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Elevated preoperative hemoglobin A1c is associated with higher stage and grade of endometrial carcinoma

  • Teuku Mirza Iskandar ,


Introduction: The incidence of endometrial cancer (EC) and diabetes mellitus has been linked in many studies. EC patients had more severely impaired glucose tolerance than individuals with other malignancies. An indicator that determines glycemic index control is hemoglobin A1c (HbA1c). This study aimed to assess whether the preoperative level of HbA1c in diabetes mellitus patients is related to the stage and grade of endometrial carcinoma.

Methods: This cross-sectional study uses a retrospective observational analytic design. Diabetes mellitus patients diagnosed with EC and measured for HbA1c levels in Dr. Kariadi General Hospital Semarang from January 2018 to December 2021 were involved as the subjects of this study. The data was analyzed using correlation analysis and linear regression analysis. A value of p<0.05 was used to determine the statistical significance.

Results: This study involved 27 EC patients who had preoperative HbA1c data. The overall average HbA1c was 7.88±1.35 in the early-stage group and 10.85±1.15 in the advanced-stage group, significantly different between groups (p<0.001). There was also a significant difference between HbA1c in low-grade and high-grade tumors (p<0.001). With an increase of HbA1c in one unit value, the endometrial carcinoma stage also increases by 0.323 units or 32.3%, while the grade of endometrial carcinoma also increases by 0.275 units or 27.5%.

Conclusion: HbA1c level significantly correlates with both the stage and grade of EC. This study also found a linear relationship between increased HbA1c levels and higher stage and grade of EC, indicating that HbA1c levels influence the stage and grade of endometrial carcinoma.


  1. Zhang S, Gong T-T, Liu F-H, Jiang Y-T, Sun H, Ma X-X, et al. Global, Regional, and National Burden of Endometrial Cancer, 1990–2017: Results From the Global Burden of Disease Study, 2017. Front Oncol. 2019;9.
  2. Teuku Mirza Iskandar, Very Great Eka Putra, Ediwibowo Ambari, Endy Cahyono, Lubena. Clinicopathological characteristics and possible risk factors for extrauterine metastases in endometrial carcinoma. Bali Medical Journal. 2022;11(3):1410–4.
  3. Polednak AP. Trends in incidence rates for obesity-associated cancers in the US. Cancer Detect Prev. 2003;27(6):415–21.
  4. Bray F, Dos Santos Silva I, Moller H, Weiderpass E. Endometrial Cancer Incidence Trends in Europe: Underlying Determinants and Prospects for Prevention. Cancer Epidemiology, Biomarkers & Prevention. 2005;14(5):1132–42.
  5. Saed L, Varse F, Baradaran HR, Moradi Y, Khateri S, Friberg E, et al. The effect of diabetes on the risk of endometrial Cancer: An updated a systematic review and meta-analysis. BMC Cancer. 2019;19(1):1–10.
  6. Kim JJ, Kurita T, Bulun SE. Progesterone action in endometrial cancer, endometriosis, uterine fibroids, and breast cancer. Endocr Rev. 2013;34(1):130–62.
  7. Schmandt RE, Iglesias DA, Co NN, Lu KH. Understanding obesity and endometrial cancer risk: opportunities for prevention. Am J Obstet Gynecol. 2011;205(6):518–25.
  8. Wibowo ZK, Mudjanarko SW, Khairina K. The relationship between diabetes distress and HbA1C level in type 2 diabetes mellitus therapy patients: a systematic review. Bali Medical Journal. 2022;11(1):476–84.
  9. Limijadi EKS, Widyastiti NS, Hendrianingtyas M, Rachmawati B. Association of appetite hormone levels with HbA1c in obese type-2 diabetes mellitus patients. Bali Medical Journal. 2023;12(1):729–32.
  10. Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomark Insights. 2016;11:BMI-S38440.
  11. Byrne FL, Martin AR, Kosasih M, Caruana BT, Farrell R. The role of hyperglycemia in endometrial cancer pathogenesis. Cancers (Basel). 2020;12(5):1191.
  12. Lai Y, Sun C. Association of abnormal glucose metabolism and insulin resistance in patients with atypical and typical endometrial cancer. Oncol Lett. 2018;15(2):2173–8.
  13. Iavazzo C, McComiskey M, Datta M, Ryan M, Kiernan J, Winter-Roach B, et al. Preoperative HBA1c and risk of postoperative complications in patients with gynaecological cancer. Arch Gynecol Obstet. 2016;294:161–4.
  14. Mahdy H, Casey MJ, Crotzer D. Endometrial Cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Available from:
  15. Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, et al. Factors associated with Type I and Type II endometrial cancer. Cancer Causes & Control. 2010;21(11):1851–6.
  16. Karaman E, Karaman Y, Numanoglu C, Ark HC. Evaluation of hemoglobin A1c levels in endometrial cancer patients: a retrospective study in Turkey. Asian Pacific Journal of Cancer Prevention. 2015;16(5):1817–20.
  17. Li W, Zhang X, Sang H, Zhou Y, Shang C, Wang Y, et al. Effects of hyperglycemia on the progression of tumor diseases. Journal of Experimental & Clinical Cancer Research. 2019;38(1):1–7.
  18. Yin C, Qie S, Sang N. Carbon source metabolism and its regulation in cancer cells. Crit Rev Eukaryot Gene Expr. 2012;22(1).
  19. Kyo S, Nakayama K. Endometrial cancer as a metabolic disease with dysregulated PI3K signaling: Shedding light on novel therapeutic strategies. Int J Mol Sci. 2020;21(17):6073.
  20. Stevens EE, Yu S, Van Sise M, Pradhan TS, Lee V, Pearl ML, et al. Hemoglobin A1c and the relationship to stage and grade of endometrial cancer. Arch Gynecol Obstet. 2012;286:1507–12.
  21. Levran D, Modan M, Menczer J, Dulitzy M. Increased rate of glucose intolerance in endometrial cancer–a community-based study. Gynecol Obstet Invest. 1984;18(4):190–3.

How to Cite

Iskandar, T. M. (2023). Elevated preoperative hemoglobin A1c is associated with higher stage and grade of endometrial carcinoma. Bali Medical Journal, 12(3), 3061–3063.




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