The effects of body mass index on complications and survival outcomes in patients with cervical carcinoma undergoing curative chemoradiation therapy

Abstract

Background The effect of body mass index (BMI) on treatment outcomes for patients with locally advanced cervical carcinoma undergoing definitive chemoradiation is unclear. Methods This study cohort included all cervical carcinoma patients (n = 404) with stage IB1 and positive lymph nodes or stage ≥ IB2 treated at our facility from January 1998 to January 2008. Mean follow-up time was 47.2 months. BMI was calculated using the National Institute of Health online calculator. BMI categories were created according to the World Health Organization classification system. Primary outcomes were overall survival, disease free survival, and complication rate. Univariate and multivariate analyses were performed. Kaplan-Meier survival curves were generated and compared using Cox proportional hazard models. Results On multivariate analysis, when compared to normal weight subjects (18.5-24.9 kg/m2), a BMI < 18.5 kg/m2 was associated with decreased overall survival (HR 2.37, 95% CI 1.28 - 4.38, p<0.01). The 5-year overall survivals were 33%, 60%, and 68% for a BMI < 18.5 kg/m2, BMI 18.5-24.9 kg/m2, and a BMI > 24.9 kg/m2 respectively. A BMI < 18.5 kg/m2 was associated with increased risk for grade 3 or 4 complications when compared to patients with a BMI > 24.9 kg/m2 (radiation enteritis: 16.7% vs. 13.6 % p= 0.03, fistula: 11.1% vs. 8.8% p= 0.05, bowel obstruction 33.3% vs. 4.4% p< 0.001, lymphedema: 5.6% vs. 1.2% p=0.02). Conclusions Underweight patients (BMI < 18.5 kg/m2) with locally advanced cervical cancer have diminished overall survival and more complications than normal weight and obese patients.

Impact of being underweight on the long-term outcomes of patients with gastric cancer

“…These studies focused primarily on the prognostic value of being overweight or obese. On the other hand, recent studies have shown that being underweight is associated with a worse prognosis in various types of cancers, including colon cancer [10], hepatocellular carcinoma [11], nasopharyngeal carcinoma [12], breast cancer [13,14], cervical carcinoma [15], and urothelial carcinoma [16]. However, there is currently little information regarding the prognostic value in gastric cancer patients of being underweight [17].…”

Body mass index versus bladder and rectal doses using 2D planning for patients with carcinoma of the cervix undergoing HDR brachytherapy

“…The same is observed in our study, different rectal points RLS, RLI and RLP with correlation coefficients -0.34 (p = 0.150), -0.48 (p = 0.001) and -0.47 (p = 0.001) respectively, showing reduction in dose with increase in BMI. In contrast to this Kizer et al 17 showed patients with higher BMI to have lower rectal toxicities (compared to lower BMI) undergoing chemoradiation treatment. In another study Boyle et al 18 studied body mass index and dose to organ at risk during vaginal cuff brachytherapy with vaginal cylinders and concluded that women with higher BMI received lower bladder and small bowel dose compared to patients with lower BMI.…”

“…9 Several studies evaluated radiation induced toxicities to OARs i.e., bladder, rectum and bowel using dosimetric parameters. 10-12 Nora et al 13 studied effects of BMI on complications and survival outcomes in patients undergoing curative chemoradiotherapy for cervical carcinoma. Jihoon et al 14 studied dependence of rectal does on BMI of the patient underwent ICBT with the application of tandem and ring applicator.…”

Lack of any Prognostic Value of Body Mass Index for Patients Undergoing Chemoradiotherapy for Esophageal Squamous Cell Carcinoma

“…In a pooled analysis of eight population-based prospective cohorts studies in Japan, Matsuo et al (2012) found a significant positive association between BMI and colorectal cancer risk in female and stronger association in male, and Morrison et al (2013) found that Increasing BMI was associated with increased hazards of death from colorectal cancer. Kizer et al (2011) analyzed the outcome of 404 patients with locally advanced cervical carcinoma and showed that the 5-year OS rate was 33%, 60%, and 68% for a BMI <18.5 kg/m 2 , a BMI from 18.5 kg/m 2 to 24.9 kg/m 2 , and a BMI >24.9 kg/m 2 , respectively and underweight patients (BMI <18.5 kg/m 2 ) had diminished OS. Kaviani et al (2013) reported that obesity was associated with poorer survival in 646 patients with breast cancer.…”