TY - JOUR
T1 - Does Clinical and Biochemical Thyroid Dysfunction Impact on Endometrial Cancer Survival Outcomes? A Prospective Database Study
AU - Barr, Chloe E.
AU - Njoku, Kelechi
AU - Hotchkies, Leo
AU - Ryan, Neil A. J.
AU - Wan, Y. Louise
AU - Davies, David A.
AU - Razvi, Salman
AU - Crosbie, Emma
PY - 2021/10/29
Y1 - 2021/10/29
N2 - Endometrial cancer is the commonest gynaecological malignancy in developed countries and women presenting with high risk or advanced disease have poor outcomes. Thyroid hormones play a key role in cellular metabolism and can influence cancer growth and invasion. Our aim was to evaluate the association between clinical and biochemical thyroid dysfunction and en-dometrial cancer survival outcomes. This was a prospective cohort study of women treated for endometrial cancer at a specialist centre. Clinical diagnosis of hypothyroidism was based on clinical and biochemical assessment, verified by general practitioner (GP) records. Pre-treatment serum samples were tested for thyrotropin (TSH), thyroid hormones (free T4 and total T3) and thyroid peroxidase antibodies. Kaplan-Meier survival estimates and log rank tests were used to compare survival between groups while Cox regression was used for multivariable analysis, ad-justing for known confounders and effect modifications.. In total, 333 women with a median age and body mass index (BMI) of 66 years (interquartile range (IQR) 56, 73) and 33kg/m2 (IQR 27, 41) respectively were included. Fifty-one (15.3%) women had a diagnosis of hypothyroidism, 39 (11.9%) had biochemical evidence of overt or subclinical hypothyroidism. Median follow-up was 35 months (IQR 21, 45) with 38 (11.7%) relapses and 50 (15.0%) deaths. Women with a diagnosis of hypothyroidism had improved overall survival (adjusted HR=0.22, 95%CI 0.06-0.74, p=0.02), cancer-specific survival (adjusted HR=0.21, 95%CI 0.05-0.98, p=0.04) and fewer recurrences (ad-justed HR=0.17, 95%CI 0.04-0.77, p=0.02) than those who did not. Confirmatory studies should explore underlying mechanisms and the potential for therapeutic exploitation.
AB - Endometrial cancer is the commonest gynaecological malignancy in developed countries and women presenting with high risk or advanced disease have poor outcomes. Thyroid hormones play a key role in cellular metabolism and can influence cancer growth and invasion. Our aim was to evaluate the association between clinical and biochemical thyroid dysfunction and en-dometrial cancer survival outcomes. This was a prospective cohort study of women treated for endometrial cancer at a specialist centre. Clinical diagnosis of hypothyroidism was based on clinical and biochemical assessment, verified by general practitioner (GP) records. Pre-treatment serum samples were tested for thyrotropin (TSH), thyroid hormones (free T4 and total T3) and thyroid peroxidase antibodies. Kaplan-Meier survival estimates and log rank tests were used to compare survival between groups while Cox regression was used for multivariable analysis, ad-justing for known confounders and effect modifications.. In total, 333 women with a median age and body mass index (BMI) of 66 years (interquartile range (IQR) 56, 73) and 33kg/m2 (IQR 27, 41) respectively were included. Fifty-one (15.3%) women had a diagnosis of hypothyroidism, 39 (11.9%) had biochemical evidence of overt or subclinical hypothyroidism. Median follow-up was 35 months (IQR 21, 45) with 38 (11.7%) relapses and 50 (15.0%) deaths. Women with a diagnosis of hypothyroidism had improved overall survival (adjusted HR=0.22, 95%CI 0.06-0.74, p=0.02), cancer-specific survival (adjusted HR=0.21, 95%CI 0.05-0.98, p=0.04) and fewer recurrences (ad-justed HR=0.17, 95%CI 0.04-0.77, p=0.02) than those who did not. Confirmatory studies should explore underlying mechanisms and the potential for therapeutic exploitation.
U2 - 10.3390/cancers13215444
DO - 10.3390/cancers13215444
M3 - Article
SN - 2072-6694
JO - Cancers
JF - Cancers
ER -
