Gynecologic Oncology Unit, Giovanni Paolo II Foundation, Campobasso, Italy.
Acta Oncol. 2013 Jan;52(1):166-73. doi: 10.3109/0284186X.2012.698753. Epub 2012 Jul 2.
This study aims at comparing the morbidity and oncologic outcomes in normal weight, overweight, and obese women with locally advanced cervical cancers (LACC) submitted to radical surgery after chemoradiation.
A review of LACC patients with body mass index (BMI) ≥ 18.5 kg/m(2) who underwent neoadjuvant chemoradiation followed by radical surgery between January 1996 and December 2010 was performed. BMI categories were created according to the World Health Organization (WHO) classification.
Two hundred sixty-eight women met the inclusion criteria: 118 (44.0%) were normal weight, 100 (37.3%) overweight and 50 (18.7%) obese. The median follow-up was 42 months. Higher BMI was associated with older age (p = 0.0041), while there were no differences among the three groups in Charlson comorbidity score, tumor characteristics, radiotherapy dosing, type of surgery, and pathological response. There were no differences among the three groups in the intraoperative and postoperative complications as well as rate of patients requiring adjuvant treatments: 21 (7.8%) patients experienced grade 3-4 toxicity, including six normal weight, 12 overweight and three obese patients (p = 0.14). Only the rate of grade 1-2 skin toxicity was higher in obese (14%) with respect to overweight (1%) and normal women (0%) (p = 0.00001). There were no differences in the five-year DFS (74%, 77%, and 84% for normal weight, overweight, and obese women, respectively, p = n.s.), and five-year OS (76%, 78%, and 78% for normal weight, overweight, and obese women, respectively, p = n.s.).
The role of obesity should not be overestimated when evaluating the chance of enrolment of LACC patients into preoperative chemoradiation protocols.
本研究旨在比较接受新辅助放化疗后行根治性手术的体质量指数（BMI）≥18.5kg/m²的局部晚期宫颈癌（LACC）患者中，正常体重、超重和肥胖患者的发病率和肿瘤学结局。
对 1996 年 1 月至 2010 年 12 月期间接受新辅助放化疗后行根治性手术的 LACC 患者进行了回顾性研究，这些患者的 BMI≥18.5kg/m²。BMI 分类根据世界卫生组织（WHO）的分类标准进行。
共有 268 名女性符合纳入标准：118 名（44.0%）为正常体重，100 名（37.3%）为超重，50 名（18.7%）为肥胖。中位随访时间为 42 个月。较高的 BMI 与年龄较大相关（p=0.0041），但三组患者的 Charlson 合并症评分、肿瘤特征、放疗剂量、手术类型和病理反应均无差异。三组患者的术中及术后并发症发生率以及需要辅助治疗的患者比例均无差异：21 名（7.8%）患者出现 3-4 级毒性，包括 6 名正常体重、12 名超重和 3 名肥胖患者（p=0.14）。只有肥胖患者（14%）1-2 级皮肤毒性发生率高于超重（1%）和正常体重（0%）（p=0.00001）。5 年无病生存率（DFS）（正常体重、超重和肥胖组分别为 74%、77%和 84%，p=n.s.）和 5 年总生存率（OS）（正常体重、超重和肥胖组分别为 76%、78%和 78%，p=n.s.）也无差异。
在评估 LACC 患者入组术前放化疗方案的可能性时，肥胖的作用不应被高估。
