The Effects of Body Mass Index on Complications and Survival Outcomes in Patients With Cervical Carcinoma Undergoing Curative Chemoradiation Therapy

BACKGROUND: The effect of body mass index (BMI) on treatment outcomes for patients with locally advanced cervical carcinoma who receive definitive chemoradiation is unclear. METHODS: The cohort in this study included all patients with cervical carcinoma (n = 404) who had stage IB1 disease and positive lymph nodes or stage >= IB2 disease and received treatment at the authors' facility between January 1998 and January 2008. The mean follow-up was 47.2 months. BMI was calculated using the National Institute of Health online calculator. BMI categories were created according to the World Health Organization classification system. Primary outcomes were overall survival, disease-free survival, and complication rate. Univariate and multivariate analyses were performed. Kaplan-Meier survival curves were generated and compared using Cox proportional hazard models. RESULTS: On multivariate analysis, compared with normal weight (BMI 18.5-24.9 kg/m(2)), a BMI <18.5 kg/m(2) was associated with decreased overall survival (hazard ratio, 2.37; 95% confidence interval, 1.28-4.38; P<.01). The 5-year overall survival rate was 33%, 60%, and 68% for a of BMI <18.5 kg/m(2), a BMI from 18.5 kg/m(2) to 24.9 kg/m(2), and a BMI >24.9 kg/m(2), respectively. A BMI <18.5 kg/m(2) was associated with increased risk of grade 3 or 4 complications compared with a BMI >24.9 kg/m(2) (radiation enteritis: 16.7% vs 13.6%, respectively; P=.03; fistula: 11.1% vs 8.8%, respectively; P=.05; bowel obstruction: 33.3% vs 4.4%, respectively; P<.001; lymphedema: 5.6% vs 1.2%, respectively; P=.02). CONCLUSIONS: Underweight patients (BMI <18.5 kg/m(2)) with locally advanced cervical cancer had diminished overall survival and more complications than normal weight and obese patients. Cancer 2011;117:948-56. (C) 2010 American Cancer Society