Extremes in body mass index affect overall survival in women with cervical cancer

• Underweight and overweight/obese women with cervical cancer have worse RFS and OS.
• There is no difference in stage at diagnosis across BMI categories.
• Optimizing weight in cervical cancer patients may improve outcomes.

ObjectiveTo examine the effect of BMI on pathologic findings, cancer recurrence and survival in cervical cancer patients.MethodsA retrospective cohort study of cervical cancer patients treated from July 2000 to March 2013 was performed. BMI was calculated, and patients were classified by BMI. The primary outcome was overall survival (OS). Secondary outcomes included stage, histopathology, disease-specific survival (DSS) and recurrence free survival (RFS). Kaplan–Meier survival curves were generated and compared using Cox proportional hazard ratios.ResultsOf 632 eligible patients, 24 (4%) were underweight, 191 (30%) were normal weight, 417 (66%) were overweight/obese. There was no difference in age (p = 0.91), stage at presentation (p = 0.91), grade (p = 0.46), or histology (p = 0.76) between weight categories. There were fewer White patients in the underweight (54%) and overweight/obese (58%) groups compared to the normal weight (71%) group (p = 0.04). After controlling for prognostic factors, underweight and overweight/obese patients had worse median RFS than normal weight patients (7.6 v 25.0 months, p = 0.01 and 20.3 v 25.0 months, p = 0.03). Underweight patients also had worse OS (10.4 v 28.4 months, p = 0.031) and DSS (13.8 v 28.4 months, p = 0.04) compared to normal weight patients. Overweight/obese patients had worse OS than normal weight patients (22.2 v 28.4 months, p = 0.03) and a trend toward worse DSS (21.9 v 28.4 months, p = 0.09).ConclusionBoth extremes of weight (underweight and overweight/obesity) were associated with worse survival in patients with cervical cancer. Optimizing weight in cervical cancer patients may improve outcomes in these patients.