Abstract：
OBJECTIVE: Obesity is known to be both a major risk factor for endometrial cancer and associated with surgical complexity. Therefore, the management of patients with obesity is a challenge for surgeons and oncologists. The aim of this study is to assess the adherence to European Society of Gynaecological Oncology (ESGO) guidelines in morbidly obese patients (body mass index (BMI) >40 kg/m2). The secondary objectives were the impact on overall survival and recurrence-free survival.
METHODS: All the patients who were treated for an endometrial cancer in the 11 cancer institutes of the FRANCOGYN group were included and classified into three weight groups: morbid (BMI >40 kg/m2), obese (BMI 30-40), and normal or overweight (BMI <30). Adherence to guidelines was evaluated for surgical management, lymph node staging, and adjuvant therapies.
RESULTS: In total, 2375 patients were included: 1330 in the normal or overweight group, 763 in the obese group, and 282 in the morbid group. The surgical management of the morbid group was in accordance with the guidelines in only 30% of cases, compared with 44% for the obese group and 48% for the normal or overweight group (p<0.001); this was largely because of a lack of lymph node staging. Morbid group patients were more likely to receive the recommended adjuvant therapy (61%) than the obese group (52%) or the normal or overweight group (46%) (p<0.001). Weight had no impact on overall survival (p=0.6) and morbid group patients had better recurrence-free survival (p=0.04).
CONCLUSIONS: Adherence to international guidelines for surgical management is significantly lower in morbid group patients, especially for lymph node staging. However, morbidly obese patients had more often the adequate adjuvant therapies. Morbid group patients had a better recurrence-free survival likely because of better prognosis tumors.
METHODS: All the patients who were treated for an endometrial cancer in the 11 cancer institutes of the FRANCOGYN group were included and classified into three weight groups: morbid (BMI >40 kg/m2), obese (BMI 30-40), and normal or overweight (BMI <30). Adherence to guidelines was evaluated for surgical management, lymph node staging, and adjuvant therapies.
RESULTS: In total, 2375 patients were included: 1330 in the normal or overweight group, 763 in the obese group, and 282 in the morbid group. The surgical management of the morbid group was in accordance with the guidelines in only 30% of cases, compared with 44% for the obese group and 48% for the normal or overweight group (p<0.001); this was largely because of a lack of lymph node staging. Morbid group patients were more likely to receive the recommended adjuvant therapy (61%) than the obese group (52%) or the normal or overweight group (46%) (p<0.001). Weight had no impact on overall survival (p=0.6) and morbid group patients had better recurrence-free survival (p=0.04).
CONCLUSIONS: Adherence to international guidelines for surgical management is significantly lower in morbid group patients, especially for lymph node staging. However, morbidly obese patients had more often the adequate adjuvant therapies. Morbid group patients had a better recurrence-free survival likely because of better prognosis tumors.
摘要：
目的：已知肥胖既是子宫内膜癌的主要危险因素，也与手术复杂性相关。因此,肥胖患者的管理对外科医生和肿瘤学家来说是一个挑战.这项研究的目的是评估病态肥胖患者（体重指数（BMI）>40kg/m2）对欧洲妇科肿瘤学会（ESGO）指南的遵守情况。次要目标是对总生存期和无复发生存期的影响。
方法：所有在FRANCOGYN组的11个癌症研究所接受子宫内膜癌治疗的患者均被纳入，并分为三个体重组：病态（BMI>40kg/m2），肥胖（BMI30-40），正常或超重（BMI<30）。对手术治疗指南的依从性进行了评估，淋巴结分期,和辅助治疗。
结果：总计，包括2375例患者：正常或超重组1330例，肥胖组763人，病态组282人。病态组的手术治疗仅在30％的病例中符合指南，肥胖组为44%,正常或超重组为48%(p<0.001);这主要是因为缺乏淋巴结分期.与肥胖组（52%）或正常或超重组（46%）相比，病态组患者更有可能接受推荐的辅助治疗（61%）（p<0.001）。体重对总生存率没有影响（p=0.6），病态组患者的无复发生存率更好（p=0.04）。
结论：病态组患者对国际外科治疗指南的依从性明显较低，尤其是淋巴结分期.然而,病态肥胖患者更经常接受适当的辅助治疗.病态组患者的无复发生存率较好，可能是由于肿瘤预后较好。
方法：所有在FRANCOGYN组的11个癌症研究所接受子宫内膜癌治疗的患者均被纳入，并分为三个体重组：病态（BMI>40kg/m2），肥胖（BMI30-40），正常或超重（BMI<30）。对手术治疗指南的依从性进行了评估，淋巴结分期,和辅助治疗。
结果：总计，包括2375例患者：正常或超重组1330例，肥胖组763人，病态组282人。病态组的手术治疗仅在30％的病例中符合指南，肥胖组为44%,正常或超重组为48%(p<0.001);这主要是因为缺乏淋巴结分期.与肥胖组（52%）或正常或超重组（46%）相比，病态组患者更有可能接受推荐的辅助治疗（61%）（p<0.001）。体重对总生存率没有影响（p=0.6），病态组患者的无复发生存率更好（p=0.04）。
结论：病态组患者对国际外科治疗指南的依从性明显较低，尤其是淋巴结分期.然而,病态肥胖患者更经常接受适当的辅助治疗.病态组患者的无复发生存率较好，可能是由于肿瘤预后较好。
