Impact of obesity on secondary cytoreductive surgery and overall survival in women with recurrent ovarian cancer

Abstract

Objectives: To analyze the demographics and socioeconomic status of the morbidly obese ovarian cancer patients in the United States. Methods: Data were extracted on all ovarian cancer patients from the National Inpatient Survey in 2010. Morbidly obese women were identified using the ICD-9 diagnostic codes. Chi-square, t-test, and ANOVA tests were used in statistical analyses. Results: Among the 5401 ovarian cancer patients, the median age was 61 years (range, 18 to 101 years) and the majority were white (77%). Most of the women were insured by Medicare or a private insurance (41% and 46%, respectively); the remainder had Medicaid or were uninsured (9% and 5%, respectively). A total of 211 women (4%) were identified as being morbidly obese. Morbidly obese patients were younger than the non-morbidly obese (median 56 years vs 61 years, P b 0.01). Additionally, Native Americans, blacks, and Hispanics were more likely to be morbidly obese compared to whites and Asians (10%, 7%, and 4% vs 2% and 1%, respectively, P b 0.01). Morbidly obese patients were more likely to be insured by Medicaid than by a private insurance, Medicare, or were uninsured (7% vs 4%, 3%, and 2%, respectively, P b 0.01). Moreover, morbidly obese patients were more likely to have a lower income (5% vs 3%, P b 0.01). The morbidly obese had the same average length of stay as the non-morbidly obese (8 days vs 8 days, P = 0.26). There were no significant differences between the morbidly obese and non-morbidly obese based on hospital volume, region of the United States, and academic vs community institution. Conclusions: Morbidly obese ovarian cancer patients were more likely to be younger, of lower socioeconomic class, and have Medicaid insurance. Characterizing the morbidly obese patients with ovarian cancer may allow for focused preventive strategies and better allocation of resources to care for these vulnerable patients.Objectives: Obesity may negatively influence tumor biology in women with epithelial ovarian cancers. To date, only body mass index (BMI) determined at the time of diagnosis has correlated with clinical outcome. We hypothesized that obesity negatively affects survival throughout the disease course and sought to determine the prognostic role of BMI at the time of secondary cytoreductive surgery (SCS) for recurrent ovarian cancer.Methods: We performed a retrospective institutional review boardapproved review of patients undergoing SCS for recurrent epithelial ovarian or peritoneal cancer between 1997 and 2012. We abstracted data that included patient height, weight at SCS, age, and clinical outcome. Statistical analyses included Fisher's exact test, Kaplan-Meier survival, and Cox regression analysis. Results: We identified 104 patients; 2% were underweight (BMI b18.5), 45% were of ideal body weight (BMI ≥18.5 to b25), 30% were overweight (BMI ≥25 to b30), and 23% were obese (BMI ≥30). There were no differences in age or incidence of hypertension, diabetes, coronary artery disease, or venous thromboembolism among the BMI strata. Overall...

Predictive value of peritoneal cancer index for survival in patients with mucinous peritoneal malignancies treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience

“…Polanco et al [16] demonstrated no difference in perioperative mortality and overall survival, but an increased risk for perioperative renal and pulmonary complications for obese patients treated with CRS and HIPEC for mucinous appendiceal neoplasm. Our analysis confirmed increasing BMI as a negative predictor of overall survival, as shown by Tran et al [17] in women with recurrent ovarian cancer treated with CRS.…”

Obesity is not associated with increased morbidity in patients undergoing cytoreductive surgery with intraperitoneal chemotherapy

“…A recent large national cohort study of patients undergoing major surgery for cancer found no significant increase in morbidity in overweight or obese patients, and only a marginally increased morbidity in morbidly obese (BMI >35.0 km/m 2 ) patients compared to normal weight patients . While obesity may not be associated with increased complication rates for various surgeries, it may be associated with procedure dependent increases in specific complication patterns . The role of BMI in perioperative risk assessment appears more complex, with interplay of other factors such as functional status, concurrent pulmonary comorbidities, and metabolic syndrome potentially affecting post‐operative outcomes .…”

“…Prior studies evaluating the impact of obesity on morbidity following cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC), a procedure involving lengthy operative time and concomitant chemotherapy in patients with advanced malignancies, are largely limited to smaller single institutional series. Recent data have shown that, obesity does not appear to confer a significant increase in death or serious morbidity following CRS with HIPEC . Specific risk factors among obese patients have not been well characterized and complications following this procedure have been variably reported .…”

Obesity and gynecological cancers: A toxic relationship

“…We also demonstrated in two international cohorts (The Cancer Genome Atlas and Australian Ovarian Cancer Study) that HGSOC overexpressing obesity and lipid metabolism‐related genes have poorer oncologic outcomes 57 . Obesity also impacts on secondary cytoreductive surgery and overall survival in women with recurrent disease 68 . In relation to vulvar cancer, obesity was associated with a shorter time to recurrence in the AGO‐CaRE‐1 study and this was mainly attributed to a higher risk of local recurrence 69 …”