Impact of metabolic syndrome on the prognosis of endometrial cancer: A systematic review of evidence
Endometrial cancer (EC) stands out as the 7th most frequent malignancy among women around the globe and as the most common gynecologic cancer in the developed world. Metabolic syndrome (MetS), the silent epidemic of the Western World and a major risk factor for cardiovascular disease, has already been recognized as a contributor to the genesis of EC. In this review, we aimed to examine the respective influence of MetS on the prognosis of EC. A systematic literature research was conducted in PubMed, Embase and Web of Science databases up to August 19th, 2024. Observational studies (retrospective cohorts, prospective cohorts and case-control studies) were included. The endpoint of our systematic review was the impact of MetS on survival, recurrence, aggression, perioperative outcomes and generally the prognosis of EC. A total of 1139 studies were identified in our initial literature search. 272 duplicates were recognized and subtracted with 867 studies remaining for screening. Finally, 13 studies including 20.297 women with EC were included in our systematic review. In four studies, a worse overall survival (OS) had been reported in patients with MetS and EC compared to patients without MetS while in two studies the impact of MetS on the survival of patients with EC was found to be non-significant. A worse cancer-specific survival (CSS) in patients with MetS was reported in one study while MetS had an unfavorable impact on recurrence-free survival (RFS) in three studies. In terms of perioperative outcomes, the rates of outcomes pertinent to an increased morbidity were higher in patients with MetS while the same population suffered from a more aggressive disease compared to patients without MetS in three studies. The coexistence of MetS could be regarded as a worse prognostic factor for patients with EC based on our findings. Intervention on prevention and treatment of MetS should be pursued but further research is needed in the field.
