by European Association for the Study of Obesity
New research to be presented at this coming week's European Congress on Obesity in Dublin, Ireland (May 17–20) and published in the Journal of the National Cancer Institute shows that both the metabolically healthy and unhealthy 'forms' of obesity are associated with an increased risk of various obesity-related cancers, with the relationship stronger in metabolically unhealthy obesity. The study is by Dr. Ming Sun, Lund University, Malmö, Sweden and colleagues.
Studies of how cancer is related to obesity with metabolic complications (commonly termed metabolically unhealthy obesity) or without such complications (healthy obesity) are scarce. In this new research, the authors investigated body mass index (BMI, normal weight/overweight/obesity) jointly and in interaction with metabolic health status in relation to obesity-related cancer risk (n=23,630) among 797,193 European individuals.
A metabolic score comprising blood pressure, plasma glucose and triglycerides (blood fats) was used to define metabolically healthy and unhealthy status, and statistical modeling was used to estimate any relationship.
The participants thus were put into six different categories—metabolically unhealthy obesity (6.8% of participants); metabolically healthy obesity (3.4%), metabolically unhealthy overweight (15.4%), metabolically health overweight (19.8%), metabolically unhealthy normal weight (12.5%), metabolically healthy normal weight (42.0%).
Metabolically unhealthy obesity, was, compared to metabolically healthy normal weight, associated with an increased relative risk of any obesity-related cancer and colon, rectal, pancreas, endometrial, liver, gallbladder, and renal cell cancer, with the highest risk estimates for endometrial, liver, and renal cell cancer (2.5 to 3.0 times increased risk).
In women, compared to metabolically healthy women of normal weight, metabolically unhealthy women with obesity had a 21% increased risk of colon cancer, a 3-times increased risk of endometrial cancer, and a 2.5 times increased risk of kidney cancer. Metabolically healthy women with obesity had a 2.4 times increased risk of endometrial cancer and an 80% increased risk of kidney cancer—but the relationship with colon cancer was no longer statistically significant.
In men, compared to metabolically healthy men of normal weight, metabolically unhealthy men with obesity had a 2.6 times increased risk of kidney cancer, an 85% increased risk of colon cancer, and a 32% increased risk of both pancreatic and rectal cancer. Metabolically healthy men with obesity had a 67% increased risk of kidney cancer, and a 42% increased risk of colon cancer, but the relationship with both pancreatic cancer and rectal cancer was no longer statistically significant. In an unusual finding, both metabolically healthy and unhealthy men with overweight (not obesity) had around a 50% increased risk of the blood cancer multiple myeloma—yet neither metabolically healthy or unhealthy men with obesity had an increased risk of this cancer.
The authors say that, among men only, the data suggest that obesity jointly with metabolic complications increases the risk of these obesity-related cancers more than expected from the sum of either risk factor individually. They say, "This has important public health implications, suggesting that a significant number of cancer cases could potentially be prevented by targeting the co-existence of metabolic problems and obesity, in particular for obesity-related cancers among men."
The authors conclude, "This study highlights that the type of metabolic obesity phenotype is important when assessing obesity-related cancer risk. In general, being metabolically unhealthy further increased the obesity-related cancer risk, suggesting that both obesity and metabolic conditions are useful targets for prevention for obesity-related cancers."
The material has been peer reviewed by the congress selection committee, and recently published in the Journal of the National Cancer Institute.
More information: The poster abstract P2.027 will be presented at the European Congress of Obesity (ECO 2023).
Ming Sun et al, Metabolically (un)healthy obesity and risk of obesity-related cancers: a pooled study, JNCI: Journal of the National Cancer Institute (2023). DOI: 10.1093/jnci/djad008
Journal information: Journal of the National Cancer Institute
Provided by European Association for the Study of Obesity
by International Association for the Study of Lung Cancer
A modified adenocarcinoma classification approach significantly enhances reproducibility and may be an improvement on the existing World Health Organization classification system, according to research unveiled at the International Association for the Study of Lung Cancer (IASLC) 2023 World Conference on Lung Cancer in Singapore.
The study, led by Dr. Erik Thunnissen, Department of Pathology, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands, was born out of the IASLC Pathology Committee's acknowledgment of challenges in accurately assigning invasion status based on the criteria outlined in the World Health Organization (WHO) classification of pulmonary adenocarcinomas. The objective was to establish a baseline and investigate the potential for an improved classification system, aided by biomarker analysis.
Dr. Thunnissen and colleagues conducted a case-control study involving resected adenocarcinomas measuring up to 3cm (n=70), the research evaluated the potential of a modified classification system. The modified classification factored in iatrogenic collapsed adenocarcinoma in situ, identified through elastin and cytokeratin 7 staining.
Pathologists initially assessed the cases according to the WHO criteria and then underwent a tutorial, after which they scored the cases based on the modified classification. A heatmap analysis was conducted to identify areas commonly or less frequently identified as invasive.
The study drew participation from 42 pathologists across 13 countries who scored the cases in three rounds. The kappa values for the three rounds were 0.27, 0.45, and 0.62, respectively. These results indicated that the standard WHO criteria for determining invasion faced challenges in achieving consistent and reproducible results.
However, the modified classification exhibited notably higher reproducibility. Pathologists displayed a more significant increase in competence, reflected by a higher kappa score, both when evaluated blindly (0.45) and with guidance (0.62). The outcomes suggested that the revised classification overcomes the limitations of the WHO criteria, thereby addressing concerns about inconsistent assessments.
Importantly, the research revealed that cases scored with "no-invasion" consensus in the second and third rounds achieved a 100% recurrence-free survival (RFS) rate. The diagnosis of adenocarcinoma in situ after resection with the modified classification implies that the patient is cured. In contrast, with the diagnosis of invasive adenocarcinoma in these cases based on the WHO classification, the patient has to bear the anxiety of a chance of recurrence.
Further bolstering the modified classification, biomarker analyses associated with invasion and poor outcomes were conducted. These analyses unveiled intriguing correlations, including a low proliferation rate in adenocarcinoma in situ compared to invasive adenocarcinomas and the presence of TP53 mutations in invasive adenocarcinomas, underscoring their role as late-stage events.
"Our findings suggest that the modified adenocarcinoma classification significantly enhances reproducibility and aligns better with the clinical reality. These results open new avenues for refining our understanding of these cancers and improving patient care," Dr. Thunnissen reported.
"These findings could enable a more confident diagnosis and treatment decisions for patients with pulmonary adenocarcinomas," he said.
Provided by International Association for the Study of Lung Cancer
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