title: Obesity is associated with worse overall survival in women with low-grade papillary serous epithelial ovarian cancer.
abstract: OBJECTIVE
  The objective of this study was to evaluate prognostic risk factors for survival in women with low-grade serous epithelial ovarian cancer (LGSC).
  
  
  METHODS
  A multicenter retrospective analysis of patients with LGSC was conducted. Potential epidemiologic risk factors evaluated included obesity, age, parity, race, smoking, oral contraceptive pill and/or hormonal replacement therapy use, and previous hysterectomy or surgery on fallopian tubes and/or ovaries. Additional factors included stage, extent of debulking, residual disease, and disease status.
  
  
  RESULTS
  Eighty-one patients were identified, and pathologic diagnosis was independently confirmed. Median age at diagnosis was 56 years (range, 21-86 years). Thirty-four percent were obese, and 80% had optimally debulked disease. Forty-six percent were alive, 14% with disease, whereas 25% were dead of disease, 2% died of intercurrent disease, and 27% had an unknown status. In a univariate analysis, optimal surgical debulking was associated with improved progression-free survival (P = 0.01), disease-specific survival (P = 0.03), and overall survival (OS) (P < 0.001) and body mass index with worse OS (P = 0.05). On multivariate analysis, obesity (hazard ratio, 2.8; 95% confidence interval, 1.05-7.3; P = 0.04) and optimal tumor debulking (hazard ratio, 0.05; 95% confidence interval, 0.008-0.29; P = 0.001) were a significant predictor of OS.
  
  
  CONCLUSIONS
  In a multivariate analysis, obesity and optimal tumor cytoreduction were significant predictors of OS. However, obesity was not associated with worse disease-specific survival, suggesting that mortality of obese patients with LGSC may result from other comorbidities. Interventions addressing obesity may improve survival for women diagnosed with LGSC, and further study is warranted to address the role of obesity in LGSC.
authors.affiliation: *Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham; †University of North Carolina School of Medicine, Chapel Hill; ‡Department of Pathology, Duke University Medical Center, Durham; and §Department of Pathology and Laboratory Medicine and ∥Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC.
authors.forename: Rebecca Ann
authors.initials: RA
authors.lastname: Previs
authors.forename: Joshua
authors.initials: J
authors.lastname: Kilgore
authors.forename: Renatta
authors.initials: R
authors.lastname: Craven
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.forename: Sarah
authors.initials: S
authors.lastname: Bean
authors.forename: Sara
authors.initials: S
authors.lastname: Wobker
authors.forename: Megan
authors.initials: M
authors.lastname: DiFurio
authors.forename: Victoria
authors.initials: V
authors.lastname: Bae-Jump
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002291:Carcinoma, Papillary / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D018284:Cystadenocarcinoma, Serous / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009765:Obesity / Q000150:complications* / Q000401:mortality / Q000473:pathology; D010051:Ovarian Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult