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Rehabilitation effectiveness after radical surgical treatment of endometrial cancer

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2023.392

Abstract

Aim: to assess an effectiveness of medical rehabilitation after radical surgical treatment of endometrial cancer (EC).  

Materials and Methods. Post-surgery EC patients were stratified into two groups: the main group included 29 women who underwent the proposed program of complex "active" medical rehabilitation, the comparison group – 32 patients treated in accordance with the approved clinical guidelines. Body mass index (BMI), waist and hip measurements, atherogenic index, serum glucose, leptin, tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels were analyzed at week 1, as well as 3, 6 and 12 months later.  

Results. Significant inter-group differences were observed 6 and 12 months later during the follow-up. Starting from 6 months after EC surgical treatment, in the main group BMI decreased reaching 31.14, whereas in the comparison group, it increased up to 35.07 (p < 0.05). Differences in waist and hip measurements became significant by month 6 and 12, respectively, after the onset. The glucose level in the main and comparison group 6 months later was 6.16 ± 0.24 mmol/l and 6.16 ± 0.33 mmol/l, respectively; in the main group it decreased to the norm at month 12 comprising 5.09 ± 0.30 mmol/l, whereas in the comparison group it was higher than normal range reaching up to 5.87 ± 0.27 mmol/l (p < 0. 05). The decrease in the atherogenic index in the main vs. comparison group, which plateaued, became significant at month 6 and 12, respectively. A decrease in serum leptin, TNF-α and IL-6 level was found in the main group, but not in the comparison group.  

Conclusion. For the first time, a phenomenon of dynamically decreased level of serum pro-inflammatory markers was established during the complex "active" medical rehabilitation of women after radical surgical EC treatment. In addition to the previously verified improvement in the quality of life based on subjective questionnaires and scales, the effectiveness of the proposed medical rehabilitation program for such patients was confirmed by objective methods. This rehabilitation program can be recommended to all EC females in the recovery period after surgical treatment. 

About the Authors

D. V. Blinov
Sechenov University; Institute for Preventive and Social Medicine; Moscow Haass Medical – Social Institute
Russian Federation

Dmitry V. Blinov – MD, PhD, MBA, Assistant, Department of Sports Medicine and Medical Rehabilitation, Sklifosovsky Institute of Clinical Medicine; Head of Medical and Scientific Affairs; Associate Professor, Department of Sports, Physical and Rehabilitation Medicine

Scopus Author ID: 6701744871

Researcher ID: E-8906-2017

RSCI: 9779-8290

bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

4–10 Sadovaya-Triumfalnaya Str., Moscow 127006

5 bldg. 1–1a, 2-ya Brestskaya Str., Moscow 123056



A. G. Solopova
Sechenov University
Russian Federation

Antonina G. Solopova – MD, Dr Sci Med, Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health

Scopus Author ID: 6505479504.

Researcher ID: Q-1385-2015

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991



E. E. Achkasov
Sechenov University
Russian Federation

Evgeniy E. Achkasov – MD, Dr Sci Med, Professor, Head of the Department of Sports Medicine and Rehabilitation, Sklifosovsky Institute of Clinical Medicine, Director of the Clinic for Medical Rehabilitation

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991



L. N. Sandzhieva
Sechenov University
Russian Federation

Lidiya N. Sandzhieva – MD, Postgraduate Student, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health,

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991



D. I. Korabelnikov
Moscow Haass Medical – Social Institute
Russian Federation

Daniil I. Korabelnikov – MD, PhD, Professor , Department of Internal Medicine with Courses in Family Medicine, Functional Diagnostics, Infectious Diseases, Rector

5 bldg. 1–1a, 2-ya Brestskaya Str., Moscow 123056



G. K. Bykovshchenko
Sechenov University
Russian Federation

Georgy K. Bykovshchenko – 6th year Student

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991



D. A. Petrenko
Sechenov University
Russian Federation

Daria A. Petrenko – MD, Clinical Resident, Department of Clinical Pharmacology and Propaedeutics of Internal Diseases

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991



References

1. American Cancer Society. Key Statistics for Endometrial Cancer. Available at: https://www.cancer.org/cancer/endometrial-cancer/about/ key-statistics.html. [Accessed: 10.10.2022].

2. Dalmartello M., Vermunt J., Negri E. et al. Adult lifetime body mass index trajectories and endometrial cancer risk. BJOG. 2022;129(9):1521–9. https://doi.org/10.1111/1471-0528.17087.

3. Pérez-Martín A.R., Castro-Eguiluz D., Cetina-Pérez L. et al. Impact of metabolic syndrome on the risk of endometrial cancer and the role of lifestyle in prevention. Bosn J Basic Med Sci. 2022;22(4):499–510. https://doi.org/10.17305/bjbms.2021.6963.

4. International Agency for Research on Cancer (IARC). GLOBOCAN 2020: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2020. Available at: https://gco.iarc.fr/today/data/factsheets/cancers/24-uterine-cancer-fact-sheet.pdf. [Accessed: 10.10.2022].

5. Korsakov A.V. Kryukova A.E., Troshin V.P. et al. Cervical and endometrial cancer Incidence in the female population from the Bryansk region living in conditions of chemical, radioactive and combined environmental contamination (2000–2020). Life (Basel). 2022;12(10):1488. https://doi. org/10.3390/life12101488.

6. The state of oncological care for the Russian population in 2021. Eds. A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova. [Costoyanie onkologicheskoj pomoshchi naseleniyu Rossii v 2021 godu. Pod red. A.D. Kaprina, V.V. Starinskogo, A.O. Shahzadovoj. Moscow: Hertsen Moscow Oncology Research Center – Branch of National Medical Research Radiological Centre, 2022. 239 p. (In Russ.).

7. Sung H., Ferlay J., Siegel R.L., Laversanne M. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660.

8. Kong T.W., Chang S.J., Paek J. et al. Comparison of survival outcomes between surgical and non-surgical management of patients with earlystage endometrial cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23(4):1247–55. https://doi.org/10.1245/s10434- 015-4981-7.

9. Shikama A., Minaguchi T., Takao W. et al. Predictors of favorable survival after secondary cytoreductive surgery for recurrent endometrial cancer. Int J Clin Oncol. 2019;24(10):1256–63. https://doi. org/10.1007/s10147-019-01469-z.

10. Koutras A., Peteinaris A., Davakis S. et al. Surgical versus conservative treatment for endometrial cancer in women of reproductive age: incidence of urinary tract symptoms. Anticancer Res. 2020;40(6):3065– 9. https://doi.org/10.21873/anticanres.14287.

11. Restaino S., Giorgia Dinoi G., La Fera E. et al. Recurrent endometrial cancer: which is the best treatment? Systematic review of the literature. Cancers (Basel). 2022;14(17):4176. https://doi.org/10.3390/ cancers14174176.

12. Concin N., Matias-Guiu X., Vergote I. et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021;31(1):12–39. https://doi.org/10.1136/ijgc-2020-002230.

13. Clinical guidelines. Cancer of uterus body and uterine sarcomas. [Klinicheskie rekomendacii. Rak tela matki i sarkomy matki]. Moscow: Ministerstvo zdravoohraneniya Rossijskoj Federacii, 2021. Available at: https://cr.minzdrav.gov.ru/recomend/460_3. [Accessed: 10.10.2022].

14. Clinical guidelines. Cancer of uterus body and uterine sarcomas. [Klinicheskie rekomendacii. Rak tela matki i sarkomy matki]. Moscow: Ministerstvo zdravoohraneniya Rossijskoj Federacii, 2020. 64 p. Available at: https://old.oncology-association.ru/files/clinical-guidelines-2020/rak_tela_matki_i_sarkomy_matki.pdf. [Accessed: 10.10.2022].

15. Sandzhieva L.N., Solopova A.G., Blinov D.V. et al. Comparatively analyzed quality of life in patients with atypical endometrial hyperplasia and endometrial cancer during various rehabilitation activities. [Sravnitel'nyj analiz kachestva zhizni u pacientok s atipicheskoj giperplaziej i rakom endometriya pri razlichnyh reabilitacionnyh meropriyatiyah]. Obstetrics, Gynecology and Reproduction. 2022;16(4):410–25. (In Russ.). https://doi.org/10.17749/2313-7347/ ob.gyn.rep.2022.344.

16. Sandzhieva L.N., Solopova A.G., Blinov D.V. et al. Personalized comprehensive rehabilitation program after surgical treatment of endometrial cancer: results of a prospective randomized comparative study. [Personificirovannaya programma kompleksnoj reabilitacii posle hirurgicheskogo lecheniya raka endometriya: rezul'taty prospektivnogo randomizirovannogo sravnitel'nogo issledovaniya]. Obstetrics, Gynecology and Reproduction. 2022;16(2):143–57. (In Russ.). https://doi.org/10.17749/2313-7347/ob.gyn.rep.2022.31.

17. Solopova A.G., Blinov D.V., Begovich E. et al. Neurological disorders after hysterectomy: from pathogenesis to clinical manifestations. [Nevrologicheskie rasstrojstva posle gisterektomii: ot patogeneza k klinike]. Epilepsy and paroxysmal conditions. 2022;14(1):54–64. (In Russ.). https://doi.org/10.17749/2077-8333/epi.par.con.2022.115.

18. Solopova A.G., Blinov D.V., Demyanov S.V. et al. Epigenetic aspects in rehabilitation of female cancer patients. [Epigeneticheskie aspekty reabilitacii onkoginekologicheskih bol'nyh]. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2022;15(2):294–303. (In Russ.). https://doi.org/10.17749/2070-4909/ farmakoekonomika.2022.141.

19. Blinov D.V., Solopova A.G., Plutnitskiy A.N. et al. Strengthening health care to provide rehabilitation services for women with cancer diseases of the reproductive system. [Organizaciya zdravoohraneniya v sfere reabilitacii pacientok s onkologicheskimi zabolevaniyami reproduktivnoj sistemy]. Modern Pharmacoeconomics and Pharmacoepidemiology. 2022;15(1):119–30. (In Russ.). https://doi.org/10.17749/2070-4909/ farmakoekonomika.2022.132.

20. Blinov D.V., Solopova A.G., Sandzhieva L.N. et al. Strengthening medical rehabilitation services in health system: a situation analysis. [Sovershenstvovanie organizacii medicinskoj reabilitacii v sisteme zdravoohraneniya: analiz situacii]. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2022;15(2):237–49. (In Russ.). https://doi.org/10.17749/2070-4909/ farmakoekonomika.2022.140.

21. Haggerty A.F., Sarwer D.B., Schmitz K.H. et al. Obesity and endometrial cancer: a lack of knowledge but opportunity for intervention. Nutr Cancer. 2017;69(7):990–5. https://doi.org/10.1080/01635581.2017.13 59313.

22. Simpson A.N., Feigenberg T., Clarke B.A. et al. Fertility sparing treatment of complex atypical hyperplasia and low grade endometrial cancer using oral progestin. Gynecol Oncol. 2014;133(2):229–33. https://doi.org/10.1016/j.ygyno.2014.02.020.

23. Schover L.R., van der Kaaij M., van Dorst E. et al. Sexual dysfunction and infertility as late effects of cancer treatment. EJC Suppl. 2014;12(1):41–53. https://doi.org/10.1016/j.ejcsup.2014.03.004.

24. Koskas M., Uzan J., Luton D. et al. Prognostic factors of oncologic and reproductive outcomes in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and metaanalysis. Fertil Steril. 2014;101(3):785–94.e3. https://doi.org/10.1016/j.fertnstert.2013.11.028.

25. Nagle C.M., Crosbie E.J., Brand A. et al. The association between diabetes, comorbidities, body mass index and all-cause and causespecific mortality among women with endometrial cancer. Gynecol Oncol. 2018;150(1):99–105. https://doi.org/10.1016/j. ygyno.2018.04.006.

26. Rahmanian E., Salari N., Mohammadi M., Jalali R. Evaluation of sexual dysfunction and female sexual dysfunction indicators in women with type 2 diabetes: a systematic review and meta-analysis. Diabetol Metab Syndr. 2019;11:73. https://doi.org/10.1186/s13098- 019-0469-z.

27. Luo Y.Z., Yang Z., Qiu Y.L. et al. Pretreatment triglycerides-to-high density lipoprotein cholesterol ratio in postmenopausal women with endometrial cancer. Kaohsiung J Med Sci. 2019;35(5):303–9. https://doi.org/10.1002/kjm2.12033.

28. Seth D., Garmo H., Wigertz A. et al. Lipid profiles and the risk of endometrial cancer in the Swedish AMORIS study. Int J Mol Epidemiol Genet. 2012;3(2):122–33.

29. Madeddu C., Sanna E., Gramignano G. et al. Correlation of leptin, proinflammatory cytokines and oxidative stress with tumor size and disease stage of endometrioid (type I) endometrial cancer and review of the underlying mechanisms. Cancers (Basel). 2022;14(2):268. https://doi.org/10.3390/cancers14020268.

30. Alexander C., Cochran C.J., Gallicchio L. et al. Serum leptin levels, hormone levels, and hot flashes in midlife women. Fertil Steril. 2010;94(3):1037–43. https://doi.org/10.1016/j.fertnstert.2009.04.001.

31. Ding S., Madu C.O., Lu. Y. The impact of hormonal imbalances associated with obesity on the incidence of endometrial cancer in postmenopausal women. J Cancer. 2020;11(18):5456–65. https://doi.org/10.7150/jca.47580.


Review

For citations:


Blinov D.V., Solopova A.G., Achkasov E.E., Sandzhieva L.N., Korabelnikov D.I., Bykovshchenko G.K., Petrenko D.A. Rehabilitation effectiveness after radical surgical treatment of endometrial cancer. Obstetrics, Gynecology and Reproduction. 2023;17(1):33-43. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2023.392

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ISSN 2313-7347 (Print)
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