Obesity contributes to the stealth peritoneal dissemination of ovarian cancer: a multi-institutional retrospective cohort study
Shohei Iyoshi
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Spemann Graduate School of Biology and Medicine, University of Freiburg, Freiburg, Germany
Search for more papers by this authorAsami Sumi
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Department of Obstetrics and Gynecology, Tosei General Hospital, Seto, Japan
Search for more papers by this authorCorresponding Author
Masato Yoshihara
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence
Masato Yoshihara, Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.
Email: [email protected]
Search for more papers by this authorKazuhisa Kitami
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
Search for more papers by this authorKazumasa Mogi
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorKaname Uno
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Division of Clinical Genetics, Department of Laboratory Medicine, Lund University Graduate School of Medicine, Lund, Sweden
Search for more papers by this authorHiroki Fujimoto
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Discipline of Obstetrics and Gynaecology, Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
Search for more papers by this authorEmiri Miyamoto
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorSho Tano
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorNobuhisa Yoshikawa
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorRyo Emoto
Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorShigeyuki Matsui
Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorHiroaki Kajiyama
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorShohei Iyoshi
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Spemann Graduate School of Biology and Medicine, University of Freiburg, Freiburg, Germany
Search for more papers by this authorAsami Sumi
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Department of Obstetrics and Gynecology, Tosei General Hospital, Seto, Japan
Search for more papers by this authorCorresponding Author
Masato Yoshihara
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence
Masato Yoshihara, Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.
Email: [email protected]
Search for more papers by this authorKazuhisa Kitami
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
Search for more papers by this authorKazumasa Mogi
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorKaname Uno
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Division of Clinical Genetics, Department of Laboratory Medicine, Lund University Graduate School of Medicine, Lund, Sweden
Search for more papers by this authorHiroki Fujimoto
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Discipline of Obstetrics and Gynaecology, Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
Search for more papers by this authorEmiri Miyamoto
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorSho Tano
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorNobuhisa Yoshikawa
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorRyo Emoto
Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorShigeyuki Matsui
Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorHiroaki Kajiyama
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorShohei Iyoshi and Asami Sumi contributed equally to this work.
Funding information: The present study was supported by the Japan Society for the Promotion of Science (JSPS) Grants-in-Aid for Scientific Research (KAKENHI): grant numbers 19H03797 and 20H03824.
Abstract
Objective
The clinical significance of a higher BMI on the prognosis of ovarian cancer remains controversial; therefore, a more detailed analysis is demanded. This study investigated the impact of BMI on peritoneum-specific recurrence to clarify the involvement of adipose tissue in the proliferation of cancer cells at sites of peritoneal dissemination.
Methods
Among 4,730 patients with malignant ovarian tumors, 280 diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IIIC epithelial ovarian cancer and who underwent complete resection in the primary surgery were included in the present study.
Results
There were 42, 201, and 37 women in the low, normal, and high BMI groups, respectively. Peritoneum-specific recurrence-free survival and overall survival were both significantly shorter in patients with a high BMI than in those with a normal BMI (p = 0.028 and 0.018, respectively). No significant differences were observed in the distribution of sites of recurrence between these two groups. A multivariate analysis identified obesity as an independent prognostic factor in addition to pT3 tumor staging and positive ascites cytology.
Conclusions
Patients with a high BMI had a significantly worse prognosis than those with a normal BMI, and peritoneal adipose tissue may have contributed to this difference.
CONFLICT OF INTEREST
The authors declared no conflict of interest.
Supporting Information
| Filename | Description |
|---|---|
| oby23497-sup-0001-Supinfo.pdfPDF document, 2.4 MB | Table S1 Baseline characteristics of patients in each BMI categories. Table S2 Multivariate analysis for recurrence-free and overall survival. Figure S1 (A-C) Kaplan–Meier curves for peritoneum-specific recurrence-free, recurrence-free, and overall survival in patients with epithelial ovarian cancer who were diagnosed with pT2b-3c tumors and underwent complete resection in the primary surgery in each BMI category. P values were estimated by the logrank test. Figure S2 (A,B) Kaplan–Meier curves for all-cause recurrence-free and recurrence-after survival in patients with epithelial ovarian cancer with a normal or high BMI who were diagnosed with pT2b-3c tumors and underwent complete resection in the primary. P values were estimated by the logrank test. Figure S3 Adjusted ratios for the site of recurrence in patients with and without positive ascites cytology are shown as a Venn diagram. p values were estimated by the χ2 test. Figure S4 (A) Representative macroscopic images of mesenterium dissemination of OvCa. The area marked by the black square in left is magnified in right. Scale bar = 10 mm. (B) Representative HE staining of OvCa peritoneal dissemination, indicating the existence of adipocytes within sub-mesothelial connective tissue. The area marked by the red square in left is magnified in right. A: adipocytes, T: tumor. Scale bars = 1 mm for left panel and 100 μm for right panel. HE, hematoxylin and eosin; OvCa, ovarian cancer. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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