Obesity and epithelial ovarian cancer survival: a systematic review and meta-analysis.
BACKGROUND
Studies on the association between obesity and ovarian cancer survival have had conflicting results. We reviewed and quantitatively summarized the existing evidence, exploring potentially important sources of variability, such as the timing of body mass index (BMI) assessment, BMI cut points, references used in multivariate analysis, and ovarian cancer stage.


METHODS
Eligible studies were searched using MEDLINE (PubMed), EMBASE, and Cochrane Central Register of Controlled Trials, relevant bibliographies were manually reviewed for additional studies. Adjusted hazard ratios (HRs) from individual studies were pooled using a random effects model.


RESULTS
17 cohort studies of 929 screened articles were included in the final analysis. Obesity in early adulthood and obesity 5 years before ovarian cancer diagnosis were associated with poor patient survival (early adulthood: pooled HR 1.67; 95% CI 1.29-2.16; 5 years prediagnosis: pooled HR 1.35; 95% CI 1.03-1.76). However, the results for obesity at diagnosis depended on whether BMI was analyzed as a categorical or continuous variable. Analysis of obesity with BMI as a categorical variable did not affect ovarian cancer prognosis (pooled HR 1.07; 95% CI 0.95-1.21); obesity with BMI as a continuous variable showed slightly poorer survival with each incremental increase in BMI (pooled HR 1.02; 95% CI 1.01-1.04).


CONCLUSIONS
Obesity 5 years before ovarian cancer diagnosis and obesity at a young age were associated with poor prognosis. The association between obesity at diagnosis and survival of ovarian cancer patients still remains equivocal. BMI at diagnosis cannot be a prognostic factor for the survival of ovarian cancer patients. Further well-designed studies are needed to elucidate the variety effect of obesity on the survival of ovarian cancer patients.
Departments of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
Hyo Sook
HS
Bae
Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
Hyun Jung
HJ
Kim
Departments of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
Jin Hwa
JH
Hong
Departments of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
Jae Kwan
JK
Lee
Departments of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
Nak Woo
NW
Lee
Departments of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
Jae Yun
JY
Song
D015992:Body Mass Index; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality*; D009765:Obesity / Q000401:mortality*; D010051:Ovarian Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models
Body mass index; Obesity; Ovarian Neoplasms; Survival