaborating Center at the University of Pittsburgh, USA partnering with Nazarbayev University, developed the Central Asian Journal of Global Health (CAJGH, cajgh.pitt.edu) in order to increase scientific productivity in Kazakhstan and Central Asia. Scientists in this region often have difficulty publishing in upper tier English language scientific journals due to language barriers, high publication fees, and a lack of access to mentoring services. CAJGH seeks to help scientists overcome these challenges by providing peer-reviewed publication free of change with English and research mentoring services available to selected authors. CAJGH began as a way to expand the Supercourse scientific network (www.pitt.edu/~super1) in the Central Asian region in order to rapidly disseminate educational materials. The network began with approximately 60 individuals in five Central Asian countries and has grown to over 1,300 in a few short years. The CAJGH website receives nearly 900 visits per month. The University of Pittsburgh’s “open access publishing system” was utilized to create CAJGH in 2012. There are two branches of the CAJGH editorial board: Astana (at the Center for Life Sciences, Nazarbayev University) and Pittsburgh (WHO Collaborating Center). Both are comprised of leading scientists and expert staff who work together throughout the review and publication process. Two complete issues have been published since 2012 and a third is now underway. Even though CAJGH is a new journal, the editorial board uses a rigorous review process; fewer than 50% of all submitted articles are forwarded to peer review or accepted for publication. Furthermore, in 2014, CAJGH will apply to be cross referenced in PubMed and Scopes. CAJGH is one of the first English language journals in the Central Asian region that reaches a large number of scientists. This journal fills a unique niche that will assist scientists in Kazakhstan and Central Asia publish their research findings and share their knowledge with others around the region and the world.

The Central Asian Supercourse to Increase Scientific Productivity

New articles in this journal are licensed under a Creative Commons Attribution 3.0 United States License. This site is published by the University Library System of the University of Pittsburgh as part of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.