The Ohio State University Medical Center, Columbus, OH; and †University of Texas Southwestern, Dallas, TX, USA.
Int J Gynecol Cancer. 2011 Dec;21(9):1601-5. doi: 10.1097/IGC.0b013e31822d2aa3.
Obesity is a known risk factor and poor prognostic factor for many comorbidities including cancer. However, the influence of body mass index (BMI) on ovarian cancer outcomes is inconclusive. Therefore, the objective of this study was to evaluate the impact of BMI and weight changes on survival in patients with advanced ovarian cancer after primary treatment.
All patients with a diagnosis of advanced epithelial ovarian cancer from January 2000 to December 2007 undergoing primary cytoreductive surgery and adjuvant chemotherapy were identified. Patients were divided into 3 categories: underweight/normal weight (BMI, <25 kg/m), overweight (BMI, 25-30 kg/m), and obese (BMI, >30 kg/m). Adjusted hazard ratios for progression-free survival (PFS) and overall survival (OS) were calculated via Cox proportional hazards models.
One hundred ninety-eight patients met the inclusion criteria. For all patients, the mean BMI was 26 kg/m (range, 16.4-49.1 kg/m), with 43% of patients being classified as normal weight, 29% overweight, and 28% as obese. Median 5-year OS was 48.2 months (95% confidence interval, 16.4-49.1 months), and no differences in OS were noted between BMI groups. Unadjusted median PFS for patients with normal weight was 13.7 months, compared with 15.5 and 17.9 months for the overweight and obese groups. Adjusted analysis of BMI over time indicates a trend of increased risk for patients who gain weight in the 6 months after primary therapy on disease progression (hazard ratio, 1.68; 95% confidence interval, 0.87-3.26).
After adjustment for confounders, such as stage, grade, histology, age, and debulking status, data suggest a trend toward a shorter PFS in patients with a normal BMI. However, OS was not significantly related to BMI, and weight change in the 6 months after completion of treatment had no effect on PFS or OS. Further research should be directed at elucidating relationships between weight and cancer biology.
肥胖是许多合并症（包括癌症）的已知危险因素和预后不良因素。然而，体重指数（BMI）对卵巢癌结局的影响尚无定论。因此，本研究的目的是评估原发性治疗后晚期卵巢癌患者的 BMI 和体重变化对生存的影响。
确定了 2000 年 1 月至 2007 年 12 月期间接受初次减瘤手术和辅助化疗的所有诊断为晚期上皮性卵巢癌的患者。患者分为 3 类：体重不足/正常体重（BMI，<25kg/m）、超重（BMI，25-30kg/m）和肥胖（BMI，>30kg/m）。通过 Cox 比例风险模型计算无进展生存期（PFS）和总生存期（OS）的调整后风险比。
198 名患者符合纳入标准。所有患者的平均 BMI 为 26kg/m（范围为 16.4-49.1kg/m），43%的患者体重正常，29%超重，28%肥胖。中位 5 年 OS 为 48.2 个月（95%置信区间，16.4-49.1 个月），BMI 组之间的 OS 无差异。体重正常患者的未调整中位 PFS 为 13.7 个月，而超重和肥胖患者的 PFS 分别为 15.5 个月和 17.9 个月。BMI 随时间调整的分析表明，在原发性治疗后 6 个月内体重增加的患者疾病进展的风险增加（风险比，1.68；95%置信区间，0.87-3.26）。
在调整了分期、分级、组织学、年龄和减瘤状态等混杂因素后，数据表明 BMI 正常的患者 PFS 较短，但 OS 与 BMI 无显著相关，且治疗结束后 6 个月体重变化对 PFS 或 OS 无影响。应进一步研究体重与癌症生物学之间的关系。
