Effect of obesity on survival in epithelial ovarian cancer

Abstract

In a recent report in Cancer, Pavelka et al described a provocative association between obesity and inferior survival in patients with stage III/IV ovarian cancer.1 Although the authors acknowledged the limitations of their retrospective analysis, which include very small patient numbers, they still suggested that obesity itself was the most likely explanation for this finding. Yet, what was perhaps most striking in this limited series was the observation of the high proportion of women with a body mass index (BMI) ≥30 kg/m2 who also were diabetic (23%) compared with the incidence of diabetes in individuals with a BMI <30 kg/m2 (P = .0002). It is possible to speculate that patients with diabetes may have required more, and earlier, dose reductions of the 2 neurotoxic chemotherapeutic agents (platinum/taxane) that were employed as standard chemotherapy in ovarian cancer, even if the total number of courses delivered was similar in the obese and nonobese patient populations (as stated in the article). Furthermore, because patients with ovarian cancer routinely are given corticosteroids as antiemetic agents and as prophylaxis for taxane-associated hypersensitivity reactions,2 is it possible that the known effects of this class of agents in diabetics (heightened risk of infection; worsening of blood-sugar control) had a negative impact on the ultimate outcome? Finally, because diabetes also increases the risk of heart, vascular, and renal disease, is it possible that the inferior survival was related at least in part to 1 (or more) of these important comorbidities in this patient population? Although further investigation may reveal that obesity itself is a highly relevant variable in influencing the survival of women with advanced ovarian cancer, results from the study by Pavelka et al equally may be interpreted to suggest an important negative impact of diabetes in this clinical setting. Maurie Markman M.D.*, * Department of Gynecologic Medical Oncology The University of Texas M. D. Anderson Cancer Center Houston, Texas.