Body mass index and mortality in endometrial cancer: A systematic review and meta-analysis

Abstract

Objective: To evaluate the association between body mass index (BMI) and mortality in women with endometrial cancer.

Methods: A systematic review was performed utilizing a Medline search with Mesh keywords 'endometrial neoplasms' and ('body mass index' or 'obesity') and ('survival analysis' or 'mortality' or 'survivor' or 'survival') for studies published prior to June 2013. Inclusion criteria included studies that assessed associations between BMI and survival in endometrial cancer patients. Two investigators independently reviewed the title and abstract and full-text of articles for inclusion or exclusion decision; discordant decisions were adjudicated by a third reviewer. A random-effects model was constructed that was comparable to the standard random-effects models used in the meta-analysis of odds ratios. The model was fitted using SAS PROC NLMIXED.

Results: 1451 studies were identified and reviewed in duplicate, 18 met inclusion criteria. A random-effects meta-analysis demonstrated significantly higher odds of mortality with increasing BMI in endometrial cancer patients. Specifically the odds ratios were 1.01, 1.17, 1.26, and 1.66 for BMI categories of 25-29.9, 30-34.9, 35-39.9, and 40+, respectively. The odds ratio for all-cause mortality in endometrial cancer patients with a BMI≥40 compared to those with a BMI<25 was 1.66 (CI: 1.10-2.51, p=0.02). A single dose-response model indicated that a 10% increase in BMI resulted in a 9.2% increase in the odds of all-cause mortality (p=0.007).

Conclusion: Increased BMI is significantly associated with increased all-cause mortality in women with endometrial cancer, with the highest risk for those with a BMI≥40.

Keywords: Body mass index; Endometrial cancer; Mortality; Obesity; Survival.

Fig. 1.

A systematic review was performed utilizing a Medline search using exploded Mesh keywords ‘endometrial neoplasms’ and (‘body mass index’ (n = 250) or ‘obesity’ (n = 272)) and (‘survival analysis’ (n = 1145) or ‘mortality’ (n = 986) or ‘survivor’ (n = 45) or ‘survival’ (n = 10)).

Fig. 2.

The figure depicts the odds ratio of all-cause mortality relative to a BMI of 25 based on the overall model and on the interval estimates. The odds of all-cause mortality were significantly increased with increasing BMI.