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Association of obesity with survival in patients with endometrial cancer☆
Anne Van Arsdale a, Devin T. Miller a, , Dennis Y. Kuo a, Sara Isani a, Lauren Sanchez b, Nicole S. Nevadunsky a,c
a Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States of America
b Albert Einstein College of Medicine, Bronx, NY, United States of America
c Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
• In women with endometrial cancer there are differences in histology and LY 379268 associated with obesity.
• Increased obesity is associated with younger age at endometrial cancer diagnosis.
• Obesity may have a protective effect on higher stage non-endometrioid endometrial cancer.
Background. Obesity confers an overall increased risk for development of endometrial cancer. However there are conflicting reports regarding the effect of obesity on patients' overall and disease specific survival. The pur-pose of this study was to evaluate the effect of obesity on survival in women with endometrial cancer.
Methods. After IRB approval, records of women with diagnosis and treatment of endometrial cancer from 1999 to 2016 were abstracted for histopathological, treatment and demographic data. Death was confirmed by query of the Social Security Death Index. Kaplan Meier survival curves and Cox regression modeling was per-formed with Stata version 14.0.
Results. Of 1732 evaluable patients, there were significant differences in age at diagnosis, histology (endometrioid versus non-endometrioid), stage, race, grade, hypertension, hyperlipidemia, diabetes, and treat-ment between normal weight, overweight, obese, and morbidly obese patients (p b 0.01). There was a linear as-sociation of younger age at diagnosis with increasing obesity (p b 0.01) R2 = 0.04. Younger age, endometrioid histology, lower stage, and statin use were independently associated with decreased hazard of death (p b 0.01). However, in stratified analysis of non-endometrioid histologies, patients with Stage 3 and 4 disease over the age of 65 showed a survival benefit for women associated with obesity (p = 0.02).
Conclusions. Obesity is associated with younger age at diagnosis and earlier stage disease. Obesity is associ-ated with improved disease specific survival for stage 3 and 4 non-endometrioid endometrial cancers. © 2019 Published by Elsevier Inc.
The association between obesity and development of endometrioid endometrial cancers has been well established, and there has been re-cent data suggesting that obesity is a risk factor for non-endometrioid endometrial cancers [1–3]. Up to 80% of endometrial cancer risk has been attributed to body mass index (BMI), physical activity and diet . In the general population of healthy women, disease specific
Corresponding author at: Montefiore Medical Center, Albert Einstein College of Medicine, Department of Obstetrics, Gynecology and Women's Health, 3332 Rochambeau Ave, Bronx, NY 10467, United States of America. E-mail address: [email protected] (D.T. Miller).
mortality from endometrial cancer has been reported as 6.25-fold higher (95% confidence interval (CI) 3.75–10.42) in the comparison of obese versus non-obese women with obesity defined as BMI ≥ 40 kg/m2 . The impact of obesity on mortality including disease spe-cific and overall survival, for endometrial cancer survivors is controversial.
The impact of morbid obesity on endometrial cancer survivors has been reported from several centers using different methodologies and with opposite conclusions. These conclusions include improved sur-vival, no association with survival and worsened survival associated with obesity depending on the population sampled, methodology of BMI comparison, and control for other variables. Obesity was described as conferring a favorable prognosis by prolonged progression free and overall survival by Anderson et al., and Munstedt et al. respectively [6,7]. Similarly, Mauland et al. and Jeong et al. found significantly better