Treatment Effects, Disease Recurrence, and Survival
in Obese Women With Early Endometrial Carcinoma
A Gynecologic Oncology Group Study
Vivian E. von Gruenigen, MD1,2
Chunqiao Tian, MS3
Heidi Frasure, MS1,2
Steven Waggoner, MD1,2
Henry Keys, MD4
Richard R. Barakat, MD5
1Department of Obstetrics and Gynecology, Divi-
sion of Gynecologic Oncology, University Hospitals
of Cleveland, MacDonald Women’s Hospital, and
the Ireland Cancer Center, Cleveland, Ohio.
2Department of Reproductive Biology, Case Wes-
tern Reserve University, Cleveland, Ohio.
3Gynecologic Oncology Group Statistical and
Data Center, Roswell Park Cancer Institute, Buf-
falo, New York.
4Department of Radiation Oncology, Albany Medi-
cal College, Albany, New York.
5Gynecology Service, Department of Surgery,
Memorial Sloan-Kettering Cancer Center, New
York, New York.
BACKGROUND. The objective was to examine whether rates of disease recurrence,
treatment-related adverse effects, and survival differed between obese or morbidly
obese and nonobese patients.
METHODS. Data from patients who participated in a randomized trial of surgery
with or without adjuvant radiation therapy were retrospectively reviewed.
RESULTS. Body mass index (BMI) data were available for 380 patients, of whom 24%
were overweight (BMI, 25–29.9), 41% were obese (BMI, 30–39.9), and 12% were mor-
bidly obese (BMI, ?40). BMI did not significantly differ based on age, performance
status, histology, tumor grade, myometrial invasion, or lymphovascular-space invol-
vement. BMI > 30 was more common in African Americans (73%) than non-African
Americans (50%). Patients with a BMI ? 40 compared with BMI < 30 (hazards ratio
[HR], 0.42; 95% confidence interval [CI], 0.09–1.84; P ¼.246) did not have lower re-
currence rates. Compared with BMI < 30, there was no significant difference in sur-
vival in patients with BMI 30–39.9 (HR, 1.48; 95% CI, 0.82–2.70; P ¼.196); however,
there was evidence for decreased survival in patients with BMI ? 40 (HR, 2.77; 95%
CI, 1.21–6.36; P ¼.016). Unadjusted and adjusted BMI hazards ratios for African
Americans versus non-African Americans in the current study differed, thus suggest-
ing a confounding effect of BMI on race. Eight (67%) of 12 deaths among 45 mor-
bidly obese patients were from noncancerous causes. For patients who received
adjuvant radiation therapy, increased BMI was significantly associated with less gas-
trointestinal (R, ?0.22; P ¼.003) and more cutaneous (R, 0.17; P ¼.019) toxicities.
CONCLUSIONS. In the current study, obesity was associated with higher mortality
from causes other than endometrial cancer but not disease recurrence. Increased
BMI was also associated with more cutaneous and less gastrointestinal toxicity in
patients who received adjuvant radiation therapy. Future recommendations
include lifestyle intervention trials to improve survival in obese endometrial can-
cer patients. Cancer 2006;107:2786–91. ? 2006 American Cancer Society.
KEYWORDS: endometrial cancer, obesity, side effects, body mass index (BMI), survival.
Henry Keys’s current address: 1 Foxcare Drive,
Suite 310, Oneonta, New York 13820.
Supported by National Cancer Institute grants to
the Gynecologic Oncology Group (GOG) Adminis-
trative Office (CA 27469) and the GOG Statistical
and Data Center (CA 37517).
The following Gynecologic Oncology Group member
institutions participated in the related treatment
study: University of Alabama at Birmingham, Oregon
Health Sciences University, Duke University Medical
Center, Abington Memorial Hospital, University of
Center, University of Minnesota Medical School, Uni-
versity of Southern California Medical Center at Los
Angeles, University of Mississippi Medical Center,
Colorado Foundation for Medical Care, University of
California Medical Center at Los Angeles, University
of Washington Medical Center, University of Miami
icine of the Pennsylvania State University, George-
town University Hospital, University of Cincinnati
College of Medicine, University of North Carolina
School of Medicine, University of Iowa Hospitals and
Clinics, University of Texas Health Science Center at
Dallas, Indiana University School of Medicine, Bow-
man Gray School of Medicine of Wake Forest Univer-
sity, Albany Medical College of Union University,
New England Medical Center, Rush Presbyterian-
Downstate Medical Center, University of Kentucky,
Eastern Virginia Medical School, Cleveland Clinic
Foundation, Johns Hopkins Oncology Center, Penn-
sylvania Hospital, Washington University School of
Medicine, Cooper Hospital/University Medical Center,
Columbus Cancer Council, Fox Chase Cancer Center,
Medical University of South Carolina, Women’s Can-
cer Center, University of Oklahoma Health Science
Center, University of Virginia Health Science Center,
Wethank CaronModeasforcriticalreview ofthe cur-
Address for reprints: Vivian E. von Gruenigen, MD,
Division of Gynecologic Oncology, University Mac-
Donald Women’s Hospital, 11100 Euclid Avenue,
Henry Keys’s current address: 1 Foxcare Drive,
Suite 310, Oneonta, New York 13820.
ª2006 American Cancer Society
Published online 9 November 2006 in Wiley InterScience (www.interscience.wiley.com).
disease; study objectives, including analyses of toxicity,
response, recurrence, and survival, were achieved through
close monitoring and adherence to standard methods
of assessment; and various internal checks provided
quality assurance. These conditions minimized con-
founding and bias.
As previously reported, endometrial cancer survi-
vors are not making positive lifestyle changes despite
obesity being the greatest risk factor for development
of the disease and potentially affecting their survival. At
6 months postsurgery, these patients are not losing
weight, increasing their exercise, or changing their
diets.8Future recommendations include lifestyle inter-
vention trials to improve survival in obese endometrial
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