肥胖早期子宫内膜癌女性的治疗效果、疾病复发及生存情况：一项妇科肿瘤学组研究

Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma : a Gynecologic Oncology Group study.

作者信息

von Gruenigen Vivian E, Tian Chunqiao, Frasure Heidi, Waggoner Steven, Keys Henry, Barakat Richard R

机构信息

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospitals of Cleveland, MacDonald Women's Hospital, and the Ireland Cancer Center, Cleveland, Ohio 44106, USA.

出版信息

Cancer. 2006 Dec 15;107(12):2786-91. doi: 10.1002/cncr.22351.

DOI:10.1002/cncr.22351

PMID:17096437

Abstract

BACKGROUND

The objective was to examine whether rates of disease recurrence, treatment-related adverse effects, and survival differed between obese or morbidly obese and nonobese patients.

METHODS

Data from patients who participated in a randomized trial of surgery with or without adjuvant radiation therapy were retrospectively reviewed. RESULTS.: Body mass index (BMI) data were available for 380 patients, of whom 24% were overweight (BMI, 25-29.9), 41% were obese (BMI, 30-39.9), and 12% were morbidly obese (BMI, > or =40). BMI did not significantly differ based on age, performance status, histology, tumor grade, myometrial invasion, or lymphovascular-space involvement. BMI > 30 was more common in African Americans (73%) than non-African Americans (50%). Patients with a BMI > or = 40 compared with BMI < 30 (hazards ratio [HR], 0.42; 95% confidence interval [CI], 0.09-1.84; P = .246) did not have lower recurrence rates. Compared with BMI < 30, there was no significant difference in survival in patients with BMI 30-39.9 (HR, 1.48; 95% CI, 0.82-2.70; P = .196); however, there was evidence for decreased survival in patients with BMI > or = 40 (HR, 2.77; 95% CI, 1.21-6.36; P = .016). Unadjusted and adjusted BMI hazards ratios for African Americans versus non-African Americans in the current study differed, thus suggesting a confounding effect of BMI on race. Eight (67%) of 12 deaths among 45 morbidly obese patients were from noncancerous causes. For patients who received adjuvant radiation therapy, increased BMI was significantly associated with less gastrointestinal (R, -0.22; P = .003) and more cutaneous (R, 0.17; P = .019) toxicities.

CONCLUSIONS

In the current study, obesity was associated with higher mortality from causes other than endometrial cancer but not disease recurrence. Increased BMI was also associated with more cutaneous and less gastrointestinal toxicity in patients who received adjuvant radiation therapy. Future recommendations include lifestyle intervention trials to improve survival in obese endometrial cancer patients.

摘要

背景

目的是研究肥胖或病态肥胖患者与非肥胖患者之间疾病复发率、治疗相关不良反应及生存率是否存在差异。

方法

对参与手术联合或不联合辅助放疗随机试验的患者数据进行回顾性分析。结果：380例患者有体重指数（BMI）数据，其中24%超重（BMI，25 - 29.9），41%肥胖（BMI，30 - 39.9），12%病态肥胖（BMI，≥40）。BMI在年龄、体能状态、组织学、肿瘤分级、肌层浸润或脉管间隙受累方面无显著差异。BMI > 30在非裔美国人（73%）中比非非裔美国人（50%）更常见。BMI≥40的患者与BMI < 30的患者相比（风险比[HR]，0.42；95%置信区间[CI]，0.09 - 1.84；P = 0.246）复发率并未降低。与BMI < 30相比，BMI 30 - 39.9的患者生存率无显著差异（HR，1.48；95% CI，0.82 - 2.70；P = 0.196）；然而，有证据表明BMI≥40的患者生存率降低（HR，2.77；95% CI，1.21 - 6.36；P = 0.016）。本研究中，非裔美国人与非非裔美国人未校正和校正后的BMI风险比不同，因此提示BMI对种族有混杂效应。45例病态肥胖患者中有12例死亡，其中8例（67%）死于非癌症原因。对于接受辅助放疗的患者，BMI升高与较少的胃肠道毒性（R， - 0.22；P = 0.003）和较多的皮肤毒性（R, 0.17；P = 0.019）显著相关。