University of Oklahoma, Department of Obstetrics & Gynecology, Section of Gynecologic Oncology, Oklahoma City, OK, USA.
Gynecologic Oncology Group Statistical & Data Center, Roswell Park Cancer Institute, Buffalo, NY, USA.
Gynecol Oncol. 2014 Apr;133(1):23-7. doi: 10.1016/j.ygyno.2014.01.041.
To determine the association of body mass index (BMI) on complications, recurrence, and survival in GOG LAP2, a randomized comparison of laparoscopic versus open staging in clinically early stage uterine cancer (EC).
An ancillary data analysis of GOG LAP2 was performed. Categorical variables were compared using Pearson chi-square test and continuous variables using the Wilcoxon-Mann-Whitney and Kruskal-Wallis tests by BMI group. Survival was estimated using the Kaplan-Meier method. Cox proportional hazards model was used to evaluate independent prognostic factors on survival. Statistical tests were two-tailed with α=0.05, except where noted. Statistical analyses utilized R programming language.
2596 women were included. BMI (kg/m(2)) groups were <25 (29.5%), 25-30 (28.2%), 30-35 (21%), 35-40 (10.9%), and ≥40 (10.4%). Stage (p=0.021), grade (p<0.001), and histology (p=0.005) differed by BMI. Obese women were less likely to have high risk (HR) disease (+lymph nodes/ovaries/cytology) or tumor features that met GOG99 high intermediate risk (HIR) criteria (p<0.001). Adjuvant therapy (p=0.151) and recurrence (p=0.46) did not vary by BMI. Hospitalization >2days, antibiotic use, wound infection, and venous thrombophlebitis were higher with BMI ≥40. BMI (p=0.016), age (p<0.0001), race (p=0.033), and risk group (p<0.0001) predicted all-cause mortality. BMI was not predictive of disease-specific survival (p=0.79), but age (p=0.032) and risk group (p<0.0001) were significant factors.
Obese women have greater surgical risk and lower risk of metastatic disease. BMI is associated with all-cause but not disease-specific mortality, emphasizing the detrimental effect of obesity (independent of EC), which deserves particular attention.
确定体重指数（BMI）与 GOG LAP2 中并发症、复发和生存的关系，这是一项比较腹腔镜与开腹分期治疗临床早期子宫癌（EC）的随机对照研究。
对 GOG LAP2 进行辅助数据分析。通过 BMI 组比较分类变量使用 Pearson 卡方检验，比较连续变量使用 Wilcoxon-Mann-Whitney 和 Kruskal-Wallis 检验。使用 Kaplan-Meier 方法估计生存情况。使用 Cox 比例风险模型评估生存的独立预后因素。除另有说明外，统计检验均为双侧，α=0.05。统计分析使用 R 编程语言。
共纳入 2596 例患者。BMI（kg/m²）组分别为<25（29.5%）、25-30（28.2%）、30-35（21%）、35-40（10.9%）和≥40（10.4%）。BMI 与分期（p=0.021）、分级（p<0.001）和组织学（p=0.005）有关。肥胖女性患高危（HR）疾病（淋巴结/卵巢/细胞学阳性）或符合 GOG99 中高危（HIR）标准的肿瘤特征的可能性较低（p<0.001）。辅助治疗（p=0.151）和复发（p=0.46）与 BMI 无关。BMI≥40 时，住院时间>2 天、抗生素使用、伤口感染和静脉血栓栓塞的发生率更高。BMI（p=0.016）、年龄（p<0.0001）、种族（p=0.033）和风险组（p<0.0001）预测全因死亡率。BMI 与疾病特异性生存无关（p=0.79），但年龄（p=0.032）和风险组（p<0.0001）是重要因素。
肥胖女性手术风险更大，转移性疾病风险更低。BMI 与全因死亡率相关，但与疾病特异性死亡率无关，但肥胖（独立于 EC）有不良影响，应引起特别关注。
