title: Clinical significance of surgical staging for obese women with endometrial cancer: a retrospective analysis in a Japanese cohort.
abstract: OBJECTIVE
  In patients with endometrial cancer, obesity is associated with a well-differentiated histological grade but not with prolonged survival. It is possible that this lack of survival advantage is caused by incomplete surgical staging.
  
  
  METHODS
  In total, 716 patients with endometrial cancer were retrospectively reviewed. Obesity was defined as body mass index of ≥30 kg/m(2). The relationships between clinicopathological factors and disease-specific survival were analyzed by Cox regression analysis.
  
  
  RESULTS
  Older age (hazard ratio, 1.6; 95% confidence interval, 1.1-2.4), advanced stage (hazard ratio, 11.2; 95% confidence interval, 7.2-17.5), high-risk histology (hazard ratio, 2.7; 95% confidence interval, 1.8-4.0), no hysterectomy (hazard ratio, 3.1; 95% confidence interval, 1.7-5.8) and no lymphadenectomy (hazard ratio, 2.0; 95% confidence interval, 1.3-3.0) were independently associated with poor disease-specific survival. Survival was similar in obese and non-obese women (hazard ratio, 0.9; 95% confidence interval, 0.5-1.6) despite the fact that obesity was significantly associated with younger age and a well-differentiated histological grade. Although there was no difference in the distribution of disease stage between the two groups, obesity was associated with lower rates of hysterectomy (3.6 vs. 6.1%, P = 0.23) and lymphadenectomy (25.0 vs. 36.4%, P = 0.017). Obese patients who underwent hysterectomy had a significantly better disease-specific survival than those who did not (P = 0.002). The 5-year disease-specific survival rate in obese patients who underwent lymphadenectomy was 6.2% better than that in those who did not [86.0 vs. 79.8%, P = 0.36 (not statistically significant)].
  
  
  CONCLUSIONS
  Poor-quality surgical staging in obese women may result in worse than expected survival outcomes.
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan yukiharu@sap-cc.go.jp.
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Todo
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Kazuhira
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Minobe
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications* / Q000175:diagnosis*; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies
keywords: body mass index; disease-specific survival; endometrial cancer; lymphadenectomy; obesity