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Body Weight Makes No Difference in Ovarian Cancer Survival May 25, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Body Weight Makes No Difference in Ovarian Cancer Survival

By Todd Neale, Staff Writer, MedPage Today
Published: December 30, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

BIRMINGHAM, Ala., Dec. 30 — Obese patients with epithelial ovarian cancer do not appear to have worse survival than their slimmer counterparts, a retrospective chart review showed.

Obese and non-obese patients had similar progression-free survival (17 versus 11 months, P=0.14) and overall survival (48 versus 40 months, P=0.37) following primary cytoreductive surgery that resulted in similar rates of optimal debulking, Kellie Matthews, M.D., of the University Alabama at Birmingham, and colleagues reported online in Gynecologic Oncology.

All patients received chemotherapy administered according to their actual body weight. Often, chemotherapy is administered based on ideal weight, which may lead to insufficient doses for obese patients, according to the researchers.

Some past studies have suggested that obesity is an independent predictor of lower survival in patients with epithelial ovarian cancer, but others have not. Few have included information on differences in rates of optimal debulking between obese and non-obese patients, the researchers said.

To explore the issue, they reviewed charts for 304 patients with FIGO stages II to IV epithelial ovarian cancer from a gynecologic oncology database from 1996 to 2005.

All patients underwent primary cytoreductive surgery followed by IV taxane and platinum-based chemotherapy dosed according to actual body weight.

Nearly a quarter (23.4%) were obese and the rest had a body mass index of less than 30 kg/m2.

Obese and non-obese patients had similar disease stage, grade, and histology, rates of platinum sensitivity, and administration of chemotherapy.

Obese patients were significantly more likely to be younger than 65 (P=0.02) and to be black (P=0.01).

There were no significant differences between the groups in estimated blood loss, time spent in the operating room, or operative complications. Only wound complications were more common in the obese group (11% versus 2%, P<0.001).

Rates of optimal debulking — defined as a lack of residual tumors greater than 1 cm in diameter — were similar in obese and non-obese patients (52% versus 51%, P=0.88), in spite of potential challenges to the surgical treatment of obese patients.

Such potential difficulties include comorbid chronic illnesses, administration of anesthesia, operative complications, and technical challenges, the researchers said.

“This demonstrates that any disadvantage obesity affords in the treatment of ovarian cancer is likely not related to the surgeon’s ability to achieve optimal cytoreduction,” the researchers said.

Although obese patients had a lower recurrence rate (68% versus 79%, P=0.04), there were no significant differences in progression-free and overall survival between the two groups.

The authors acknowledged that the study had several limitations, including the retrospective design, a trend toward poorer outcomes in underweight women that could not be compared with outcomes in obese women because of small patient numbers, potential selection bias, and optimal debulking rates that were lower than those found in other studies.

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