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Cancer risk

RYGB linked to reduction in endometrial cancer risk

Endometrial adenocarcinoma
Small study appears to show endometrial pathology is mitigated by bypass surgery

Cancer-associated biomarkers were significantly reduced in obese women who were women who were at increased risk of endometrial cancer and who had a Roux en Y gastric bypass.

"Our data demonstrate that endometrial pathology appears to be partially mitigated by weight loss through bariatric surgery, which reduces the expression of cellular proliferation markers, inflammation, and hormone receptors, suggesting these pathways may be relevant in the pathogenesis of endometrial cancer," said Dr Faina Linkov, of the University of Pittsburgh.

The study, ‘Biomarker changes in the endometrium of morbidly obese women undergoing bariatric surgery: Implications for endometrial cancer risk reduction?’, which was presented at the American Association for Cancer Research meeting, Washington DC, was designed detect changes occurring in several biomarkers in the endometrium of asymptomatic morbidly obese women pre- and post- bariatric surgery, with the hypothesis that some of the premalignant changes may be normalised with weight loss.

The investigators obtained endometrial samples from obese women at the time of gastric bypass surgery and one year following the surgery. Both investigators and pathologists were blinded to the status of patients until the conclusion of the study.

All endometrial biopsies were subjected to immunohistochemical stains for hormone receptors, Estrogen (ER), Progesterone (PR) and Androgen (AR) along with stains for CD3, CD20, COX 2, and Ki-67 using standard immunohistochemistry protocols

Fifty nine women were enrolled and underwent an initial biopsy. The mean age was 42 (range 22-62) and the mean weight and BMI prior to surgery was 127kg (range 87-176) and 46.8 (range 36-64.3), respectively.

In total, four (6.8%) abnormal endometrial findings were identified, three simple and one complex hyperplasia all without atypia), in patients who had bariatric surgery.

The sign-rank test demonstrated marginally significant difference (p =0.0522) in H score for ER. Statistically significant difference has been observed between matched pre- and post-surgery levels of CD20 (p=0.0196).

Pre- and postop biopsy specimens showed all three women had complete resolution of abnormal pathology, two with 12 months and a third with 24 months).

However, the researchers acknowledge that the small sample size did not demonstrate significance for CD3, Cox2, and Ki-67. Nevertheless, the tendency towards decrease in the biomarker expression level has been observed for Ki67, and CD3.

“Morbidly obese women who present for bariatric surgery are at relatively high risk of harbouring a premalignant condition of the endometrium,” concluded the researchers. “We are the first group to demonstrate that trends for improvement in several cancer associated markers can be achieved with weight loss, especially for CD20 and ER.”

Co-authors of the study included Drs Robert Edwards, Marina L Komaroff, Esther Elishaev, Nika Gloyeske and Peter Argenta from the University of Pittsburgh and the University of Minnesota.

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