Overweight and underweight women with cervical cancer did not live as long as their normal-weight counterparts, according to the results of a retrospective cohort study.

The median overall survival time in overweight/obese women was 6 months shorter than in women of normal weight (22 versus 28 months). For underweight women, median overall survival time was cut in half (14 versus 28 months), reported Leslie Clark, MD, of the University of North Carolina at Chapel Hill, and colleagues.

Being overweight or underweight, as determined by body-mass index (BMI), was also associated with worse recurrence-free survival and disease-free survival, Clark and colleagues said in Gynecologic Oncology.

“In understanding the effect of BMI on cervical cancer outcomes, it is important to recognize that both extremes of weight appear to negatively impact survival. Optimizing weight in cervical cancer patients may improve outcomes in these patients.”

The study included 632 women diagnosed with cervical cancer and treated at the university from 2000 to 2013. Their BMI was calculated using height and weight measurements taken at initial presentation to the oncology clinic. Four percent of the women were underweight (n=24), 30% were normal weight (n=191), and 66% were overweight or obese (n=417).

The investigators looked for connections between BMI at time of presentation and survival, controlling for factors including age, race, smoking, cancer stage, tumor grade, and histology.

Being overweight or obese was associated with significantly reduced median overall survival time compared with normal weight (22 versus 28 months; P=0.031). For underweight women, the reduced survival time was more dramatic (14 versus 28 months;P=0.018).

Compared with for normal-weight women, median recurrence-free survival time was also significantly shorter in obese/overweight women (7.6 versus 25 months; P=0.009) and in underweight women (20 versus 25 months; P=0.026).

There was a borderline-significant trend toward worse disease-specific survival in overweight/obese women compared with those of normal weight (22 versus 28 months; P=0.089). For underweight women, the difference was significant (14 versus 28 months; P=0.042).

Potential Underlying Mechanisms

“A potential unifying hypothesis connecting both extremes of weight to poor cancer prognosis is chronic systemic inflammation,” Clark and colleagues wrote. “Both patients with cancer cachexia/sarcopenia and overweight/obese patients are in a heightened inflammatory state, which may lead to increased cell proliferation and inhibition of apoptosis.

“However, this is likely not the only mechanism of poor outcomes. Co-morbid medical conditions might account for some of the differences in survival, particularly in morbidly obese patients.”

“This study shows that the extremes of weight are detrimental to survival in women with cervical cancer, and further investigation regarding the cause of poor prognosis is warranted. Providers should optimize weight in underweight and overweight/obese patients to attempt to improve outcomes in these women. Interventions that target nutritional counseling and physical activity should be explored in these populations,” Clark and colleagues concluded.

Corroborating Evidence

A similar study presented at the recent Society of Gynecologic Oncology meeting corroborates the results of Clark et al.

That study, conducted by Aida Moeini, MD, of the University of Southern California, Los Angeles, and colleagues, examined the effect of weight change over time on disease-free survival rates in 665 women with endometrial cancer.

At 5 years, disease-free survival had fallen well below 50% for women who had either lost or gained 15% or more of their body mass. For women in the smallest weight-change category, those who had lost or gained less than 7.5% of body mass, disease-free survival was about 80%, Moeini and colleagues reported.

“Our results demonstrated that endometrial cancer patients continued to gain weight after hysterectomy, and post-treatment weight change had a bi-directional effect on survival outcome.”