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681 Obesity paradox: is a high body mass index positively influencing survival outcomes in gynecological cancers? A systematic review and meta-analysis
  1. Matteo Pavone1,2,3,
  2. Marta Goglia4,
  3. Cristina Taliento5,6,
  4. Lise Lecointre1,7,8,
  5. Nicolò Bizzarri3,
  6. Francesco Fanfani3,
  7. Anna Fagotti3,
  8. Giovanni Scambia3,
  9. Jacques Marescaux2,
  10. Denis Querleu3,
  11. Barbara Seeliger1,7,9,2 and
  12. Cherif Akladios8
  1. 1Institut Hospitalo-Universitaire (IHU) Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
  2. 2IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
  3. 3Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Rome, Italy
  4. 4Department of Translational Medicine and Oncology, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
  5. 5Department of Obstetrics and Gynecology, University Hospital Ferrara, Ferrara, Italy
  6. 6Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
  7. 7ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France
  8. 8University Hospitals of Strasbourg, Department of Gynecologic Surgery, Strasbourg, France
  9. 9University Hospitals of Strasbourg, Department of Digestive and Endocrine Surgery, Strasbourg, France


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 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.

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