title: Influence of body mass index on prognosis in gynecological malignancies.
abstract: OBJECTIVE
  To evaluate the effect of obesity on the presentation and course of disease in patients with gynecological cancers.
  
  
  METHODS
  Records of patients with endometrial (n = 1180), cervical (n = 738), and ovarian cancer (n = 824) treated between 1986 and 2005 were reviewed. Body mass index (BMI) was analyzed in relation to tumor stage, tumor grading, and prognosis. Steroid hormone receptor status and growth fraction (MIB1; Ki-67-antigen) of tumors in relation to BMI were analyzed in subgroups with endometrial (n = 183) and advanced ovarian (n = 221) cancers. In the latter subgroup, tumor vascularization (CD31) and expression of bcl-2, c-erb-B2, fibronectin, and tumor markers (CA-125, CA15-3, CEA) were also evaluated. Statistical analyses included bivariate correlation, cross-tabulation, Kaplan-Meier-survival analyses, and multifactorial residual survival analyses.
  
  
  RESULTS
  Obese patients with endometrial carcinoma were significantly younger (p < 0.001) and their tumors were less advanced at diagnosis (p = 0.001) and were better differentiated (p = 0.010). In the subgroups, neither steroid hormone receptor status nor MIB1-determined growth fraction correlated with BMI. For both endometrial and cervical carcinomas, a high BMI influenced overall survival favorably (p (endometrial )= 0.004 and p (cervical )= 0.026). In ovarian cancer, there was a trend toward improved survival in more obese patients (p = 0.053). Immunohistochemistry revealed that c-erb-B2 expression was slightly lower in tumors of obese patients (r = -0.142; p = 0.039), but BMI did not influence any other factor.
  
  
  CONCLUSIONS
  Although obesity increases the incidence of cancer, a high BMI does not seem to adversely influence the prognosis in patients with the mentioned gynecological malignancies.
authors.affiliation: Department of Obstetrics and Gynecology, Clinic of the Universities Giessen and Marburg, Giessen, Germany. karsten.muenstedt@gyn.med.uni-giessen.de
authors.forename: Karsten
authors.initials: K
authors.lastname: Münstedt
authors.forename: Mathias
authors.initials: M
authors.lastname: Wagner
authors.forename: Uwe
authors.initials: U
authors.lastname: Kullmer
authors.forename: Andreas
authors.initials: A
authors.lastname: Hackethal
authors.forename: Folker E
authors.initials: FE
authors.lastname: Franke
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005833:Genital Neoplasms, Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009765:Obesity; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies