Impact of body mass index on ovarian cancer survival varies by stage.
Impact of body mass index on ovarian cancer survival varies by stage.
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DOI：
10.1038/bjc.2017.162
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发表时间：
2017-07-11
影响因子：
8.8
通讯作者：
Kushi LH
中科院分区：
文献类型：
--
作者：
Bandera EV;Lee VS;Qin B;Rodriguez-Rodriguez L;Powell CB;Kushi LH
关于体重指数（BMI）对卵巢癌生存影响的研究并不一致，但之前的研究没有考虑腹水、肠梗阻或恶病质可能产生的影响，而这些通常发生在晚期疾病中。我们在一项针对 2000 年至 2013 年北加州 Kaiser Permanente (KPNC) 诊断的原发性浸润性上皮性卵巢癌 (n=1184) 的队列研究中，评估了诊断前和诊断前后 BMI 与总体生存率和疾病特异性生存率之间的关联。截至 2014 年 12 月，中位随访时间为 37 个月。比例风险回归用于估计总体死亡率和卵巢癌特异性死亡率，考虑预后变量，包括诊断时的年龄、种族、分期、分级、组织学、合并症、治疗、治疗后 CA125 水平、腹水和肠梗阻。没有证据表明 BMI 与总体生存率或卵巢癌特异性生存率之间存在关联。然而，我们发现阶段性修改效果很强（Pinteraction<0.01）。与诊断前正常 BMI (18.5–24.9 kg m−2) 相比，对于诊断前肥胖 (BMI⩾35 kg m−2) 的女性，I/II 期诊断的卵巢癌特异性生存率较低（风险比 (HR)：3.40；95% 置信区间 (CI)：1.16–9.99），但诊断为 IV 期疾病的女性卵巢癌特异性生存率较高（人力资源： 0.58； 95% CI：0.35–0.96）。排除那些诊断为恶病质的患者（n = 82）并进一步调整腹水和肠梗阻后，相关性减弱，没有证据表明这些因素的影响发生改变。肥胖与卵巢癌生存的关系可能因阶段而异，局部疾病患者的生存率降低，而晚期疾病患者的生存率增加。肥胖对生存的特定阶段影响表明，改善预后的定制方法可能是合适的。
Research on the effect of body mass index (BMI) on ovarian cancer survival is inconsistent, but previous studies did not consider the possible impact of ascites, bowel obstruction, or cachexia, which commonly occur in late-stage disease. We evaluated the association of BMI, before and around the time of diagnosis, with overall and disease-specific survival in a cohort study of primary invasive epithelial ovarian cancers diagnosed from 2000 to 2013 in Kaiser Permanente Northern California (KPNC) (n=1184). Deaths were identified through December 2014, with a median follow-up of 37 months. Proportional hazards regression was used to estimate overall and ovarian cancer-specific mortality, accounting for prognostic variables including age at diagnosis, race, stage, grade, histology, comorbidities, treatment, post-treatment CA125 levels, ascites, and bowel obstruction. There was no evidence of an association between BMI and overall or ovarian cancer-specific survival. However, we found strong effect modification by stage (Pinteraction<0.01). Compared with normal prediagnosis BMI (18.5–24.9 kg m−2), for women who were obese before diagnosis (BMI⩾35 kg m−2) ovarian cancer-specific survival was lower among those diagnosed at stages I/II (hazard ratio (HR): 3.40; 95% confidence interval (CI): 1.16–9.99), but increased among those diagnosed with stage IV disease (HR: 0.58; 95% CI: 0.35–0.96). Associations were attenuated after excluding those diagnosed with cachexia (n=82) and further adjustment for ascites and bowel obstruction, with no evidence of effect modification by these factors. Associations of obesity with ovarian cancer survival may differ by stage, with decreased survival among those with localised disease and increased survival among those with late-stage disease. Stage-specific effects of obesity on survival suggest a tailored approach to improve prognosis may be appropriate.
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影响因子：
4.5
作者：
Bae HS;Hong JH;Ki KD;Song JY;Shin JW;Lee JM;Lee JK;Lee NW;Lee C;Lee KW;Kim YM
通讯作者：
Kim YM
影响因子：
28.4
作者：
Bandera, Elisa V.;Lee, Valerie S.;Kushi, Lawrence H.
通讯作者：
Kushi, Lawrence H.
影响因子：
11.5
作者：
Hefler, Lukas A.;Concin, Nicole;Reinthaller, Alexander
通讯作者：
Reinthaller, Alexander
影响因子：
4.7
作者：
Kotsopoulos, Joanne;Moody, Joel R. K.;Narod, Steven A.
通讯作者：
Narod, Steven A.
影响因子：
6.2
作者：
Goodman, MT;Correa, CN;Howe, HL
通讯作者：
Howe, HL