子宫内膜癌中内在和治疗相关预后因素的 BMI 类别分布模式。
A BMI-category distribution pattern of intrinsic and treatment-related prognostic factors in endometrial cancer.
机构信息
Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
出版信息
Jpn J Clin Oncol. 2021 Apr 30;51(5):722-727. doi: 10.1093/jjco/hyaa274.
OBJECTIVE
In patients with endometrial cancer, obesity is associated with favorable prognostic characteristics but not with prolonged survival. The aim of this study was to elucidate the reason for this clinical paradox.
METHODS
We retrospectively reviewed 1173 patients with endometrial cancer. Patients were divided into a non-obese group [body mass index (BMI) < 30 kg/m2], class I obesity group (BMI 30-35 kg/m2) and class II obesity group (BMI ≥ 35 kg/m2). The relationship between clinicopathological factors and disease-specific survival (DSS) was analyzed by Cox regression analysis. To correct for three-time significance testing, we used the Bonferroni method, giving the level of probability at which findings were considered significant as P < 0.0167.
RESULTS
Three disease-intrinsic variables-older age, advanced stage and high-risk histology-and three treatment-related variables-no hysterectomy, no lymphadenectomy and no chemotherapy-were independently associated with poor DSS. DSS was similar among the three groups of patients even though the proportion of patients with plural pretreatment-related unfavorable risk factors significantly decreased with increment of BMI category (40.1 vs. 27.5 vs. 17.6%, P = 0.0003). The proportion of patients with plural treatment-related unfavorable prognostic factors significantly increased with increment of BMI category (21.3 vs. 26.7 vs. 39.3%, P = 0.0072).
CONCLUSIONS
Poor-quality surgical staging in obese women may result in worse than expected survival outcomes.
目的
在子宫内膜癌患者中，肥胖与有利的预后特征相关，但与生存时间延长无关。本研究旨在阐明这一临床矛盾的原因。
方法
我们回顾性分析了 1173 例子宫内膜癌患者。患者分为非肥胖组（BMI<30kg/m2）、I 度肥胖组（BMI 30-35kg/m2）和 II 度肥胖组（BMI≥35kg/m2）。采用 Cox 回归分析探讨临床病理因素与疾病特异性生存（DSS）的关系。为了校正三次显著性检验，我们使用了 Bonferroni 方法，将有意义的发现概率水平定义为 P<0.0167。
结果
三个疾病内在变量——年龄较大、晚期和高危组织学，以及三个与治疗相关的变量——无子宫切除术、无淋巴结切除术和无化疗，与较差的 DSS 独立相关。尽管随着 BMI 类别的增加，预处理相关不良风险因素的患者比例显著下降（40.1%、27.5%、17.6%，P=0.0003），但三组患者的 DSS 相似。随着 BMI 类别的增加，预处理相关不良预后因素的患者比例显著增加（21.3%、26.7%、39.3%，P=0.0072）。
结论
肥胖女性手术分期质量较差可能导致预后不良。
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