Yıl: 2020 Cilt: 17 Sayı: 3 Sayfa Aralığı: 209 - 214 Metin Dili: İngilizce DOI: 10.4274/tjod.galenos.2020.83773 İndeks Tarihi: 16-06-2021

The impact of morbid obesity on survival of endometrial cancer

Öz:
Objective: Morbid obesity is identified as patients with a body mass index more than 40 kg/m2. Obesity is known as a risk factor for endometrial cancer due to the increase of the deposited estrogen. This study was conducted to evaluate the effect of morbid obesity on the survival of endometrial cancer.Materials and Methods: The archival records and pathologic reports of patients with endometrial cancer who underwent surgery and were followed up in Çukurova University Gynecologic Oncology Center between January 1996 and December 2018 were reviewed, retrospectively. Data regarding body mass index and survival was reported in 520 patients. These patients were stratified into two groups according to their body mass index, <40 and ≥40 kg/m2. The groups’ clinic, pathologic features, and survival rates were compared.Results: There were 146 patients in the morbidly obese group and 374 patients in the obese group. The mean age of the groups was 58.5 and 56.2 years, respectively. The mean follow-up time was 51.6 months. Comorbidities were significantly higher in the morbidly obese group. The five-year disease-free and overall survival rates were 78.3% and 85.3% in the morbidly obese group, and 81.6% and 90.1% in the obese group, respectively. Although the groups’ clinical and pathologic features were homogeneously distributed, disease-free and overall survival rates were significantly different (p=0.053 and p=0.054, respectively).Conclusion: Morbidly obese patients with endometrial cancer were associated with 2.7-fold increased risk of death and 1.7-fold increased risk of recurrence compared with those who had body mass index <40 kg/m2. It is important to deal with the frequent comorbidities in this special group, which could be simply altered by lifestyle changes. Morbidly obese patients with endometrial cancer should be encouraged in lifestyle changes and consulted by dieticians and endocrinologists.
Anahtar Kelime:

Morbid obezitenin endometriyal kanserli hastaların sağkalımına etkisi

Öz:
Amaç: Morbid obezite, vücut kitle indeksi 40 kg/m2’den fazla olan hastaları tanımlar. Obezite, yağ dokusunda depolanan östrojenin artışı nedeniyle endometriyum kanseri için bir risk faktörü olarak bilinir. Bu çalışma, endometriyal kanserin sağkalımı üzerine morbid obezite etkisini değerlendirmek için planlanmıştır.Gereç ve Yöntemler: Çukurova Üniversitesi Jinekolojik Onkoloji Birimi’nde Ocak 1996 - Aralık 2018 tarihleri arasında opere edilen ve takip edilen endometriyum kanserli olgularının arşiv kayıtları ve patolojik raporları retrospektif olarak incelendi. Bu hastalardan vücut kitle indeksi ve sağkalım ile ilgili tam verilerine ulaşılabilen 520 olgu çalışmaya dahil edildi. Hastalar vücut kitle indeksleri <40 ve ≥40 şeklinde iki gruba ayrıldı. Grupların kliniği, patolojik özellikleri ve sağkalım oranları karşılaştırıldı.Bulgular: Morbid obez hasta grubunda 146 ve vücut kitle indeksi <40 kg/m2 olan grupta 374 hasta vardı. Grupların yaş ortalaması sırasıyla 58,5 ve 56,2 idi. Ortalama takip süresi 51,6 aydı. Komorbiditeler, morbid obez grupta anlamlı derecede yüksekti. Beş yıllık hastalıksız ve genel sağkalım oranları, morbid obez grupta sırasıyla; %78,3 ve %85,3, vücut kitle indeksi <40 kg/m2 olan grupta %81,6 ve %90,1 idi. Grupların klinik ve patolojik özelliklerinin homojen olarak dağılmış olmasına rağmen, hastalıksız ve genel sağkalım oranlarının anlamlı derecede farklı olduğu görülmüştür (sırasıyla, p=0,053 ve p=0,054).Sonuç: Morbid obez endometriyal kanserli hastalar, vücut kitle indeksi <40 kg/m2 olanlara göre 2,7 artmış ölüm riski ve 1,7 artmış nüks riski ile ilişkiliydi. Yaşam tarzındaki değişimlerle kolayca değiştirilebilecek olan ve bu özel grupta sıkça görülen komorbiditelerle baş etmek son derece önemlidir. Morbid obez endometriyal kanserli hastalar yaşam tarzı değişiklikleri için teşvik edilmeli ve diyetisyenler ile endokrinologlara konsülte edilmelidir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. Lancet 2005;366:491-505.
  • 2. Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983;15:10-7.
  • 3. Arem H, Irwin ML. Obesity and endometrial cancer survival: a systematic review. Int J Obes (Lond) 2013;37:634-9.
  • 4. Pavelka JC, Ben-Shachar I, Fowler JM, Ramirez NC, Copeland LJ, Eaton LA, et al. Morbid obesity and endometrial cancer: surgical, clinical, and pathologic outcomes in surgically managed patients. Gynecol Oncol 2004;95:588-92.
  • 5. Gunderson CC, Java J, Moore KN, Walker JL. The impact of obesity on surgical staging, complications, and survival with uterine cancer: a Gynecologic Oncology Group LAP2 ancillary data study. Gynecol Oncol 2014;133:23-7.
  • 6. Bouwman F, Smits A, Lopes A, Das N, Pollard A, Massuger L, et al. The impact of BMI on surgical complications and outcomes in endometrial cancer surgery--an institutional study and systematic review of the literature. Gynecol Oncol 2015;139:369-76.
  • 7. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894:i-xii, 1-253.
  • 8. Fader AN, Arriba LN, Frasure HE, von Gruenigen VE. Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship. Gynecol Oncol 2009;114:121-7.
  • 9. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348:1625-38.
  • 10. Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D, et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 2007;335:1134.
  • 11. Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet 2009;105:109.
  • 12. Clarke BA, Gilks CB. Endometrial carcinoma: controversies in histopathological assessment of grade and tumour cell type. J Clin Pathol 2010;63:410-5.
  • 13. Temkin SM, Pezzullo JC, Hellmann M, Lee YC, Abulafia O. Is body mass index an independent risk factor of survival among patients with endometrial cancer? Am J Clin Oncol 2007;30:8-14.
  • 14. von Gruenigen VE, Tian C, Frasure H, Waggoner S, Keys H, Barakat RR. Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma : a Gynecologic Oncology Group study. Cancer 2006;107:2786-91.
  • 15. Bittoni MA, Fisher JL, Fowler JM, Maxwell GL, Paskett ED. Assessment of the effects of severe obesity and lifestyle risk factors on stage of endometrial cancer. Cancer Epidemiol Biomarkers Prev 2013;22:76-81.
  • 16. Everett E, Tamimi H, Greer B, Swisher E, Paley P, Mandel L, et al. The effect of body mass index on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 2003;90:150-7.
  • 17. Foley K, Lee RB. Surgical complications of obese patients with endometrial carcinoma. Gynecol Oncol 1990;39:171-4.
  • 18. Villareal DT, Apovian CM, Kushner RF, Klein S, American Society for N; Naaso, TOS. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Am J Clin Nutr 2005;82:923-34.
  • 19. Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 2004;4:579- 91.
  • 20. Reeves KW, Carter GC, Rodabough RJ, Lane D, McNeeley SG, Stefanick ML, et al. Obesity in relation to endometrial cancer risk and disease characteristics in the Women’s Health Initiative. Gynecol Oncol 2011;121:376-82.
  • 21. Suidan RS, He W, Sun CC, Zhao H, Fleming ND, Ramirez PT, et al. Impact of body mass index and operative approach on surgical morbidity and costs in women with endometrial carcinoma and hyperplasia. Gynecol Oncol 2017;145:55-60.
  • 22. Blanchard CM, Courneya KS, Stein K, American Cancer Society’s SCS, II. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol 2008;26:2198-204.
  • 23. Basen-Engquist K, Scruggs S, Jhingran A, Bodurka DC, Lu K, Ramondetta L, et al. Physical activity and obesity in endometrial cancer survivors: associations with pain, fatigue, and physical functioning. Am J Obstet Gynecol 2009;200:288.e1-8.
  • 24. Courneya KS, Karvinen KH, Campbell KL, Pearcey RG, Dundas G, Capstick V, et al. Associations among exercise, body weight, and quality of life in a population-based sample of endometrial cancer survivors. Gynecol Oncol 2005;97:422-30.
APA güzel a, Khatib G, Kucukgoz Gulec U, GÜMÜRDÜLÜ D, vardar M (2020). The impact of morbid obesity on survival of endometrial cancer. , 209 - 214. 10.4274/tjod.galenos.2020.83773
Chicago güzel ahmet barış,Khatib Ghanim,Kucukgoz Gulec Umran,GÜMÜRDÜLÜ DERYA,vardar Mehmet The impact of morbid obesity on survival of endometrial cancer. (2020): 209 - 214. 10.4274/tjod.galenos.2020.83773
MLA güzel ahmet barış,Khatib Ghanim,Kucukgoz Gulec Umran,GÜMÜRDÜLÜ DERYA,vardar Mehmet The impact of morbid obesity on survival of endometrial cancer. , 2020, ss.209 - 214. 10.4274/tjod.galenos.2020.83773
AMA güzel a,Khatib G,Kucukgoz Gulec U,GÜMÜRDÜLÜ D,vardar M The impact of morbid obesity on survival of endometrial cancer. . 2020; 209 - 214. 10.4274/tjod.galenos.2020.83773
Vancouver güzel a,Khatib G,Kucukgoz Gulec U,GÜMÜRDÜLÜ D,vardar M The impact of morbid obesity on survival of endometrial cancer. . 2020; 209 - 214. 10.4274/tjod.galenos.2020.83773
IEEE güzel a,Khatib G,Kucukgoz Gulec U,GÜMÜRDÜLÜ D,vardar M "The impact of morbid obesity on survival of endometrial cancer." , ss.209 - 214, 2020. 10.4274/tjod.galenos.2020.83773
ISNAD güzel, ahmet barış vd. "The impact of morbid obesity on survival of endometrial cancer". (2020), 209-214. https://doi.org/10.4274/tjod.galenos.2020.83773
APA güzel a, Khatib G, Kucukgoz Gulec U, GÜMÜRDÜLÜ D, vardar M (2020). The impact of morbid obesity on survival of endometrial cancer. Turkish Journal of Obstetrics and Gynecology, 17(3), 209 - 214. 10.4274/tjod.galenos.2020.83773
Chicago güzel ahmet barış,Khatib Ghanim,Kucukgoz Gulec Umran,GÜMÜRDÜLÜ DERYA,vardar Mehmet The impact of morbid obesity on survival of endometrial cancer. Turkish Journal of Obstetrics and Gynecology 17, no.3 (2020): 209 - 214. 10.4274/tjod.galenos.2020.83773
MLA güzel ahmet barış,Khatib Ghanim,Kucukgoz Gulec Umran,GÜMÜRDÜLÜ DERYA,vardar Mehmet The impact of morbid obesity on survival of endometrial cancer. Turkish Journal of Obstetrics and Gynecology, vol.17, no.3, 2020, ss.209 - 214. 10.4274/tjod.galenos.2020.83773
AMA güzel a,Khatib G,Kucukgoz Gulec U,GÜMÜRDÜLÜ D,vardar M The impact of morbid obesity on survival of endometrial cancer. Turkish Journal of Obstetrics and Gynecology. 2020; 17(3): 209 - 214. 10.4274/tjod.galenos.2020.83773
Vancouver güzel a,Khatib G,Kucukgoz Gulec U,GÜMÜRDÜLÜ D,vardar M The impact of morbid obesity on survival of endometrial cancer. Turkish Journal of Obstetrics and Gynecology. 2020; 17(3): 209 - 214. 10.4274/tjod.galenos.2020.83773
IEEE güzel a,Khatib G,Kucukgoz Gulec U,GÜMÜRDÜLÜ D,vardar M "The impact of morbid obesity on survival of endometrial cancer." Turkish Journal of Obstetrics and Gynecology, 17, ss.209 - 214, 2020. 10.4274/tjod.galenos.2020.83773
ISNAD güzel, ahmet barış vd. "The impact of morbid obesity on survival of endometrial cancer". Turkish Journal of Obstetrics and Gynecology 17/3 (2020), 209-214. https://doi.org/10.4274/tjod.galenos.2020.83773