Yukiharu Todo1, Kazuhira Okamoto2, Shinichiro Minobe2, Hidenori Kato2. 1. Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan yukiharu@sap-cc.go.jp. 2. Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
Abstract
OBJECTIVE: In patients with endometrial cancer, obesity is associated with a well-differentiated histological grade but not with prolonged survival. It is possible that this lack of survival advantage is caused by incomplete surgical staging. METHODS: In total, 716 patients with endometrial cancer were retrospectively reviewed. Obesity was defined as body mass index of ≥30 kg/m(2). The relationships between clinicopathological factors and disease-specific survival were analyzed by Cox regression analysis. RESULTS: Older age (hazard ratio, 1.6; 95% confidence interval, 1.1-2.4), advanced stage (hazard ratio, 11.2; 95% confidence interval, 7.2-17.5), high-risk histology (hazard ratio, 2.7; 95% confidence interval, 1.8-4.0), no hysterectomy (hazard ratio, 3.1; 95% confidence interval, 1.7-5.8) and no lymphadenectomy (hazard ratio, 2.0; 95% confidence interval, 1.3-3.0) were independently associated with poor disease-specific survival. Survival was similar in obese and non-obese women (hazard ratio, 0.9; 95% confidence interval, 0.5-1.6) despite the fact that obesity was significantly associated with younger age and a well-differentiated histological grade. Although there was no difference in the distribution of disease stage between the two groups, obesity was associated with lower rates of hysterectomy (3.6 vs. 6.1%, P = 0.23) and lymphadenectomy (25.0 vs. 36.4%, P = 0.017). Obese patients who underwent hysterectomy had a significantly better disease-specific survival than those who did not (P = 0.002). The 5-year disease-specific survival rate in obese patients who underwent lymphadenectomy was 6.2% better than that in those who did not [86.0 vs. 79.8%, P = 0.36 (not statistically significant)]. CONCLUSION: Poor-quality surgical staging in obese women may result in worse than expected survival outcomes.
OBJECTIVE: In patients with endometrial cancer, obesity is associated with a well-differentiated histological grade but not with prolonged survival. It is possible that this lack of survival advantage is caused by incomplete surgical staging. METHODS: In total, 716 patients with endometrial cancer were retrospectively reviewed. Obesity was defined as body mass index of ≥30 kg/m(2). The relationships between clinicopathological factors and disease-specific survival were analyzed by Cox regression analysis. RESULTS: Older age (hazard ratio, 1.6; 95% confidence interval, 1.1-2.4), advanced stage (hazard ratio, 11.2; 95% confidence interval, 7.2-17.5), high-risk histology (hazard ratio, 2.7; 95% confidence interval, 1.8-4.0), no hysterectomy (hazard ratio, 3.1; 95% confidence interval, 1.7-5.8) and no lymphadenectomy (hazard ratio, 2.0; 95% confidence interval, 1.3-3.0) were independently associated with poor disease-specific survival. Survival was similar in obese and non-obesewomen (hazard ratio, 0.9; 95% confidence interval, 0.5-1.6) despite the fact that obesity was significantly associated with younger age and a well-differentiated histological grade. Although there was no difference in the distribution of disease stage between the two groups, obesity was associated with lower rates of hysterectomy (3.6 vs. 6.1%, P = 0.23) and lymphadenectomy (25.0 vs. 36.4%, P = 0.017). Obesepatients who underwent hysterectomy had a significantly better disease-specific survival than those who did not (P = 0.002). The 5-year disease-specific survival rate in obesepatients who underwent lymphadenectomy was 6.2% better than that in those who did not [86.0 vs. 79.8%, P = 0.36 (not statistically significant)]. CONCLUSION: Poor-quality surgical staging in obesewomen may result in worse than expected survival outcomes.
Authors: Fausto Petrelli; Alessio Cortellini; Alice Indini; Gianluca Tomasello; Michele Ghidini; Olga Nigro; Massimiliano Salati; Lorenzo Dottorini; Alessandro Iaculli; Antonio Varricchio; Valentina Rampulla; Sandro Barni; Mary Cabiddu; Antonio Bossi; Antonio Ghidini; Alberto Zaniboni Journal: JAMA Netw Open Date: 2021-03-01