Obesity and Lymphovascular Invasion in Women with Uterine Endometrioid Carcinoma

Aim: Obesity is classically linked to type I endometrial cancer (EC). Lymphovascular invasion (LVI) is a well-known adverse prognostic factor in EC. In other disease sites, it has been reported that obesity and LVI are strongly associated. The objective of the present study was to investigate the association between obesity and LVI in women with EC. Patients and Methods: For this Institutional Review Board (IRB)-approved study, we reviewed our prospectively-maintained uterine cancer database of 1,950 patients with EC International Federation of Gynecology and Obstetrics (FIGO) stages I-IV who underwent hysterectomy from 1/1988 through 12/2011. Bivariate and multivariate analyses were conducted to investigate the relationships between obesity, as measured by body mass index (BMI) at the time of hysterectomy and tumor features including LVI. Results: A total of 1,341 patients with uterine endometrioid carcinoma were identified. All patients underwent hysterectomy, and salpingoophrectomy with or without lymph node dissection. The median BMI for study patients was 34.3 (range= 15.7-71.3) kg/m(2). 46.8% of the patients were morbidly obese. 625 patients (46.7%) were < 60 years at diagnosis with a median BMI of 36.31 (range= 19.7-69.8) kg/m(2) while the median BMI for women 61 years or older was 32.2 (15.7-71.3) kg/m(2) (p= 0.002). In univariate analyses, high BMI was not significantly associated with LVI. In multivariate analyses, higher BMI was independently associated with younger age at diagnosis (odd ratio (OR)= 0.97, 95% confidence interval (CI)= 0.96-9.97) and the presence of lower tumor FIGO grade (OR= 0.98, 95% CI= 0.97-0.99). Conclusion: Increased BMI was significantly associated with lower tumor grade and younger patient age at diagnosis. Increased body mass index was not associated with LVI. The higher prevalence of obesity in young women with EC is alarming.