Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Teaching and Research Hospital, Istanbul, Turkey.
Arch Gynecol Obstet. 2012 Nov;286(5):1269-76. doi: 10.1007/s00404-012-2431-2. Epub 2012 Jun 24.
To examine the influence of obesity on the patient characteristics and clinicopathologic features of endometrial cancer, and to find how treatment and prognosis were affected by obesity in women with endometrial cancer.
The data of 370 consecutive women operated for endometrial cancer were retrospectively reviewed. Patients were divided into three categories as <25, 25-29.9 and ≥30 according to BMI. All patients underwent primary surgical treatment including total abdominal hysterectomy, bilateral oophorectomy and peritoneal cytology. Pelvic lymphadenectomy was carried out for all patients except for those with no myometrial invasion regardless of the tumor grade or for whom it was technically impossible. Paraaortic lymphadenectomy was performed when pre- and intraoperative assessments suggested non-endometrioid or grade 3 endometrioid cancer, >50 % myometrial invasion and cervical involvement.
Patients with a BMI (body mass index) of <25 were significantly younger. Patients with a BMI of ≥30 were statistically less likely to have >50 % myometrial invasion and more likely to have stage I disease. There were no significant differences in the incidences of positive pelvic and paraaortic lymph nodes and tumor grades between the three groups. Also, there were no differences in surgery type, the mean of removed pelvic and paraaortic lymph node number, hospital stay, blood loss and complications between the groups. The patients with a BMI of ≥30 had significantly longer operating time. There were no statistically significant differences in recurrences, the median number of months at recurrence or the site of recurrence between the three groups, as well as the 5-year overall and disease-free survival of patients. Multivariate proportional hazard models identified stage III and IV disease as significant covariates for mortality rates, while stage III and IV disease, hypertension and pelvic irradiation were identified as significant covariates for recurrence rates.
Positive peritoneal cytology, deep myometrial invasion and stage II-IV endometrial cancer were significantly more common in patients with a BMI of <25. There were no significant differences in tumor grade, surgical technique, surgical morbidity or adjuvant radiotherapy between the BMI groups. Recurrence and cancer-related mortality rates were not affected by the BMI.
探讨肥胖对子宫内膜癌患者特征和临床病理特征的影响，以及肥胖如何影响子宫内膜癌患者的治疗和预后。
回顾性分析 370 例连续接受子宫内膜癌手术的患者资料。患者根据 BMI 分为<25、25-29.9 和≥30 三组。所有患者均接受了包括全子宫切除术、双侧卵巢切除术和腹腔细胞学检查的初始手术治疗。除无肌层浸润或因技术原因无法进行手术的患者外，所有患者均行盆腔淋巴结切除术。对于术前和术中评估提示非子宫内膜样或 3 级子宫内膜样癌、>50%肌层浸润和宫颈受累的患者，行腹主动脉旁淋巴结切除术。
BMI<25 的患者明显更年轻。BMI≥30 的患者肌层浸润程度<50%的比例较低，Ⅰ期疾病的比例较高。三组患者盆腔和腹主动脉旁淋巴结阳性率及肿瘤分级无显著差异。三组患者的手术类型、盆腔和腹主动脉旁淋巴结清扫数目平均值、住院时间、出血量和并发症发生率均无差异。BMI≥30 的患者手术时间明显较长。三组患者的复发率、复发中位时间和复发部位、以及患者的 5 年总生存率和无病生存率均无统计学差异。多变量比例风险模型确定Ⅲ期和Ⅳ期疾病是死亡率的显著预测因素，而Ⅲ期和Ⅳ期疾病、高血压和盆腔放疗是复发率的显著预测因素。
BMI<25 的患者中，阳性腹腔细胞学、深部肌层浸润和Ⅱ-Ⅳ期子宫内膜癌更为常见。BMI 组之间肿瘤分级、手术技术、手术发病率或辅助放疗无显著差异。复发率和癌症相关死亡率不受 BMI 影响。
