title: Morbid obesity as an independent risk factor for disease-specific mortality in women with cervical cancer.
abstract: OBJECTIVE
  To assess whether obesity is an independent predictor of mortality in women with cervical cancer.
  
  
  METHODS
  This retrospective cohort study of patients with stages IB1-IVA cervical cancer treated with curative intent at MD Anderson Cancer Center from 1980 through 2007 categorized these women as underweight, normal weight, overweight, obese, or morbidly obese according to National Institutes of Health definitions. In addition to weight category, known prognostic factors for survival after a diagnosis of cervical cancer were included in a multivariate model. These known prognostic factors included age, smoking status, race or ethnicity (self-reported), socioeconomic status, comorbidities, tumor histologic subtype, tumor stage, tumor size, presence or absence of hydronephrosis, radiologic evidence of nodal metastasis, and the addition of concurrent chemotherapy with definitive radiation.
  
  
  RESULTS
  A total of 3,086 patients met the inclusion criteria. The median survival for the entire cohort was 81 months (range 0-365 months). The presence of lymph node spread and advancing stage were the most significant predictors of survival. Compared with normal-weight women, morbidly obese women had a significantly higher hazard ratio for both all-cause death (hazard ratio 1.26, 95% confidence interval [CI] 1.10-1.45) and disease-specific death (hazard ratio 1.24, 95% CI 1.06-1.47). Underweight, overweight, and obese women did not have an increased risk for death compared with normal-weight women.
  
  
  CONCLUSIONS
  After controlling for all previously known prognostic factors, morbid obesity remains an independent risk factor for death from cervical cancer. Overweight and obese women have the same prognosis as normal-weight women.
authors.affiliation: Departments of Gynecologic Oncology and Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.forename: Ann H
authors.initials: AH
authors.lastname: Klopp
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Eifel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications* / Q000401:mortality*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000401:mortality*; D055815:Young Adult