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Obesity paradox: is a high body mass index positively influencing survival outcomes in gynecological cancers? A systematic review and meta-analysis
    1. 1Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
    2. 2UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
    3. 3Research Institute against Digestive Cancer, IRCAD France, Strasbourg, France
    4. 4Department of Medical and Surgical Science and Translational Medicine, Faculty of Medicine and Psycology, 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. 7Department of Gynecology, Hôpitaux universitaires de Strasbourg, Strasbourg, France
    8. 8Department of Digestive and Endocrine Surgery, The University Hospitals of Strasbourg, Strasbourg, France
    1. Correspondence to Dr Matteo Pavone, Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, 67091, France; matteopavone.21{at}gmail.com

    Abstract

    Objective Obesity represents an exponentially growing preventable disease leading to different health complications, particularly when associated with cancer. 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.

    Methods This study adheres to PRISMA guidelines and is registered with PROSPERO. Studies reporting the impact of a body mass index (BMI) of >30 kg/m2 compared with <30 kg/m2 in patients with gynecological cancers listed in 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 of the selected articles.

    Results Twenty-one studies were identified for the meta-analysis, including 14 108 patients with cervical, ovarian, or endometrial cancer. There was no benefit in 5-year overall survival for obese patients compared with non-obese patients (OR 1.2, 95% CI 1.00 to 1.44, p=0.05; I2=71%). When pooling for cancer sub-groups, there were no statistically significant differences in 5-year overall survival in patients with cervical cancer and 5-year overall survival and progression-free survival in patients with ovarian cancer. For obese women diagnosed with endometrial cancer, a significant decrease of 44% in 5-year overall survival (p=0.01) was found, with no significant difference in 5-year disease-free survival (p=0.78).

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

    • Obesity, Morbid
    • Cervical Cancer
    • Ovarian Cancer
    • Endometrial Neoplasms

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. We will provide our data for independent analysis by a selected team or for additional data analysis or for the reproducibility of this study in other centers if such is requested.

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. We will provide our data for independent analysis by a selected team or for additional data analysis or for the reproducibility of this study in other centers if such is requested.

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    Footnotes

    • X @frafanfani, @annafagottimd

    • Contributors Study design: MP, CA. Literature search: MP, MG, CT. Manuscript drafting: MP, MG, LL, NB, BS. Critical revision of the manuscript: AF, FF, GS, JM, DQ, CA. Statistical analysis: MP, MG. Guarantor: CA. All authors approved the final version of the manuscript for submission.

    • Funding This work was supported by French state funds managed within the “Plan Investissements d’Avenir” and by the ANR (reference ANR-10-IAHU-02).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.