Evaluation of socio-economic and immune factors related to endometrial cancer

Aneesh Chawla, Stacy Parr, Taylor Badger, Emily Dirks, Kathleen Groesch, Teresa Wilson, Paula Díaz‐Sylvester, Kristin Delfino, Sarah C. Nelson, J. Ricardo Loret de Mola, Laurent Brard, Andrea Braundmeier‐Fleming
In: North American Proceedings in Gynecology & Obstetrics · 2024 · vol. 3(2) · doi:10.54053/001c.93899 · W4391915868
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This study investigated the hypothesis that socio-economic factors correlate with altered immune profiles, specifically an elevated Th17:Treg ratio, and a subsequent higher stage or grade of endometrial cancer.

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This study evaluated relationships among endometrial cancer grade and stage, peripheral immune phenotypes (including the Th17:Treg ratio), BMI, and socio-economic factors (income, education, insurance status, rural vs urban residence as collected, and tobacco use) in women scheduled for surgery at a single U.S. institution, comparing women with biopsy-confirmed endometrial cancer to surgical controls. Using questionnaire data and FACS-based immune profiling of peripheral blood, the authors found no significant differences in EC stage or grade by income, education level, insurance type, or tobacco use. They observed a significant pro-inflammatory immune shift in EC patients, with higher Th17:Treg ratios versus controls, and also confirmed higher BMI in EC patients, while Th17:Treg ratios were not correlated with socio-economic variables, BMI, or tumor grade. Major limitations explicitly noted were the small sample size (58 total patients) and single-institution enrollment. Relevance to endometriosis: the paper does not explicitly discuss endometriosis; it was included in the corpus via keyword match in the upstream search index.

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Abstract

By Aneesh Chawla, Stacy Parr & 10 more. We hypothesized that socio-economic factors correlate with altered inflammatory profiles (elevated Th17:Treg ratio) and subsequent higher stage and/or grade of EC at the time of surgery.
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Methods

This study was approved by the local IRB under protocol #16-493. Women scheduled for surgery, with biop- sy confirmed EC or benign gynecologic conditions (controls), were enrolled within SIU School of Medicine, Department of Ob/Gyn, Division of Gynecologic Oncology. All eligible women who consented completed a questionnaire including socio-demographic data. Pathological analysis was performed at the time of surgery based on primary tumor samples and peripheral blood was collected to assess immune cell populations via FACS analysis. Wilcoxon rank sum test, Spearman coefficient and Cochran Armitage trend test were used for statistical analysis.

Results

Our data did not show any significant differences in EC stage or grade at time of surgery based on income, ed- ucation level, insurance type or tobacco use. We observed a significant immune shift toward a pro-inflammatory phenotype, as seen by the elevated Th17:Treg ratio, in peripheral blood from EC patients compared to control patients (3.50 ± 0.40 vs. 1.74 ± 0.32, respectively; P-value=0.031). Our data also confirmed significantly higher BMIs in EC patients compared to control subjects (P-value=0.003). We were not able to identify any correlations between the ratio of Th17:Treg and insur - ance status, tumor grade, BMI, income or education level. Evaluation of socio-economic and immune factors related to endometrial cancer

Abstract

1. Department of Obstetrics and Gynecology, SIU School of Medicine, Springfield, IL, USA 2. Center for Clinical Research, SIU School of Medicine, Springfield, IL, USA 3. Department of Medical Microbiology, Immunology and Cell Biology, SIU School of Medicine, Springfield, IL, USA 4. Simmons Cancer Institute, SIU School of Medicine, Springfield, IL, USA 34CAOG Conference Abstracts Special Issue Aneesh S. Chawla, MD , Stacy Paar, MD , Taylor Badger, BS , Emily Dirks, BS , Kathleen Groesch, MS , Teresa Wilson, BA , Paula Diaz-Sylvester, PhD , Kristin Delfino, PhD , Sarah Nelson, BS , J. Ricardo Loret de Mola, MD , Laurent Brard, MD, PhD , Andrea Braundmeier- Fleming, PhD 1 1,2 31 3 1,2 1,2,4 2 3 1,3 1,4 1,3,4 CAOG Conference Abstracts Special Issue North American Proceedings in Gynecology & Obstetrics Winter 2022

Conclusions

While our data failed to show any significant correlations between socio-economic status and inflam- matory phenotypes or EC stage/grade, one major limitation of our study is the small sample size (58 patients) and the fact that all subjects were enrolled at a single institution. Our data confirms previous studies indicating obesity is associated with EC and shows the presence of a pro-inflammatory phenotype in EC patients. More data are needed to further evaluate this phenotype and its impact on cancer progression. 35

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