The characteristics of each group with different body mass index for one-year weight management.

The characteristics of each group with different body mass index for one-year weight management.</p

A Prospective Study of Gynecological Cancer Risk in Relation to Adiposity Factors: Cumulative Incidence and Association with Plasma Adipokine Levels

<div><p>Background</p><p>Associations of obesity and obesity-related metabolic factors (adiposity factors) with uterine corpus cancer (UCC) and ovarian cancer (OVC) risk have been described. Still, a cause-effect relationship and the underlying mediators remain unclear, particularly for low-incidence populations. We aimed to prospectively determine whether adiposity factors could predict the development of UCC and OVC in Taiwanese women. To explore the biological mediators linking adiposity factors to cancer risk, we examined the association of two adipokines, leptin and adiponectin, with the gynecological cancers.</p><p>Methods</p><p>Totally, 11,258 women, aged 30–65, were recruited into the Community-Based Cancer Screening Program (CBCSP) study during 1991–1993, and were followed for UCC and OVC cases until December 31, 2011. Cox proportional hazard models were used to estimate hazard ratios (HRs). Adiposity factors and risk covariates were assessed at recruitment. Newly-developed cancer cases were determined from data in the government’s National Cancer Registry and Death Certification System. For adipokienes study, a nested case-control study was conducted within the cohort. Baseline plasma samples of 40 incident gynecological cancer cases and 240 age-menopause-matched controls were assayed for adipokines levels.</p><p>Findings</p><p>There were 38 and 30 incident cases of UCC and OVC, respectively, diagnosed during a median 19.9 years of follow-up. Multivariate analysis showed that alcohol intake (HR = 16.00, 95% = 4.83–53.00), high triglyceride levels (HR = 2.58, 95% = 1.28–5.17), and years of endogenous estrogen exposure per 5-year increment (HR = 1.91, 95% = 1.08–3.38) were associated with increased UCC risk. High body mass index (BMI≥27 kg/m², HR = 2.90, 95% = 1.30–6.46) was associated with increased OVC risk. Analysis further showed an independent effect of adipokines on UCC and OVC risk after adjustment of the risk covariates.</p><p>Conclusion</p><p>We provided evidence that alcohol intake, high triglyceride levels and long endogenous estrogen exposure increase UCC risk, whereas obesity positively predicts OVC risk. Circulating adipokines may mediate the link of adiposity factors to gynecological cancer risk.</p></div

Additional file 1 of Treatment benefit of upfront autologous stem cell transplantation for newly diagnosed multiple myeloma: a systematic review and meta-analysis

Additional file 1: Supplementary Table S1. Qualities of the RCT studies. Supplementary Table S2. Qualities of the observational studies. Supplementary Table S3. Main results of the observational studies before and after adjustment. Supplementary Table S4. Main results of the observational studies before and after transformation. Supplementary Table S5. Trim and fill method for adjustment of publication bias. Supplementary Figure S1. Forest plots of the meta-analysis comparing ASCT and No-ASCT, excluding the studies with a serious risk of bias or a specialized design. A. OR of CR (analysis 1) excluding the studies with a serious risk of bias; B. OR of CR (analysis 2) excluding the studies with a specialized design; C. OR of CR (analysis 3) excluding the studies with a serious risk of bias and a specialized design; D. HR of mortality for PFS; E: HR of mortality for OS. RCT, randomized controlled trial; ASCT, autologous stem-cell transplantation; CR, complete response; PFS, progression-free survival; OS, overall survival; OR, odds ratio; HR, hazard ratio; M-H, Mantel Haenszel method; IV, Inverse variance; SE, standard error; CI, confidence interval. Supplementary Figure S2. Contour funnel plots of trim and fill method. A: OR for CR; B: HR for PFS; C: HR for OS; CR, complete response; OR. odds ratio; HR, hazard ratio; PFS, progression-free survival; OS, overall survival; SE, standard error

Multivariate model of risk factors for gynecological cancer for the 11,258 study subjects, 1991–2011.

a<p>Hazard ratio (HR) and confidence interval (CI) were derived from Cox proportional hazard models using attained age during follow-up as the time axis and stratification of birth cohort in 5-year calendar periods.</p>b<p>PAF: population attributable fraction of total cases that would be reduced if a modifiable risk factor were eliminated from the study cohort. The formula for PAF estimation is presented in Methods section. N.A.: not applied.</p

Cumulative incidence of gynecological cancers on attained age during follow-up.

<p><b>A.</b> Patients of uterine corpus cancer (UCC, n = 38). <b>B.</b> Patients of ovarian cancer (OVC, n = 30). <b>C.</b> Patients of UCC for body mass index (BMI) ≥27 kg/m² (n = 8) and <27 kg/m² (n = 30). <b>D.</b> Patients of OVC for BMI≥27 kg/m² (n = 11) and <27 kg/m² (n = 18). One patient of ovarian cancer had missing data on BMI.</p

Odds ratio (OR) with 95% confidence interval (CI) of risk factors and plasma adipokine levels in the prediction of developing gynecological cancer.

a<p>Age effect was assessed as a continuous variable by year, and the risk associated with years of endogenous estrogen exposure was estimated by 5-year increment. The other variables were categorized as BMI (body mass index) ≥27 versus <27 kg/m² (reference), and triglycerides ≥150 versus <150 mg/dL (reference).</p>b<p>Tertile 1 as reference with OR = 1.00 for leptin and adiponectin variables.</p><p>*<i>p</i><0.05; **<i>p</i><0.01.</p

Multivariate linear regression analyses with circulating lipopolysaccharide-binding protein as the dependent variable.

Multivariate linear regression analyses with circulating lipopolysaccharide-binding protein as the dependent variable.</p

Incidences of uterine corpus cancer (UCC) and ovarian cancer (OVC) by age groups among 11,258 participants out of the CBCSP-HVP cohort, 1991–2011.

a<p>IR: incidence rate.</p

The serum levels of lipopolysaccharide-binding protein in each group with different body mass index before and after one-year weight management.

Abbreviations: BMI, body mass index; LBP, lipopolysaccharide-binding protein. *** Comparison of the LBP levels before and after weight management with paired t test, p-value t test, p-value <0.001.</p

Correlation and multivariate linear regression analysis between the change of lipopolysaccharide-binding protein concentration and the change of the indicated variables with one-year weight management.

Correlation and multivariate linear regression analysis between the change of lipopolysaccharide-binding protein concentration and the change of the indicated variables with one-year weight management.</p