Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma - A gynecologic oncology group study
Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma - A gynecologic oncology group study
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DOI：
10.1002/cncr.22351
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发表时间：
2006-12-15
期刊：
影响因子：
6.2
通讯作者：
Barakat, Richard R.
中科院分区：
文献类型：
--
作者：
von Gruenigen, Vivian E.;Tian, Chunqiao;Barakat, Richard R.
背景目的是研究肥胖或病态肥胖患者与非肥胖患者之间的疾病复发率、治疗相关的不良反应和生存率是否存在差异。回顾性分析了参与手术加或不加辅助放疗的随机试验患者的数据。380名患者的体重指数（BMI）数据可用，其中24%超重（BMI，25-29.9），41%肥胖（BMI，30-39.9），12%病态肥胖（BMI，>= 40）。BMI在年龄、体力状态、组织学、肿瘤分级、肌层浸润或淋巴血管间隙受累方面无显著差异。BMI > 30在非洲裔美国人中（73%）比非非洲裔美国人（50%）更常见。BMI >= 40的患者与BMI < 30的患者相比（风险比[HR]，0.42; 95%置信区间[CI]，0.09-1.84; P = 0.246），复发率并不低。与BMI < x 30相比，BMI 30-39.9患者的生存率无显著差异（HR，1.48; 95%CI，0.82-2.70; P = 0.196）;然而，有证据表明BMI >= 40患者的生存率降低（HR，2.77; 95%CI，1.21-6.36; P = 0.016）。在本研究中，非裔美国人与非裔美国人的未校正和校正BMI风险比不同，因此表明BMI对种族的混杂效应。在45例病态肥胖患者中，12例死亡中有8例（67%）是非癌症原因。对于接受辅助放射治疗的患者，BMI增加与胃肠道毒性减少（R，-0.22; P = 0.003）和皮肤毒性增加（R，0.17; P = 0.019）显著相关。在目前的研究中，肥胖与子宫内膜癌以外的其他原因的死亡率较高有关，但与疾病复发无关。在接受辅助放射治疗的患者中，BMI增加也与皮肤毒性增加和胃肠道毒性减少相关。未来的建议包括生活方式干预试验，以提高肥胖子宫内膜癌患者的生存率。
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 < x 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%0 Cl, 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.CONCLUSIONS. 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.