Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma

A Gynecologic Oncology Group study

Authors

  • Vivian E. von Gruenigen MD,

    Corresponding author
    1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospitals of Cleveland, MacDonald Women's Hospital, and the Ireland Cancer Center, Cleveland, Ohio
    2. Department of Reproductive Biology, Case Western Reserve University, Cleveland, Ohio
    • Division of Gynecologic Oncology, University MacDonald Women's Hospital, 11100 Euclid Avenue, Room 7128, Cleveland, Ohio 44106
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    • Fax: (216) 844-8772

  • Chunqiao Tian MS,

    1. Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, New York
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  • Heidi Frasure MS,

    1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospitals of Cleveland, MacDonald Women's Hospital, and the Ireland Cancer Center, Cleveland, Ohio
    2. Department of Reproductive Biology, Case Western Reserve University, Cleveland, Ohio
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  • Steven Waggoner MD,

    1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospitals of Cleveland, MacDonald Women's Hospital, and the Ireland Cancer Center, Cleveland, Ohio
    2. Department of Reproductive Biology, Case Western Reserve University, Cleveland, Ohio
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  • Henry Keys MD,

    1. Department of Radiation Oncology, Albany Medical College, Albany, New York
    Current affiliation:
    1. 1 Foxcare Drive, Suite 310, Oneonta, New York 13820
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  • Richard R. Barakat MD

    1. Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • The following Gynecologic Oncology Group member institutions participated in the related treatment study: University of Alabama at Birmingham, Oregon Health Sciences University, Duke University Medical Center, Abington Memorial Hospital, University of Rochester Medical Center, Walter Reed Army Medical Center, University of Minnesota Medical School, University of Southern California Medical Center at Los Angeles, University of Mississippi Medical Center, Colorado Foundation for Medical Care, University of California Medical Center at Los Angeles, University of Washington Medical Center, University of Miami School of Medicine, Milton S. Hershey School of Medicine of the Pennsylvania State University, Georgetown University Hospital, University of Cincinnati College of Medicine, University of North Carolina School of Medicine, University of Iowa Hospitals and Clinics, University of Texas Health Science Center at Dallas, Indiana University School of Medicine, Bowman Gray School of Medicine of Wake Forest University, Albany Medical College of Union University, University of California Medical Center at Irvine, Tufts-New England Medical Center, Rush Presbyterian-St. Luke's Medical Center, State University of New York Downstate Medical Center, University of Kentucky, Eastern Virginia Medical School, Cleveland Clinic Foundation, Johns Hopkins Oncology Center, Pennsylvania Hospital, Washington University School of Medicine, Cooper Hospital/University Medical Center, Columbus Cancer Council, Fox Chase Cancer Center, Medical University of South Carolina, Women's Cancer Center, University of Oklahoma Health Science Center, University of Virginia Health Science Center, University of Chicago, and Tacoma General Hospital.

Abstract

BACKGROUND.

The objective was to examine whether rates of disease recurrence, treatment-related adverse effects, and survival differed between obese or morbidly obese and nonobese patients.

METHODS.

Data from patients who participated in a randomized trial of surgery with or without adjuvant radiation therapy were retrospectively reviewed.

RESULTS.

Body mass index (BMI) data were available for 380 patients, of whom 24% were overweight (BMI, 25–29.9), 41% were obese (BMI, 30–39.9), and 12% were morbidly obese (BMI, ≥40). BMI did not significantly differ based on age, performance status, histology, tumor grade, myometrial invasion, or lymphovascular-space involvement. BMI > 30 was more common in African Americans (73%) than non-African Americans (50%). Patients with a BMI ≥ 40 compared with BMI < 30 (hazards ratio [HR], 0.42; 95% confidence interval [CI], 0.09–1.84; P = .246) did not have lower recurrence rates. Compared with BMI < 30, there was no significant difference in survival in patients with BMI 30–39.9 (HR, 1.48; 95% CI, 0.82–2.70; P = .196); however, there was evidence for decreased survival in patients with BMI ≥ 40 (HR, 2.77; 95% CI, 1.21–6.36; P = .016). Unadjusted and adjusted BMI hazards ratios for African Americans versus non-African Americans in the current study differed, thus suggesting a confounding effect of BMI on race. Eight (67%) of 12 deaths among 45 morbidly obese patients were from noncancerous causes. For patients who received adjuvant radiation therapy, increased BMI was significantly associated with less gastrointestinal (R, −0.22; P = .003) and more cutaneous (R, 0.17; P = .019) toxicities.

RESULTS.

In the current study, obesity was associated with higher mortality from causes other than endometrial cancer but not disease recurrence. Increased BMI was also associated with more cutaneous and less gastrointestinal toxicity in patients who received adjuvant radiation therapy. Future recommendations include lifestyle intervention trials to improve survival in obese endometrial cancer patients. Cancer 2006. © 2006 American Cancer Society.

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