Obesity and mortality among endometrial cancer survivors: A systematic review and meta‐analysis

Abstract

Summary Excess body fat is a major risk factor for endometrial cancer incidence, but its impact on recurrence and survival remains unclear. The aim of this systematic review and meta‐analysis was to assess the association between excess body fat with recurrence, cancer‐specific, and all‐cause mortality among endometrial cancer survivors. We searched MEDLINE and EMBASE databases up to July 2021. Risk of bias was assessed with the Ottawa Newcastle Scale. Random effects models estimated pooled hazard ratios for the main associations between body mass index (BMI) and survival outcomes and stratified by endometrial cancer type. Potential heterogeneity and publication bias were evaluated with sensitivity analyses, funnel plots, and Egger's test. Forty‐six studies were included, of which 45 estimated body fat with BMI and six used direct waist circumference measures or CT/MRI scans. Higher BMI (≥30 kg/m2) was associated with increased all‐cause mortality (HR = 1.34, 95%CI = 1.12–1.59) and recurrence (HR = 1.28, 95%CI = 1.06–1.56). In sub‐group analysis, associations between higher BMI and all‐cause mortality were observed for both Types I and II survivors, while recurrence associations were only significant among Type I cases. Obesity at endometrial cancer diagnosis was associated with increased cancer recurrence and all‐cause mortality among endometrial cancer survivors but not endometrial cancer‐specific mortality.

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

“…In particular, two large population-based studies have reported that increased BMI is strongly associated with cancer-specific mortality from endometrial cancer [ 35 , 36 ]. Notably, and consistently with our results, a recent meta-analysis showed that when assessing the prognostic role of obesity according to endometrial cancer subtypes, the association between higher BMI and recurrence was significant among type I cases alone [ 37 ]. We did not find any correlation between BMI and tumor grading; this could surely have been influenced by the fact that we assessed high-grade endometrioid tumors together with type II non-endometrioid tumors, since they have been shown to share similar prognosis [ 22 ].…”

Diet Quality and Dietary Inflammatory Index Score among Women’s Cancer Survivors

“…Nonetheless, obesity in endometrial cancer survivors is also associated with poorer quality of life, particularly regarding physical and social functioning [ 46 , 47 ]. These obesity-based results are consistent with the adiposity result in the meta-analyses [ 40 , 41 ] in that it is clear that individuals who are morbidly obese carry massive amounts of adipose tissue. Interestingly, there is a more well-established relationship between BMI and cancer recurrence for breast cancer patients.…”

“…Specifically, meta-analyses have uncovered associations between BMI status at endometrial cancer diagnosis and cancer recurrence and all-cause mortality [ 39 ]. While BMI was not associated with cancer-specific mortality in this study, a relationship was observed between visceral fat and cancer-specific mortality in two of the studies included in the meta-analysis [ 40 , 41 ]. This is extraordinarily important because the effect of obesity is mediated nearly exclusively by adipose tissue.…”

Prehabilitation to Improve Outcomes of Patients with Gynaecological Cancer: A New Window of Opportunity?

“…Currently, endometrial cancer patients are still more likely to die of cardiovascular disease than endometrial cancer [ 56 ]. Sustainable lifestyle changes could positively influence long-term survival and recurrence of cancer patients [ 57 , 58 ]. Therefore, it is clear that there is a need for future prospective randomised studies to assess the short-term and long-term impact of prehabilitation for gynaecological cancer patients.…”