title: Extremes in body mass index affect overall survival in women with cervical cancer.
abstract: To examine the effect of BMI on pathologic findings, cancer recurrence and survival in cervical cancer patients.
  
  
  
  A retrospective cohort study of cervical cancer patients treated from July 2000 to March 2013 was performed. BMI was calculated, and patients were classified by BMI. The primary outcome was overall survival (OS). Secondary outcomes included stage, histopathology, disease-specific survival (DSS) and recurrence free survival (RFS). Kaplan-Meier survival curves were generated and compared using Cox proportional hazard ratios.
  
  
  
  Of 632 eligible patients, 24 (4%) were underweight, 191 (30%) were normal weight, 417 (66%) were overweight/obese. There was no difference in age (p=0.91), stage at presentation (p=0.91), grade (p=0.46), or histology (p=0.76) between weight categories. There were fewer White patients in the underweight (54%) and overweight/obese (58%) groups compared to the normal weight (71%) group (p=0.04). After controlling for prognostic factors, underweight and overweight/obese patients had worse median RFS than normal weight patients (7.6 v 25.0months, p=0.01 and 20.3 v 25.0months, p=0.03). Underweight patients also had worse OS (10.4 v 28.4months, p=0.031) and DSS (13.8 v 28.4months, p=0.04) compared to normal weight patients. Overweight/obese patients had worse OS than normal weight patients (22.2 v 28.4months, p=0.03) and a trend toward worse DSS (21.9 v 28.4months, p=0.09).
  
  
  
  Both extremes of weight (underweight and overweight/obesity) were associated with worse survival in patients with cervical cancer. Optimizing weight in cervical cancer patients may improve outcomes in these patients.
authors.affiliation: Division of Gynecologic Oncology, Chapel Hill, NC, United States; University of North Carolina, Chapel Hill, NC, United States; Lineberger Clinical Cancer Center at UNC, Chapel Hill, NC, United States. Electronic address: Leslie.Clark@UNChealth.UNC.edu.
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Clark
authors.affiliation: University of Cincinnati, Cincinnati, OH, United States.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Jackson
authors.affiliation: University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Adrianne E
authors.initials: AE
authors.lastname: Soo
authors.affiliation: University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Danielle C
authors.initials: DC
authors.lastname: Orrey
authors.affiliation: Division of Gynecologic Oncology, Chapel Hill, NC, United States; University of North Carolina, Chapel Hill, NC, United States; Lineberger Clinical Cancer Center at UNC, Chapel Hill, NC, United States.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.affiliation: Division of Gynecologic Oncology, Chapel Hill, NC, United States; University of North Carolina, Chapel Hill, NC, United States; Lineberger Clinical Cancer Center at UNC, Chapel Hill, NC, United States.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Kim
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D056865:Ideal Body Weight; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D009765:Obesity / Q000401:mortality / Q000473:pathology; D050177:Overweight / Q000401:mortality / Q000473:pathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013851:Thinness / Q000401:mortality / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology
keywords: Body mass index; Cervical cancer; Obesity; Prognosis; Survival