Impact of severe obesity in the management of patients with high-risk endometrial cancer: A FRANCOGYN study

Objective: To assess the surgical management and survival of severely obese patients with high-risk endometrial cancer.

Materials and methods: Data from 269 patients with high-risk endometrial cancer who were treated between 2001 and 2018 were collected from a multicenter database (11 centers). We classified the patients according to their BMI and compared outcomes in two groups: a normal weight group of women with a BMI < 25 kg/m², and a severe obesity group of women with a BMI ≥ 35 kg/m². The groups were compared for epidemiologic, pathologic, management, relapse-free survival (RFS) and overall survival (OS) elements.

Results: Patients in the severe obesity group were younger (64 years vs. 68 years, p < 0.05) and had more comorbidities (hypertension, diabetes). They also had more locally advanced tumors and pelvic lymph node involvement (47% vs 24%, p < 0.05). The severely obese patients were less likely to undergo recommended surgical staging, with fewer lumbar aortic dissections than women of normal weight (23% vs 36%, p < 0.05) and fewer pelvic sentinel lymph node biopsies (26.5% vs 12.1%, p < 0.05). No difference in RFS or OS were observed between the two groups.

Conclusion: Patients with severe obesity and high-risk endometrial cancer have more locally advanced tumors, and are less likely to be managed according to surgical recommendations. However, RFS and OS do not seem to be affected.