Examining the Effect of Hypertension, Type-2 Diabetes Mellitus, Hyperlipidemia, and Obesity on Endometrial Cancer Staging

OBJECTIVES: Uterine endometrial cancer (EC) is the most prevalent gynecologic malignancy in the U.S. and a significant cause of morbidity and mortality. This cross-sectional retrospective study aims to determine if there exists a relationship between common pre-existing conditions/comorbidities and EC progression.

METHODS: Premier Healthcare Database was used to identify women ≥18 years old, diagnosed with endometrial cancer (ICD-10: C54.1) between January 2016 and June 2019. Patients with a history of hysterectomy were excluded. ICD-10 codes categorized EC stages: I & II in the uterus, III involving nearby tissues and lymph nodes, and IV affecting distant sites (e.g., bladder and bowel). Descriptive sociodemographic characteristics, baseline Charlson Comorbidity Index (CCI), and total patient cost were evaluated. ICD-10, ICD-10-PCS, and CPT codes were used to identify pre-existing conditions and comorbidities of interest which included hypertension, type-2 diabetes mellitus (T2DM), hyperlipidemia, and obesity. Chi-squared tests and univariate analyses were conducted to determine the impact of these pre-existing conditions on EC stage progression.

RESULTS: A total of 9,615 participants were included in this study (mean ± SD age: 65±11.2). By stage, 5564(57.9%) of participants had Stage I and II EC, 1922(19.9%) with Stage III EC, and 2129(22.2%) with Stage IV EC. Hypertension [OR=1.35, 95% CI:(1.22-1.50), <0.01], type-2 diabetes mellitus [OR=1.96, 95% CI:(1.76-2.19), <0.01] and hyperlipidemia [OR=1.20, 95% CI:(1.08-1.34), <0.01] were all associated with increased risk for progression to Stage IV EC. Morbidly obese patients [OR=2.13, 95% CI:(1.15-3.94), <0.01], were also at increased risk of Stage IV EC progression as compared to overweight patients.

CONCLUSIONS: We found significant associations between pre-existing hypertension, T2DM, hyperlipidemia and morbid obesity with the progression to stage IV EC. The findings highlight the need for targeted screening and interventions for women with pre-existing conditions to reduce the risk of advanced-stage EC.