Title
Author
DOI
Article Type
Special Issue
Volume
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Treatment outcomes and survival in morbidly obese women with endometrial cancer
1Obstetrics and Gynecology Institute, Department of Subspeciality Care for Women’s Health, Cleveland Clinic Foundation, Women’s Health Institute, Cleveland, OH 44195, USA
2Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
3Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
DOI: 10.22514/ejgo.2025.005 Vol.46,Issue 1,January 2025 pp.37-46
Submitted: 18 June 2024 Accepted: 17 July 2024
Published: 15 January 2025
*Corresponding Author(s): Katie K. Crean-Tate E-mail: creantkk@sutterhealth.org
Background: Morbid obesity presents a challenge in providing standard treatment in endometrial cancer (EC). We aim to evaluate the impact of morbid obesity on treatment and survival outcomes in women with EC. Methods: Patients diagnosed with EC from 2005–2015 were stratified by body mass index (BMI ≥40 kg/m2 vs. <40 kg/m2) and low risk (LR) and high risk (HR) subgroups based on stage, grade, myometrial invasion and histology. Demographics, tumor characteristics and treatment-related outcomes were analyzed. Univariate, multivariable and propensity-weighted Cox models were used to evaluate progression free survival (PFS) and overall survival (OS). Results: Of 1778 evaluable patients, those with BMI ≥40 kg/m2 were significantly younger, more likely endometrioid histology, lower grade, earlier stage, myometrial invasion <50%and absent lymph-vascular space invasion (LVSI). A similar proportion of patients with BMI <40 and ≥40 kg/m2 in LR and HR groups received radiation and chemotherapy. However, morbidly obese patients were less likely to undergo lymphadenectomy in both risk groups (p = 0.012 and p = 0.009, respectively). On propensity-weighted analysis, there was no significant difference in PFS or OS between patients with BMI <40 and ≥40 kg/m2 (HR 0.89, 95% CI (confidence interval) (0.60, 1.30) and HR 0.74, 95%CI (0.49, 1.12) respectively). Conclusions: Morbid obesity is associated with favorable prognostic factors in EC patients. When stratified by risk group, morbidly obese patients receive similar postoperative treatment but are less likely to undergo lymphadenectomy. PFS and OS are similar between patients with BMI <40 and ≥40 kg/m2 when risk groups and propensity score matching are considered.
Endometrial neoplasms; Obesity; Survival; Uterine neoplasms
Katie K. Crean-Tate,Meng Yao,Milena Radeva,Sudha Amarnath,Chad M. Michener,Peter G. Rose,Mariam M. AlHilli. Treatment outcomes and survival in morbidly obese women with endometrial cancer. European Journal of Gynaecological Oncology. 2025. 46(1);37-46.
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