Impact of obesity on surgical and oncologic outcomes in ovarian cancer

Amanika Kumar, Jamie N Bakkum-Gamez, Amy L. Weaver, Michaela E. McGree, William Arthur Cliby

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objectives. The aim of this study is to determine the impact of obesity on surgical and oncologic outcomes after primary debulking surgery (PDS) in advanced epithelial ovarian cancer (EOC).

Methods.Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/2/2003 and 12/30/2011 were included. Patient characteristics, intraoperative and postoperative outcomes, recurrence and status were abstracted. Complications were graded according to the 4-point Accordion classification. For analyses, patients were divided into three groups according to body mass index (BMI): group 1-BMI b25.0 kg/m 2 group 2-BMI 25.0-39.9 kg/m2 and group 3-BMI ≥40.0 kg/m2.

Results. Of the 620 patients included in the study, 36.6%, 56.9%, and 6.5% were in weight groups 1, 2, and 3, respectively. Weight group 3 was an independent predictor of severe complications after adjusting for confounders (adjusted odds ratio (95% CI): 2.93 (1.38, 6.20) for group 3 vs. group 2). Weight groupwas not associatedwith differences in residual disease (p = 0.80). The 90-day mortality rates were 11.9%, 6.7%, and 15.7%, respectively, in weight group 1, 2, and 3 (p = 0.049 unadjusted, p = 0.01 adjusted). There was no difference in OS (p = 0.52) or PFS (p = 0.23) between weight groups.

Conclusions. BMI ≥40.0 kg/m2 is an independent predictor of severe 30-day postoperative morbidity and 90-day mortality after PDS for EOC-information useful in preoperative counseling. BMI does not appear to impact long-term oncologic outcomes including residual disease at PDS, although we had limited power at the extremes of BMI. BMI may be an important factor to consider in risk-adjustment models and reimbursement strategies.

Original languageEnglish (US)
Pages (from-to)19-24
Number of pages6
JournalGynecologic Oncology
Volume135
Issue number1
DOIs
StatePublished - Oct 1 2014

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Ovarian Neoplasms
Body Mass Index
Obesity
Weights and Measures
Risk Adjustment
Mortality
Counseling
Odds Ratio
Morbidity
Recurrence
Ovarian epithelial cancer

Keywords

  • Ovarian cancer Obesity Overall survival Disease-free survival

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology
  • Medicine(all)

Cite this

Impact of obesity on surgical and oncologic outcomes in ovarian cancer. / Kumar, Amanika; Bakkum-Gamez, Jamie N; Weaver, Amy L.; McGree, Michaela E.; Cliby, William Arthur.

In: Gynecologic Oncology, Vol. 135, No. 1, 01.10.2014, p. 19-24.

Research output: Contribution to journalArticle

Kumar, Amanika ; Bakkum-Gamez, Jamie N ; Weaver, Amy L. ; McGree, Michaela E. ; Cliby, William Arthur. / Impact of obesity on surgical and oncologic outcomes in ovarian cancer. In: Gynecologic Oncology. 2014 ; Vol. 135, No. 1. pp. 19-24.
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abstract = "Objectives. The aim of this study is to determine the impact of obesity on surgical and oncologic outcomes after primary debulking surgery (PDS) in advanced epithelial ovarian cancer (EOC).Methods.Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/2/2003 and 12/30/2011 were included. Patient characteristics, intraoperative and postoperative outcomes, recurrence and status were abstracted. Complications were graded according to the 4-point Accordion classification. For analyses, patients were divided into three groups according to body mass index (BMI): group 1-BMI b25.0 kg/m 2 group 2-BMI 25.0-39.9 kg/m2 and group 3-BMI ≥40.0 kg/m2.Results. Of the 620 patients included in the study, 36.6{\%}, 56.9{\%}, and 6.5{\%} were in weight groups 1, 2, and 3, respectively. Weight group 3 was an independent predictor of severe complications after adjusting for confounders (adjusted odds ratio (95{\%} CI): 2.93 (1.38, 6.20) for group 3 vs. group 2). Weight groupwas not associatedwith differences in residual disease (p = 0.80). The 90-day mortality rates were 11.9{\%}, 6.7{\%}, and 15.7{\%}, respectively, in weight group 1, 2, and 3 (p = 0.049 unadjusted, p = 0.01 adjusted). There was no difference in OS (p = 0.52) or PFS (p = 0.23) between weight groups.Conclusions. BMI ≥40.0 kg/m2 is an independent predictor of severe 30-day postoperative morbidity and 90-day mortality after PDS for EOC-information useful in preoperative counseling. BMI does not appear to impact long-term oncologic outcomes including residual disease at PDS, although we had limited power at the extremes of BMI. BMI may be an important factor to consider in risk-adjustment models and reimbursement strategies.",
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AB - Objectives. The aim of this study is to determine the impact of obesity on surgical and oncologic outcomes after primary debulking surgery (PDS) in advanced epithelial ovarian cancer (EOC).Methods.Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/2/2003 and 12/30/2011 were included. Patient characteristics, intraoperative and postoperative outcomes, recurrence and status were abstracted. Complications were graded according to the 4-point Accordion classification. For analyses, patients were divided into three groups according to body mass index (BMI): group 1-BMI b25.0 kg/m 2 group 2-BMI 25.0-39.9 kg/m2 and group 3-BMI ≥40.0 kg/m2.Results. Of the 620 patients included in the study, 36.6%, 56.9%, and 6.5% were in weight groups 1, 2, and 3, respectively. Weight group 3 was an independent predictor of severe complications after adjusting for confounders (adjusted odds ratio (95% CI): 2.93 (1.38, 6.20) for group 3 vs. group 2). Weight groupwas not associatedwith differences in residual disease (p = 0.80). The 90-day mortality rates were 11.9%, 6.7%, and 15.7%, respectively, in weight group 1, 2, and 3 (p = 0.049 unadjusted, p = 0.01 adjusted). There was no difference in OS (p = 0.52) or PFS (p = 0.23) between weight groups.Conclusions. BMI ≥40.0 kg/m2 is an independent predictor of severe 30-day postoperative morbidity and 90-day mortality after PDS for EOC-information useful in preoperative counseling. BMI does not appear to impact long-term oncologic outcomes including residual disease at PDS, although we had limited power at the extremes of BMI. BMI may be an important factor to consider in risk-adjustment models and reimbursement strategies.

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