Suboptimal Weight Affects Survival in Cervical Cancer

Both overweight and underweight women with cervical cancer did not live as long as their normal-weight counterparts, according to a new study.

Researchers at the University of Cincinnati (OH, USA) and the University of North Carolina (UNC; Chapel Hill, USA) conducted a retrospective cohort study of 623 women with cervical cancer treated from July 2000 to March 2013, classifying the women according to their body mass index (BMI). In all, 4% of the women were underweight, 30% were normal weight, and 66% were overweight or obese. The primary outcome was overall survival; secondary outcomes included stage, histopathology, disease-specific survival (DSS), and recurrence free survival (RFS).

The results showed that the median overall survival time in overweight or obese women was six months shorter than in women of normal weight (22 versus 28 months); for underweight women, median overall survival time was cut in half (14 versus 28 months). There was no difference in age, stage at presentation, grade, or histology between weight categories. After controlling for prognostic factors, underweight and overweight/obese patients had worse median RFS than normal weight patients. The study was published on April 14, 2016, in in Gynecologic Oncology.

“In understanding the effect of BMI on cervical cancer outcomes, it is important to recognize that both extremes of weight appear to negatively impact survival. A potential unifying hypothesis connecting both extremes of weight to poor cancer prognosis is chronic systemic inflammation,” wrote lead author Leslie Clark, MD, of UNC, and colleagues. “Both patients with cancer cachexia/sarcopenia and overweight/obese patients are in a heightened inflammatory state, which may lead to increased cell proliferation and inhibition of apoptosis.”

"However, this is likely not the only mechanism of poor outcomes. Co-morbid medical conditions might account for some of the differences in survival, particularly in morbidly obese patients,” concluded the authors. “Providers should optimize weight in underweight and overweight/obese patients to attempt to improve outcomes in these women. Interventions that target nutritional counseling and physical activity should be explored in these populations.”

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