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Association between obesity and vulvar cancer recurrence: an analysis of the AGO-CaRE-1 study
  1. Rudiger Klapdor1,
  2. Peter Hillemanns1,
  3. Linn Wölber2,
  4. Julia Jückstock3,
  5. Felix Hilpert4,
  6. Nikolaus de Gregorio5,
  7. Annette Hasenburg6,
  8. Jalid Sehouli7,
  9. Sophie Fürst3,
  10. Hans Strauss8,
  11. Klaus Baumann9,
  12. Falk Thiel10,
  13. Alexander Mustea11,
  14. Werner Meier12,
  15. Philipp Harter13,
  16. Pauline Wimberger14,
  17. Lars Hanker15,
  18. Barbara Schmalfeld2,16 and
  19. Sven Mahner3
  1. 1Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
  2. 2Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  3. 3Department of Obstetrics and Gynecology, Ludwig Maximilians University Munich, Munich, Bayern, Germany
  4. 4Jerusalem Hospital, Hamburg, Germany
  5. 5Department of Gynecology, University of Ulm, Ulm, Germany
  6. 6Department of Gynecology and Obstetrics, Johannes Gutenberg University, Mainz, Germany
  7. 7Department of Gynecology, Charité, University Medicine Berlin, Berlin, Germany
  8. 8Department of Gynecology, University of Halle, Halle, Germany
  9. 9Department of Gynecology, Klinikum Ludwigshafen/University of Magdeburg, Ludwigshafen, Germany
  10. 10Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert/Erlangen University Hospital, Göppingen, Germany
  11. 11Department of Gynecology and Gynecologic Oncoloogy, University of Bonn, Bonn, Germany
  12. 12Department of Gynecology, Evangelisches Krankenhaus Duesseldorf/Duesseldorf University Hospital, Düsseldorf, Germany
  13. 13Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen Mitte, Essen, Germany
  14. 14Department of Gyncology and Obstetrics, Technische Universitat Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
  15. 15Department of Gynecology, UKSH Campus Lubeck, Lubeck, Germany
  16. 16Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
  1. Correspondence to Dr Rudiger Klapdor, Medizinische Hochschule Hannover, Hannover 30625, Germany; klapdor.ruediger{at}


Objective Obesity is associated with worse survival and an increased risk of relapse in several malignancies. The influence of obesity on vulvar cancer recurrence has not been previously described. The primary objective of this study was to evaluate the association between obesity and tumor recurrence in patients with vulvar cancer.

Methods This is an analysis of the AGO-CaRE-1 study. Patients diagnosed with squamous cell vulvar cancer (stage IB and higher), treated in 29 cancer centers between January 1998 and December 2008, were registered in a centralized database. The cohort was divided into two gropus depending on the body mass index (BMI) (<30 vs ≥30 kg/m²). Descriptive statistics, survival analyses, and multivariate Cox regression analyses were performed in order to evaluate the association between obesity and progression-free and overall survival.

Results In 849 (52.4%) of 1618 patients in the database, the BMI was documented. Patients were grouped according to their BMI (<30 vs ≥30 kg/m²). There were 621 patients with a BMI <30 kg/m² and 228 patients with a BMI ≥30 kg/m². Besides age, there was no difference in baseline variables (tumor diameter, depth of infiltration, tumor stage, nodal metastasis, tumor grade). Treatment variables (R0 resection, chemotherapy, radiotherapy, continuation of adjuvant therapy) did not differ between groups. However, patients with BMI ≥30 kg/m² underwent radical vulvectomy more often (61.1% vs 51.8%, p=0.04). During follow-up there was a higher recurrence rate in the group with BMI ≥30 kg/m² (43.4% vs 28.3%, p<0.01) due to an increased rate of local recurrences (33.3% vs 18.5%, p<0.01). There was a significantly shorter time to recurrence in obese patients on univariate analysis (BMI ≥30 kg/m² vs <30 kg/m²: 43.8 months (95% CI 23.3 to 64.3) vs 102.3 months (95% CI 72.6 to 131.9), p=0.001) and on multivariate Cox regression analysis (HR 1.94 (95% CI 1.4 to 2.8), p<0.001).

Conclusions In this study a BMI ≥30 kg/m² was associated with a shorter time to recurrence in patients with vulvar cancer and this was mainly attributed to a higher risk of local recurrence.

  • vulvar and vaginal cancer

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  • Contributors All authors materially participated in the research. All authors were involved in article preparation and approved the final article. RK, PH, LW, SM were involved in study conception and design. RK, PH, LW, JJ, FH, NG, AH, JS, SF, HS, KB, FT, AM, WM, PH, PW, LH, BS, and SM were involved in acquisition of data. RK, PH, LW and SM were involved in analysis and interpretation of data. RK, PH, LW, and SM wrote the initial draft of the manuscript. RK, PH, LW, JJ, FH, NG, AH, JS, SF, HS, KB, FT, AM, WM, PH, PW, LH, BS, and SM were involved in critical revision.

  • Funding The CaRE-1 study was supported by medac oncology without restriction in protocol or analysis.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data are available via the AGO e.V.