title: Effect of obesity on survival in epithelial ovarian cancer.
abstract: BACKGROUND
  Epidemiologic studies suggest that obese women are more likely to die of ovarian cancer than those of ideal body weight, but it is not known whether increased incidence, comorbidities common to obese women, or altered tumor biology is responsible for this difference. The current study attempted to determine the influence of excess body weight on ovarian cancer survival, disease progression, and clinicopathologic factors.
  
  
  METHODS
  The records of patients undergoing surgery for epithelial ovarian cancer at Cedars Sinai Medical Center between January 1, 1996 and June 30, 2003 were reviewed for height, weight, age, comorbidities, and treatment-specific details. Statistical analyses included the Fisher exact test, Kaplan-Meier survival, and Cox regression analyses.
  
  
  RESULTS
  In all, 216 patients were identified. Eight percent were underweight (body mass index [BMI] < 18.5), 50% were ideal body weight (18.5 </= BMI < 25), 25% were overweight (25 </= BMI < 30), and 16% were obese (BMI >/= 30). Age, comorbidities including coronary artery disease and venous thromboembolism, and rates of optimal surgical cytoreduction were similar among BMI strata. Diabetes and hypertension were more common in obese women. Ten (29%) of the obese patients had International Federation of Gynecology and Obstetrics (FIGO) Stage I disease, compared with 19 (10%) of the patients with BMI < 30 (P = .01). In a subcohort of 149 patients with Stage III or IV disease, a significant trend was identified favoring increased BMI as an independent negative factor for disease-free (P = .02) and overall (P = .02) survival.
  
  
  CONCLUSIONS
  Obese patients were more likely to have disease limited to the ovaries. For patients with advanced stage disease, obesity was independently associated with both shorter time to recurrence and shorter overall survival. These findings suggest an effect of excess body weight on tumor biology, and studies are under way to elucidate the molecular and hormonal mechanisms underlying these clinical observations.
authors.affiliation: Cedars-Sinai Medical Center, Women's Cancer Research Institute at the Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Pavelka
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Brown
authors.forename: Beth Y
authors.initials: BY
authors.lastname: Karlan
authors.forename: Ilana
authors.initials: I
authors.lastname: Cass
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Leuchter
authors.forename: Leo D
authors.initials: LD
authors.lastname: Lagasse
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D002277:Carcinoma / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D010051:Ovarian Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D017211:Treatment Failure