Morbid Obesity as an Independent Risk Factor for Disease-Specific Mortality in Women With Cervical Cancer

Abstract

Objective To assess whether obesity is an independent predictor of mortality in women with cervical cancer. Methods This retrospective cohort study of patients with stages IB1-IVA cervical cancer treated with curative intent at MD Anderson Cancer Center from 1980 through 2007 categorized these women as underweight, normal weight, overweight, obese, or morbidly obese according to National Institutes of Health definitions. In addition to weight category, known prognostic factors for survival after a diagnosis of cervical cancer were included in a multivariate model. These known prognostic factors included age, smoking status, race or ethnicity (self-reported), socioeconomic status, comorbidities, tumor histologic subtype, tumor stage, tumor size, presence or absence of hydronephrosis, radiologic evidence of nodal metastasis, and the addition of concurrent chemotherapy with definitive radiation. Results A total of 3,086 patients met the inclusion criteria. The median survival for the entire cohort was 81 months (range, 0–365). The presence of lymph node spread and advancing stage were the most significant predictors of survival. Compared to normal-weight women, morbidly obese women had a significantly higher hazard ratio for both all-cause death (hazard ratio, 1.26; 95% CI, 1.10–1.45) and disease-specific death (hazard ratio, 1.24; 95% CI, 1.06–1.47). Underweight, overweight, and obese women did not have an increased risk for death compared to normal-weight women. Conclusions After controlling for all previously known prognostic factors, morbid obesity remains an independent risk factor for death from cervical cancer. Overweight and obese women have the same prognosis as normal-weight women.

Incidence of high body mass index in critically ill cancer patients

“…Recently, González et al (37) reported that ambulatory patients with cancer and sarcopenia (low rate of fat-free mass) have a higher risk of death. The few reports that include oncologic patients suggest that obesity is a factor to consider in the response to oncologic treatment, and in the progression and resolution of oncologic disease over the medium or long term (40)(41)(42). In our institution, there are no statistics regarding the incidence of overweight and obesity in oncologic patients.…”

Incidence of Lymph Node Metastases in Women With Low-Risk Early Cervical Cancer (<2 cm) Without Lymph-Vascular Invasion

“…26 In addition, a retrospective cohort study of 3086 women with cervical cancer observed that obesity was an independent prognostic factor for nodal metastasis and death. 29 A recent American Society of Clinical Oncology statement supports avoiding lymphadenectomy in patients with stage IB1 cervical cancer diagnosed in areas of low resources. 30 Our study supports this principle, and the results could argue for avoiding lymphadenectomy in these select patients in regions where surgical training in oncologic surgery may not be very concrete or where technical resources may not be optimal.…”

The Prognostic Impact of Type 2 Diabetes Mellitus on Early Cervical Cancer in Asia

“…Patients for whom surgery is contraindicated might exhibit unfavorable risk factors, such as poor performance or inadequate control of DM, which could imply unfavorable prognosis. A large retrospective study performed by MD Anderson Cancer Center revealed that obese cervical cancer patients were more likely to be treated with primary radiotherapy rather than surgery and had poorer survival compared with healthy-weight patients [32].They found that obesity is also an independent poor prognostic factor for cervical cancer patients. DM patients also tend to have obesity, and that potentially leads to inadequate treatment dose in several respects that could impair outcomes.…”