Clinical implications of overweight regarding response and survival in locally advanced cervical cancers treated with curative chemoradiation: a retrospective and multi-institutional research

A multi-institutional investigation was conducted to investigate the impacts of overweight on the outcomes of locally advanced cervical cancers (LACC) treated by curative chemoradiation. Based on their body mass index (BMI), the patients were classified into an overweight (BMI, 25-29.9) or normal (BMI, 18.5-24.9) group. Parametric statistics were used to balance their baseline and treatment-related characteristics. The primary outcome was tumor response, and secondary outcomes were overall survival (OS) and disease-free survival (DFS). Univariate and multivariate logistic regressions were performed to test the contribution of overweight as a risk factor. Of the 707 patients enrolled, 228 were assigned to the overweight group and 479 to the normal group. The findings showed that the objective response rate (ORR) and disease control rate (DCR) of the overweight group was notably decreased as compared to normal group (50.0% vs. 58.5%, p = 0.03; 67.1% vs. 76.2%, p = 0.01, respectively). The median DFS of the overweight and normal groups were 34.0 and 35.0 months, respectively, with an hazard rate (HR) of 1.09 (95% confidence interval (CI): 0.87-1.36, p = 0.42). Moreover, the median OS of the overweight and normal groups were 49.0 and 52.0 months, respectively, with an HR of 1.22 (95% CI: 0.97-1.53, p = 0.06). Univariate analysis revealed that overweight was independently associated with poor ORR (odds ratio (OR): 0.710, 95% CI: 0.517-0.975; p = 0.035) and DCR (OR: 0.629, 95% CI: 0.444-0.891; p = 0.009), which was confirmed in multivariate logistic regression (OR: 0.564, 95% CI: 0.402-0.793, p = 0.001; OR: 0.513, 95% CI: 0.354-0.742, p = 0.001, respectively). To be summarized, overweight is characterized as an independent factor of poor response for curative chemoradiation, underscoring the importance of stratifying patients based on BMI during the LACC treatment process.