Secord Angeles Alvarez, Hasselblad Vic, Von Gruenigen Vivian E, Gehrig Paola A, Modesitt Susan C, Bae-Jump Victoria, Havrilesky Laura J
Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Gynecol Oncol. 2016 Jan;140(1):184-90. doi: 10.1016/j.ygyno.2015.10.020. Epub 2015 Oct 31.
To evaluate the association between body mass index (BMI) and mortality in women with endometrial cancer.
A systematic review was performed utilizing a Medline search with Mesh keywords 'endometrial neoplasms' and ('body mass index' or 'obesity') and ('survival analysis' or 'mortality' or 'survivor' or 'survival') for studies published prior to June 2013. Inclusion criteria included studies that assessed associations between BMI and survival in endometrial cancer patients. Two investigators independently reviewed the title and abstract and full-text of articles for inclusion or exclusion decision; discordant decisions were adjudicated by a third reviewer. A random-effects model was constructed that was comparable to the standard random-effects models used in the meta-analysis of odds ratios. The model was fitted using SAS PROC NLMIXED.
1451 studies were identified and reviewed in duplicate, 18 met inclusion criteria. A random-effects meta-analysis demonstrated significantly higher odds of mortality with increasing BMI in endometrial cancer patients. Specifically the odds ratios were 1.01, 1.17, 1.26, and 1.66 for BMI categories of 25-29.9, 30-34.9, 35-39.9, and 40+, respectively. The odds ratio for all-cause mortality in endometrial cancer patients with a BMI≥40 compared to those with a BMI<25 was 1.66 (CI: 1.10-2.51, p=0.02). A single dose-response model indicated that a 10% increase in BMI resulted in a 9.2% increase in the odds of all-cause mortality (p=0.007).
Increased BMI is significantly associated with increased all-cause mortality in women with endometrial cancer, with the highest risk for those with a BMI≥40.
评估体重指数（BMI）与子宫内膜癌女性死亡率之间的关联。
利用Medline进行系统综述，搜索2013年6月之前发表的研究，Mesh关键词为“子宫内膜肿瘤”以及（“体重指数”或“肥胖”）和（“生存分析”或“死亡率”或“幸存者”或“生存”）。纳入标准包括评估BMI与子宫内膜癌患者生存之间关联的研究。两名研究人员独立审查文章的标题、摘要和全文以决定纳入或排除；不一致的决定由第三位审查员裁决。构建了一个随机效应模型，该模型与用于比值比荟萃分析的标准随机效应模型相当。使用SAS PROC NLMIXED拟合该模型。
共识别并重复审查了1451项研究，18项符合纳入标准。随机效应荟萃分析表明，子宫内膜癌患者中，随着BMI升高，死亡率的比值比显著更高。具体而言，BMI分别为25 - 29.9、30 - 34.9、35 - 39.9和40及以上时，比值比分别为1.01、1.17、1.26和1.66。BMI≥40的子宫内膜癌患者与BMI<25的患者相比，全因死亡率的比值比为1.66（95%置信区间：1.10 - 2.51，p = 0.02）。单一剂量反应模型表明，BMI每增加10%，全因死亡率的比值比增加9.2%（p = 0.007）。
BMI升高与子宫内膜癌女性全因死亡率增加显著相关，BMI≥40的女性风险最高。
