Introduction/Background Obesity represents an exponentially growing preventable disease leading to different health complications, particularly when associated with cancer disease. In recent years, however, an ‘obesity paradox’ has been hypothesized where obese individuals affected by cancer counterintuitively show better survival rates. The aim of this systematic review and meta-analysis is to assess whether the prognosis in gynecological malignancies is positively influenced by obesity.

Methodology This study adheres to PRISMA guidelines and is registered with PROSPERO. Studies reporting the impact of a BMI > 30 kg/m2 compared with < 30 kg/m2 in patients with gynecological cancers querying PubMed, Google Scholar and ClinicalTrials.gov were included in the analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2) was used for quality assessment for the selected articles.

Results Twenty-one studies were identified, including 14108 patients with cervical (CC), ovarian (OC) and endometrial cancer (EC) for the meta-analysis. There was no benefit in 5-year overall survival (OS) for obese patients compared with non-obese (OR = 1.2, 95% CI 1.00–1.44, p =0.05; I2 = 71%). When pooling for cancer subgroups, there were no statistically significative differences in 5-year OS in CC and 5-year OS and progression-free survival (PFS) in OC patients. For obese women affected by EC, a significant decrease of 44% in 5-year OS (p=0.01) was revealed, without significant differences for 5-year disease-free survival (DFS) (p =0.78).

Conclusion According to the results of the present mete-analysis a BMI ≥ 30 kg/m2 does not have a positive prognostic effect on survival compared with a BMI <30 kg/m2 in women affected by gynecological cancers. The existence of the ‘obesity paradox’ in other fields, however, suggests the importance of further investigations with prospective studies.

Disclosures None.