Surgical menopause and increased risk of nonalcoholic fatty liver disease in endometrial cancer

Abstract

Objective: Our objective was to examine risk factors associated with development of nonalcoholic fatty liver disease (NAFLD) among women with endometrial cancer who underwent surgical staging with or without oophorectomy.

Methods: This is a retrospective study that evaluated endometrial cancer cases that underwent surgical staging (n = 666) and endometrial hyperplasia cases that underwent hysterectomy-based treatment (n = 209). This study included 712 oophorectomy cases and 163 nonoophorectomy cases. Archived records were reviewed for participant demographics, medical comorbidities, operative notes, histology results, and radiology reports for NAFLD. Cumulative risks of NAFLD after surgical operation were correlated to demographics and medical comorbidities.

Results: The cumulative prevalence of NAFLD in 875 women with endometrial tumor was 14.1%, 20.5%, and 38.4% at 1, 2, and 5 years after surgical operation, respectively. On multivariate analysis, after controlling for age, ethnicity, body mass index, medical comorbidities, tumor type, hormonal treatment pattern, and oophorectomy status, age younger than 40 years (2-y cumulative prevalence, 26.6% vs 16.8%; hazard ratio [HR], 1.85; 95% CI, 1.27-2.71; P = 0.001) and age 40 to 49 years (2-y cumulative prevalence, 23.1% vs 16.8%; HR, 1.49; 95% CI, 1.08-2.04; P = 0.015) remained significant predictors for developing NAFLD after surgical operation compared with age 50 years or older. Oophorectomy was an independent predictor for increased risk of NAFLD (20.9% vs 15.9%; HR, 1.70; 95% CI, 1.01-2.86; P = 0.047). In addition, NAFLD was significantly associated with postoperative development of diabetes mellitus (39.2% vs 15.3%; HR, 2.26; 95% CI, 1.52-3.35; P < 0.0001) and hypercholesterolemia (34.3% vs 17.5%; HR, 1.71; 95% CI, 1.12-2.63; P = 0.014).

Conclusions: Oophorectomy in young women with endometrial cancer significantly increases the risk of NAFLD. This is associated with development of diabetes mellitus and hypercholesterolemia after oophorectomy.

FIG. 1.

Cumulative risk of nonalcoholic fatty liver disease in endometrial cancer (log-rank test for P values). Cumulative proportional risk of fatty liver disease after surgical operation for endometrial cancer: (A) age at surgical operation for endometrial cancer, (B) body mass index, (C) diabetes mellitus, and (D) hypercholesterolemia. $\overline{\text{p}}$ surg, after surgical operation; ā surg, before surgical operation.

FIG. 2.

Effects of oophorectomy on nonalcoholic fatty liver disease. Black line, oophorectomy cases; gray line, nonoophorectomy cases. Cumulative proportional risk of fatty liver disease after surgical operation for endometrial cancer or endometrial hyperplasia: (A) age younger than 40 years, (B) age 40 to 49 years, and (C) age 50 years or older. BSO, bilateral salpingo-oophorectomy.