Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Adverse effect of excess body weight on survival in cervical cancer patients after surgery and radiotherapy

  • Choi, Yunseon (Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Ahn, Ki Jung (Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Park, Sung Kwang (Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Cho, Heunglae (Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Ji Young (Division of Oncology/Hematology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine)
  • Received : 2016.09.12
  • Accepted : 2016.11.09
  • Published : 2017.03.31
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Abstract

Purpose: This study aimed to assess the effects of body mass index (BMI) on survival in cervical cancer patients who had undergone surgery and radiotherapy (RT). Materials and Methods: We retrospectively reviewed the medical records of 70 cervical cancer patients who underwent surgery and RT from 2007 to 2012. Among them, 40 patients (57.1%) had pelvic lymph node metastases at the time of diagnosis. Sixty-seven patients (95.7%) had received chemotherapy. All patients had undergone surgery and postoperative RT. Median BMI of patients was $22.8kg/m^2$ (range, 17.7 to $35.9kg/m^2$). Results: The median duration of follow-up was 52.3 months (range, 16 to 107 months). Twenty-four patients (34.3%) showed recurrence. Local failure, regional lymph nodal failure, and distant failure occurred in 4 (5.7%), 6 (8.6%), and 17 (24.3%) patients, respectively. The 5-year actuarial pelvic control rate was 83.4%. The 5-year cancer-specific survival (CSS) and disease-free survival (DFS) rates were 85.1% and 65.0%, respectively. The presence of pelvic lymph node metastases (n = 30) and being overweight or obese (n = 34, $BMI{\geq}23kg/m^2$) were poor prognostic factors for CSS (p = 0.003 and p = 0.045, respectively). Of these, pelvic lymph node metastasis was an independent prognostic factor (p = 0.030) for CSS. Conclusion: Overweight or obese cervical cancer patients showed poorer survival outcomes than normal weight or underweight patients. Weight control seems to be important in cervical cancer patients to improve clinical outcomes.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86. https://doi.org/10.1002/ijc.29210
  2. Lee JY, Kim EY, Jung KW, et al. Trends in gynecologic cancer mortality in East Asian regions. J Gynecol Oncol 2014;25:174-82. https://doi.org/10.3802/jgo.2014.25.3.174
  3. Colombo N, Carinelli S, Colombo A, et al. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012;23 Suppl 7:vii27-32.
  4. Nagaraju GP, Rajitha B, Aliya S, et al. The role of adiponectin in obesity-associated female-specific carcinogenesis. Cytokine Growth Factor Rev 2016;31:37-48. https://doi.org/10.1016/j.cytogfr.2016.03.014
  5. Jee SH, Yun JE, Park EJ, et al. Body mass index and cancer risk in Korean men and women. Int J Cancer 2008;123:1892-6. https://doi.org/10.1002/ijc.23719
  6. Renehan AG, Zwahlen M, Egger M. Adiposity and cancer risk: new mechanistic insights from epidemiology. Nat Rev Cancer 2015;15:484-98. https://doi.org/10.1038/nrc3967
  7. Seyfried TN, Flores RE, Poff AM, D'Agostino DP. Cancer as a metabolic disease: implications for novel therapeutics. Carcinogenesis 2014;35:515-27. https://doi.org/10.1093/carcin/bgt480
  8. Keum N, Greenwood DC, Lee DH, et al. Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J Natl Cancer Inst 2015;107:djv088.
  9. Ahn HK, Shin JW, Ahn HY, et al. Metabolic components and recurrence in early-stage cervical cancer. Tumour Biol 2015;36:2201-7. https://doi.org/10.1007/s13277-014-2831-y
  10. Poorolajal J, Jenabi E. The association between BMI and cervical cancer risk: a meta-analysis. Eur J Cancer Prev 2016;25:232-8. https://doi.org/10.1097/CEJ.0000000000000164
  11. Frumovitz M, Jhingran A, Soliman PT, Klopp AH, Schmeler KM, Eifel PJ. Morbid obesity as an independent risk factor for disease-specific mortality in women with cervical cancer. Obstet Gynecol 2014;124:1098-104. https://doi.org/10.1097/AOG.0000000000000558
  12. Lopez-Hernandez D. Epidemiological association between body fat percentage and cervical cancer: a cross-sectional population-based survey from Mexico. Arch Med Res 2013;44:454-8. https://doi.org/10.1016/j.arcmed.2013.08.007
  13. Clark LH, Jackson AL, Soo AE, Orrey DC, Gehrig PA, Kim KH. Extremes in body mass index affect overall survival in women with cervical cancer. Gynecol Oncol 2016;141:497-500. https://doi.org/10.1016/j.ygyno.2016.03.035
  14. Dona MG, Vocaturo A, Giuliani M, et al. p16/Ki-67 dual staining in cervico-vaginal cytology: correlation with histology, Human Papillomavirus detection and genotyping in women undergoing colposcopy. Gynecol Oncol 2012;126:198-202. https://doi.org/10.1016/j.ygyno.2012.05.004
  15. Schlumbrecht MP, Sun CC, Huang MS, Zandstra F, Bodurka DC. Lifestyle modification in cervical cancer survivors: an ongoing need. Int J Gynecol Cancer 2014;24:570-5. https://doi.org/10.1097/IGC.0000000000000081
  16. Lou H, Villagran G, Boland JF, et al. Genome analysis of Latin American cervical cancer: frequent activation of the PIK3CA pathway. Clin Cancer Res 2015;21:5360-70. https://doi.org/10.1158/1078-0432.CCR-14-1837
  17. Bregar AJ, Growdon WB. Emerging strategies for targeting PI3K in gynecologic cancer. Gynecol Oncol 2016;140:333-44. https://doi.org/10.1016/j.ygyno.2015.09.083
  18. Zhang L, Wu J, Ling MT, Zhao L, Zhao KN. The role of the PI3K/Akt/mTOR signalling pathway in human cancers induced by infection with human papillomaviruses. Mol Cancer 2015;14:87. https://doi.org/10.1186/s12943-015-0361-x
  19. Yuan Y, Zhang J, Cai L, et al. Leptin induces cell proliferation and reduces cell apoptosis by activating c-myc in cervical cancer. Oncol Rep 2013;29:2291-6. https://doi.org/10.3892/or.2013.2390
  20. Kim JH, Jenrow KA, Brown SL. Mechanisms of radiationinduced normal tissue toxicity and implications for future clinical trials. Radiat Oncol J 2014;32:103-15. https://doi.org/10.3857/roj.2014.32.3.103
  21. Maruthur NM, Bolen SD, Brancati FL, Clark JM. The association of obesity and cervical cancer screening: a systematic review and meta-analysis. Obesity (Silver Spring) 2009;17:375-81. https://doi.org/10.1038/oby.2008.480
  22. Papadia A, Ragni N, Salom EM. The impact of obesity on surgery in gynecological oncology: a review. Int J Gynecol Cancer 2006;16:944-52. https://doi.org/10.1111/j.1525-1438.2006.00577.x
  23. Lee JK, So KA, Piyathilake CJ, Kim MK. Mild obesity, physical activity, calorie intake, and the risks of cervical intraepithelial neoplasia and cervical cancer. PLoS One 2013;8:e66555. https://doi.org/10.1371/journal.pone.0066555

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