| OBJECTIVE:To analyze the relationship between preoperative serum androgens(including testosterone and androstenedione)and insulin levels in patients with endometrial carcinoma(EC)and to analyze the relationship between them and the risk of endometrial cancer.To explore whether high serum androgen and high serum insulin levels have synergistic effects on the occurrence of endometrial cancer.METHODS:Blood samples from 510 patients with endometrial cancer and 510 healthy controls from the General Hospital of Tianjin Medical University from August 19,2003 to November 4,2015 were collected.Serum testosterone levels and insulin levels were measured by chemiluminescence.Serum androstenedione levels were determined by radioimmunoassay.Statistical analysis was performed using the SPSS 18.0 software package.Nonparametric tests were used to compare the clinical features of the endometrial cancer group and the healthy control group.Conditional logistic regression analysis was used to detect the risk factors for endometrial cancer.Unconditional logistic regression analysis was used to analyze the relationship between serum androgen(testosterone,androstenedione)and insulin levels and the risk of endometrial cancer.The relationship between testosterone,androstenedione,insulin,and other potential risk factors and risk of endometrial cancer were assessed by odds ratio(OR)and 95%confidence interval(CI)results.To investigate whether serum high androgen and high insulin levels have a synergistic effect on the occurrence of endometrial cancer.RESULTS:1.Basic characteristics and laboratory datas:(1)Compared with healthy controls,the weight,waist circumference,abdominal circumference,hip circumference,body mass index(BMI)and waist-to-hip ratio(WHR)of patients with endometrial cancer were significantly increased,and the differences were statistically significant(all P<0.05).There was no significant difference in age,height and postmenopausal age between the two groups(all P>0.05).(2)The incidence of infertility,menstrual disorders,diabetes,hypertension,and family history of cancer in patients with endometrial cancer were significantly higher than those in healthy controls(all P<0.05).(3)Compared with healthy controls,the levels of androgens(including testosterone and androstenedione)were significantly higher in patients with endometrial cancer,and serum levels of sex hormone-binding globulin(SHBG)were significantly lower,with statistically significant differences(all P<0.05).(4)Compared with healthy controls,the levels of serum C-peptide,insulin,and HOMA-IR index were significantly higher in patients with endometrial cancer,and the differences were statistically significant(all P<0.05).(5)Compared with healthy controls,the serum estrone level in patients with endometrial cancer was significantly higher(P<0.05),the difference was statistically significant.There was no significant difference in serum estradiol level between the two groups(P>0.05).2.The univariate logistic regression analysis showed:(1)Serum androgens(including testosterone and androstenedione)levels were positively correlated with the risk of endometrial cancer(OR were 1.656,2.057;95%CI were 1.293-2.121,1.603-2.640,all P<0.05).Serum sex hormone-binding globulin(SHBG)level was negatively correlated with risk of endometrial cancer(OR=0.335;95%Cl,0.260-0.432;P<0.05).(2)Serum C-peptide,insulin levels were positively correlated with the risk of endometrial cancer(OR were 2.504,2.934;95%CI were 1.946-3.222,2.275-3.783,all P<0.05).(3)The serum estradiol level was positively correlated with the risk of endometrial cancer(OR = 2.041;95%Cl,1.590-2.619;P<0.05).(4)Body mass index(= 24 kg/m2),waist-to-hip ratio(= 0.85),diabetes mellitus,hypertension,infertility,menstrual disorders,and family history of cancer were all positively correlated with risk of endometrial cancer(OR were 2.411,3.894,5.820,3.033,2.562,5.244,2.144;95%CI were 1.854-3.136,2.871-5.282,3.875-8.741,2.316-3.973,1.479-4.438,2.930-9.315,1.584-2.901;all P<0.05).3.Multivariate logistic regression analysis showed:(1)Serum testosterone level was positively correlated with the risk of endometrial cancer(OR = 1.791;95%CI,0.260-0.432;P = 0.001).Serum sex hormone-binding globulin(SHBG)level was negatively correlated with the risk of endometrial cancer.(OR = 0.475;95%Cl,0.331-0.683;P<0.05).(2)Serum C-peptide level was positively correlated with the risk of endometrial cancer(OR = 4.004;95%Cl,2.686-5.969;P<0.05).(3)Diabetes mellitus,hypertension,infertility and menstrual disorders were all positively correlated with the risk of endometrial cancer(OR were 4.153,2.155,5.990,3.301;95%CI were 2.358-7.316,1.466-3.166,2.160-16.609,1.753-6.218,all P<0.05).4.Relationship between testosterone,androstenedione,and insulin levels with EC risk after stratification for BMI,WHR,diabetes,and hypertension:(1)The serum testosterone level was positively correlated with the risk of endometrial cancer in individuals with BMI ?24kg/m2,WHR ? 0.85,and no history of diabetes(OR were 1.885,2.058,1.722;95%CI were 1.375-2.585,1.530-2.766,1.308-2.266,respectively,all P<0.05),but there was no significant correlation in BMI<24 kg/m2,WHR<0.85 and diabetic women(all P>0.05).(2)Except for women with WHR<0.85(P=0.054),the serum androstenedione levels in all other risk factors were positively correlated with the risk of endometrial cancer(all P<0.05).(3)Except for women with diabetes mellitus(P=0.137),serum insulin levels were positively correlated with the risk of endometrial cancer in all other stratified risk factors(all P<0.05).5.Synergistic effect of serum androgens and insulin levels in endometrial cancer(1)The cut-off points for serum testosterone,androstenedione,and insulin in Overall premenopausal and postmenopausal women were 40.lOng/dL,39.02ng/dL,41.00ng/dL and 1.47ng/mL,1.75ng/mL,1.39 ng/mL,and 8.82mIU/mL,8.74mIU/mL 8.90mIU/mL,respectively.(2)In the total group of women,premenopausal women and postmenopausal women,serum testosterone levels were positively correlated with the risk of endometrial cancer(OR 1.656,1.851,1.520;95%CI were 1.293-2.121,1.194-2.870,1.126-2.051,all P<0.05).(3)In the total group of women and postmenopausal women,elevated levels of serum androstenedione were associated with the risk of endometrial cancer(OR were 2.057,2.765;95%CI were 1.603-2.640,2.032-3.761,respectively,all P<0.05),but there was no significant correlation in premenopausal women(OR= 1.375;95%CI,0.890-2.123;P>0.05).(4)In the total group of women,premenopausal women and postmenopausal women,serum insulin levels were positively correlated with the risk of endometrial cancer(OR were 2.934,4.280,2.414;95%CI were 2.275-3.783,2.695-6.796,1.779-3.277,all P<0.05).(5)In the total group of women,premenopausal women and postmenopausal women,the OR of the risk of endometrial cancer were higher in patients with elevated serum testosterone and insulin levels than those with either elevated testosterone level or elevated insulin level.(6)In the total group of women and postmenopausal women,the OR of the risk of endometrial cancer in serum androstenedione and insulin increased were higher than those with either elevated androstenedione level or elevated insulin level.There is no such difference in premenopausal women.CONCLUSION:1.Univariate analysis showed that the level of serum androgens(including testosterone and androstenedione)were positively correlated with the occurrence of endometrial cancer,suggesting that elevated level of serum androgens(including testosterone and androstenedione)are risk factors of endometrial cancer.Multivariate analysis showed that serum testosterone level was positively correlated with the occurrence of endometrial cancer,suggesting that elevated serum testosterone level is an independent risk factor for endometrial cancer.2.The results of univariate analysis showed that serum insulin level was positively correlated with the occurrence of endometrial cancer,suggesting that elevated serum insulin level is an risk factor for endometrial cancer.3.? In the total group of women,premenopausal women and postmenopausal women,the OR of the risk of endometrial cancer were higher in patients with elevated serum testosterone and insulin levels than those with either elevated testosterone level or elevated insulin level.?In the total group of women and postmenopausal women,the OR of the risk of endometrial cancer in serum androstenedione and insulin increased were higher than those with either elevated androstenedione level or elevated insulin level.The results suggest that serum high androgen and high insulin levels are synergistic risk factors for endometrial cancer. |
PDF Full Text Request