The Impact of Obesity on Survival in Iraqi Patients with Epithelial Ovarian Cancer

• Reem Mohammed Jawad

  AlAmal National Hospital, Baghdad, Iraq.

• Adil S Aqabi

  Baghdad Teaching Hospital, Baghdad, Iraq.

• Zeineb Adnan

  AlAmal National Hospital, Baghdad, Iraq.

Ovarian cancer is the leading cause of gynecological cancer death and is the fifth most common cause of cancer-related death. Ovarian neoplasms are comprised of several distinct histopathology entities, with epithelial ovarian cancer accounting for 90% of all cases of malignant tumors of ovarian origin. Despite the mounting health concerns associated with obesity and its reported correlation with elevated mortality from certain forms of cancer, the association between obesity and ovarian cancer remains less delineated. The objective of this study is to ascertain the impact of excess body weight on survival outcomes and clinicopathological features of EOC in Iraqi patients. A retrospective study of 112 EOC patients was conducted at the Oncology Teaching Hospital in Baghdad. The data collected encompassed a wide range of variables, including age, BMI, histopathology, tumor grade, FIGO stage, surgical debulking method, and survival time. Kaplan-Meier and log-rank tests were used for survival analysis.

Of the 112 patients included in the study, 50% were classified as overweight, 25% as obese, and 25% as having a normal BMI. Patients with obesity exhibited more advanced stages of the condition. The investigation revealed no substantial correlation between BMI and tumor grade, histopathology, or surgical outcomes. The median survival period was found to be 57 months in the normal weight group, 52 months in the overweight group, and 26 months in the obese group. P=0.15. Despite the absence of a statistically significant correlation between BMI and survival outcomes (p = 0.15), a clinically notable trend was observed, with obese patients demonstrating a reduced median survival duration. These findings suggest that while BMI alone may not be an independent prognostic factor, its potential clinical impact warrants further investigation in larger, adequately powered studies.

Abraham, Jame., & Gulley, J. L. . (2019). The Bethesda handbook of clinical oncology. Wolters Kluwer.

Al-Asadi, J. N. (2025). Breast and Ovarian Cancers’ Incidence Trends Among Iraqi Women During 2012–2022 and Their Relationship to Fertility Patterns. Sultan Qaboos University Medical Journal, 25(1), 499–505. https://doi.org/10.18295/2075-0528.2863

Aune, D., Sen, A., Prasad, M., Norat, T., Janszky, I., Tonstad, S., Romundstad, P., & Vatten, L. J. (2016). BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ, i2156. https://doi.org/10.1136/bmj.i2156

Bae, H. S., Hong, J. H., Ki, K.-D., Song, J. Y., Shin, J. W., Lee, J. M., Lee, J. K., Lee, N. W., Lee, C., Lee, K. W., & Kim, Y. M. (2014). The Effect of Body Mass Index on Survival in Advanced Epithelial Ovarian Cancer. Journal of Korean Medical Science, 29(6), 793. https://doi.org/10.3346/jkms.2014.29.6.793

Bandera, E. V, Lee, V. S., Qin, B., Rodriguez-Rodriguez, L., Powell, C. B., & Kushi, L. H. (2017). Impact of body mass index on ovarian cancer survival varies by stage. British Journal of Cancer, 117(2), 282–289. https://doi.org/10.1038/bjc.2017.162

Calle, E. E., Rodriguez, C., Walker-Thurmond, K., & Thun, M. J. (2003). Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults. New England Journal of Medicine, 348(17), 1625–1638. https://doi.org/10.1056/NEJMoa021423

Cancer Statistics Review, 1975-2012 - Previous Version - SEER Cancer Statistics Review. (n.d.). https://seer.cancer.gov/archive/csr/1975_2012/

Goff, B. A., Mandel, L. S., Drescher, C. W., Urban, N., Gough, S., Schurman, K. M., Patras, J., Mahony, B. S., & Andersen, M. R. (2007). Development of an ovarian cancer symptom index. Cancer, 109(2), 221–227. https://doi.org/10.1002/cncr.22371

Kurman, R. J., Carcangiu, M. L., Herrington, C. S., & Young, R. H. (2014). WHO classification of tumours of female reproductive organs. International Agency for Research on Cancer.

Malvezzi, M., Carioli, G., Rodriguez, T., Negri, E., & La Vecchia, C. (2016). Global trends and predictions in ovarian cancer mortality. Annals of Oncology, 27(11), 2017–2025. https://doi.org/10.1093/annonc/mdw306

Matthews, K. S., Straughn, J. M., Kemper, M. K., Hoskins, K. E., Wang, W., & Rocconi, R. P. (2009). The effect of obesity on survival in patients with ovarian cancer. Gynecologic Oncology, 112(2), 389–393. https://doi.org/10.1016/j.ygyno.2008.10.016

Moysich, K. B., Baker, J. A., Menezes, R. J., Jayaprakash, V., Rodabaugh, K. J., Odunsi, K., Beehler, G. P., McCann, S. E., & Villella, J. A. (2007). Usual Adult Body Mass Index Is Not Predictive of Ovarian Cancer Survival. Cancer Epidemiology, Biomarkers & Prevention, 16(3), 626–628. https://doi.org/10.1158/1055-9965.EPI-06-1052

Pavelka, J. C., Brown, R. S., Karlan, B. Y., Cass, I., Leuchter, R. S., Lagasse, L. D., & Li, A. J. (2006). Effect of obesity on survival in epithelial ovarian cancer. Cancer, 107(7), 1520–1524. https://doi.org/10.1002/cncr.22194

Phelps, N. H., Singleton, R. K., Zhou, B., Heap, R. A., Mishra, A., Bennett, J. E., Paciorek, C. J., Lhoste, V. P., Carrillo-Larco, R. M., Stevens, G. A., Rodriguez-Martinez, A., Bixby, H., Bentham, J., Di Cesare, M., Danaei, G., Rayner, A. W., Barradas-Pires, A., Cowan, M. J., Savin, S., … Ezzati, M. (2024). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. The Lancet, 403(10431), 1027–1050. https://doi.org/10.1016/S0140-6736(23)02750-2

Protani, M. M., Nagle, C. M., & Webb, P. M. (2012). Obesity and Ovarian Cancer Survival: A Systematic Review and Meta-analysis. Cancer Prevention Research, 5(7), 901–910. https://doi.org/10.1158/1940-6207.CAPR-12-0048

Satagopan, J. M., Boyd, J., Kauff, N. D., Robson, M., Scheuer, L., Narod, S., & Offit, K. (2002). Ovarian cancer risk in Ashkenazi Jewish carriers of BRCA1 and BRCA2 mutations. Clinical Cancer Research : An Official Journal of the American Association for Cancer Research, 8(12), 3776–3781.

Scully, R. E. (1999). Histological Typing of Ovarian Tumours. Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-642-58564-7

Shulman, L. P. (2010). Hereditary Breast and Ovarian Cancer (HBOC): Clinical Features and Counseling for BRCA1 and BRCA2, Lynch Syndrome, Cowden Syndrome, and Li-Fraumeni Syndrome. Obstetrics and Gynecology Clinics of North America, 37(1), 109–133. https://doi.org/10.1016/j.ogc.2010.03.003

Wright, A. A., Bohlke, K., Armstrong, D. K., Bookman, M. A., Cliby, W. A., Coleman, R. L., Dizon, D. S., Kash, J. J., Meyer, L. A., Moore, K. N., Olawaiye, A. B., Oldham, J., Salani, R., Sparacio, D., Tew, W. P., Vergote, I., & Edelson, M. I. (2016). Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. Gynecologic Oncology, 143(1), 3–15. https://doi.org/10.1016/j.ygyno.2016.05.022

• HTML
• PDF

• Epidemiology and Public Health

Copyright (c) 2025 Reem Mohammed Jawad, Adil S Aqabi, Zeineb Adnan

This work is licensed under a Creative Commons Attribution 4.0 International License.