title: Prediagnosis body mass index, physical activity, and mortality in endometrial cancer patients.
abstract: Background Higher body mass index (BMI) and inactivity have been associated with a higher risk of developing endometrial cancer, but the impact on endometrial cancer survival is unclear. Methods Among incident endometrial cancer case subjects in the National Institutes of Health-AARP Diet and Health Study, we examined associations of prediagnosis BMI (n = 1400) and physical activity (n = 875) with overall and disease-specific 5- and 10-year mortality. Using Cox proportional hazards regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for tumor characteristics, treatment, and other risk factors. All statistical tests were two-sided. Results Compared with women with a BMI in the range of 18.5 to less than 25kg/m(2), the hazard ratios for 5-year all-cause mortality were 1.74 (95% CI = 1.13 to 2.66) for BMI in the range of 25 to less than 30kg/m(2), 1.84 (95% CI = 1.17 to 2.88) for BMI in the range of 30 to less than 35kg/m(2), and 2.35 (95% CI = 1.48 to 3.73) for BMI greater than or equal to 35kg/m(2) (P trend < .001). Higher BMI was also statistically significantly associated with poorer endometrial cancer-specific but not cardiovascular disease 5-year mortality. Hazard ratio estimates for 10-year all-cause and endometrial cancer-specific mortality as related to BMI were similar to 5-year hazard ratio estimates, whereas 10-year cardiovascular disease mortality became statistically significant (HR = 4.08; 95% CI = 1.56 to 10.71 comparing extreme BMI groups). More physical activity was related to lower all-cause 5-year mortality (HR = 0.57, 95% CI = 0.33 to 0.98 for >7 hours/week vs never/rarely), but the association was attenuated after adjustment for BMI (HR = 0.64, 95% CI = 0.37 to 1.12). No association was observed between physical activity and disease-specific mortality. Conclusions Our findings suggest that higher prediagnosis BMI increases risk of overall and disease-specific mortality among women diagnosed with endometrial cancer, whereas physical activity lowers risk. Intervention studies of the effect of these modifiable lifestyle factors on mortality are needed.
authors.affiliation: MHS, 6120 Executive Blvd, EPS 3029, Rockville, MD 20852, USA. aremhe2@mail.nih.gov
authors.forename: Hannah
authors.initials: H
authors.lastname: Arem
authors.forename: Yikyung
authors.initials: Y
authors.lastname: Park
authors.forename: Colleen
authors.initials: C
authors.lastname: Pelser
authors.forename: Rachel
authors.initials: R
authors.lastname: Ballard-Barbash
authors.forename: Melinda L
authors.initials: ML
authors.lastname: Irwin
authors.forename: Albert
authors.initials: A
authors.lastname: Hollenbeck
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Gierach
authors.forename: Louise A
authors.initials: LA
authors.lastname: Brinton
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
authors.forename: Charles E
authors.initials: CE
authors.lastname: Matthews
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016889:Endometrial Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009043:Motor Activity; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications* / Q000401:mortality; D017584:Reproductive History; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology