Impact of underweight after treatment on prognosis of advanced-stage ovarian cancer

Abstract

Objective: To investigate the impact of underweight on prognosis of advanced-stage ovarian cancer. Methods: Total 360 patients with stage III-IV ovarian cancer were enrolled, and divided into three groups by body mass indexes (BMIs): underweight (BMI <18.5 kg/m2)

normal weight to overweight (18.5 kg/m2≤ BMI <27.5 kg/m2)

obesity (BMI ≥27.5 kg/m2). Progression-free survival (PFS), overall survival (OS), CA-125, and neutrophil to lymphocyte ratio (NLR) as a marker reflecting host inflammation and immunity were compared among the three groups according to three treatment times: at diagnosis

after surgery

after treatment. Results: Only underweight after treatment was associated with poor OS in comparison with normal weight to overweight or obesity (mean value, 44.9 vs. 78.8 or 67.4 months

P=0.05), and it was also an unfavorable factor for OS (adjusted HR, 2.29

95% CI, 1.08-4.85). Furthermore, NLR was higher in patients with underweight than in those with obesity after treatment (median value, 2.15 vs. 1.47

P=0.03), in spite of no difference in CA-125 among the three groups at the three treatment times. In only 29 patients with underweight after treatment, the success rate of optimal debulking surgery was higher in those with weight loss <10% than in those with weight loss ≥10% (83.3% vs. 36.4%

P=0.02), and weight loss ≥10% was a poor prognostic factor for PFS and OS (adjusted HRs, 6.90 and 15.27

95% CIs, 1.51-31.54 and 1.42-164.5). Conclusions: Underweight after treatment may be a poor prognostic factor in patients with advanced-stage ovarian cancer, which accompanies increased host inflammation and decreased immunity.