Influence of body mass index on prognosis in gynecological malignancies.
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.
Münstedt
Karsten
K
Department of Obstetrics and Gynecology, Clinic of the Universities Giessen and Marburg, Giessen, Germany. karsten.muenstedt@gyn.med.uni-giessen.de
Wagner
Mathias
M
Kullmer
Uwe
U
Hackethal
Andreas
A
Franke
Folker E
FE
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