title: Body mass index and mortality in endometrial cancer: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the association between body mass index (BMI) and mortality in women with endometrial cancer.
  
  
  METHODS
  A systematic review was performed utilizing a Medline search with Mesh keywords 'endometrial neoplasms' and ('body mass index' or 'obesity') and ('survival analysis' or 'mortality' or 'survivor' or 'survival') for studies published prior to June 2013. Inclusion criteria included studies that assessed associations between BMI and survival in endometrial cancer patients. Two investigators independently reviewed the title and abstract and full-text of articles for inclusion or exclusion decision; discordant decisions were adjudicated by a third reviewer. A random-effects model was constructed that was comparable to the standard random-effects models used in the meta-analysis of odds ratios. The model was fitted using SAS PROC NLMIXED.
  
  
  RESULTS
  1451 studies were identified and reviewed in duplicate, 18 met inclusion criteria. A random-effects meta-analysis demonstrated significantly higher odds of mortality with increasing BMI in endometrial cancer patients. Specifically the odds ratios were 1.01, 1.17, 1.26, and 1.66 for BMI categories of 25-29.9, 30-34.9, 35-39.9, and 40+, respectively. The odds ratio for all-cause mortality in endometrial cancer patients with a BMI≥40 compared to those with a BMI<25 was 1.66 (CI: 1.10-2.51, p=0.02). A single dose-response model indicated that a 10% increase in BMI resulted in a 9.2% increase in the odds of all-cause mortality (p=0.007).
  
  
  CONCLUSIONS
  Increased BMI is significantly associated with increased all-cause mortality in women with endometrial cancer, with the highest risk for those with a BMI≥40.
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA. Electronic address: angeles.secord@dm.duke.edu.
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Vic
authors.initials: V
authors.lastname: Hasselblad
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Summa Health System, Akron, OH, USA.
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Von Gruenigen
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of North Carolina in Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Modesitt
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of North Carolina in Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Bae-Jump
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
mesh_terms: D015992:Body Mass Index; D016889:Endometrial Neoplasms / Q000401:mortality*; D005260:Female; D006801:Humans
keywords: Body mass index; Endometrial cancer; Mortality; Obesity; Survival