Relationship between abnormal p53 expression and high-risk histology in endometrial cancers and living in proximity to hog concentrated animal feeding operations in North Carolina

Objective

Prior research demonstrated a 2.27-fold increase in uterine cancer mortality among North Carolinians living near hog concentrated animal feeding operations (CAFOs). Endometrial cancer (EC) accounts for 90% of uterine cancer cases. Mutation and abnormal expression of the TP53 gene is a frequent causative alteration in aggressive forms ECs. We investigated whether increased proximity to hog CAFOs was associated with abnormal p53 expression, aggressive histologic subtypes, and increased mortality.

Methods

Patients with a pathologic diagnosis of EC were enrolled into the study between 2019 and 2024. Demographic and clinicopathologic data were abstracted from the electronic health record. Unadjusted survival was estimated with the Kaplan-Meier method with log-rank tests. Cox proportional hazards models were used to estimate associations between residing in a county classified as having CAFOs or no CAFOs, serous and carcinosarcoma EC subtypes, abnormal p53 expression, and survival.

Results

Of the 278 enrolled participants, the median age was 70.5 years, and 40.6 % resided in a CAFO county at the time of EC diagnosis. There was no association between abnormal p53 expression (46.9 % vs 51.5 %, p = 0.45), serous histology (27.4 % vs 35.2 %, p = 0.39), or carcinosarcoma subtype (12.4 % vs 10.3 %, p = 0.39) and residence in a CAFO vs non-CAFO county. Unadjusted overall survival rates were similar between those in counties with and without CAFOs (log-rank p = 0.62).

Conclusions

This study did not demonstrate an association between CAFO county status and abnormal p53 expression or aggressive histologic subtypes. Further studies are warranted to investigate the causes of previously established mortality differences in uterine cancer patients by CAFO proximity.