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Obesity Does Not Affect Survival Outcomes in Extremity Soft Tissue Sarcoma

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 11 July 2014

Abstract

Background

Obesity is a growing epidemic and has been associated with an increased frequency of complications after various surgical procedures. Studies also have shown adipose tissue to promote a microenvironment favorable for tumor growth. Additionally, the relationship between obesity and prognosis of soft tissue sarcomas has yet to be evaluated.

Questions/purposes

We sought to assess if (1) obesity affects survival outcomes (local recurrence, distant metastasis, and death attributable to disease) in patients with extremity soft tissue sarcomas; and (2) whether obesity affected wound healing and other surgical complications after treatment.

Methods

A BMI of 30 kg/m2 or greater was used to define obesity. Querying our prospective database between 2001 and 2008, we identified 397 patients for the study; 154 were obese and 243 were not obese. Mean followup was 4.5 years (SD, 3.1 years) in the obese group and 3.9 years (SD, 3.2 years) in the nonobese group; the group with a BMI of 30 kg/m2 or greater had a higher proportion of patients with followups of at least 2 years compared with the group with a BMI less than 30 kg/m2 (76% versus 62%). Outcomes, including local recurrence, distant metastasis, and overall survival, were analyzed after patients were stratified by BMI. Multivariable survival models were used to identify independent predictors of survival outcomes. Wilcoxon rank sum test was used to compare continuous variables. Based on the accrual interval of 8 years, the additional followup of 5 years after data collection, and the median survival time for the patients with a BMI less than 30 kg/m2 of 3 years, we were able to detect true median survival times in the patients with a BMI of 30 kg/m2 of 2.2 years or less with 80% power and type I error rate of 0.05.

Results

Patients who were obese had similar survival outcomes and wound complication rates when compared with their nonobese counterparts. Patients who were obese were more likely to have lower-grade tumors (31% versus 20%; p = 0.021) and additional comorbidities including diabetes mellitus (26% versus 7%; p < 0.001), hypertension (63% versus 38%; p < 0.001), and smoking (49% versus 37%; p = 0.027). Regression analysis confirmed that even after accounting for certain tumor characteristics and comorbidities, obesity did not serve as an independent risk factor in affecting survival outcomes.

Conclusions

Although the prevalence of obesity continues to increase and lead to many negative health consequences, it does not appear to adversely affect survival, local recurrence, or wound complication rates for patients with extremity soft tissue sarcomas.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA

    Vignesh K. Alamanda BS, David C. Moore MD, Herbert S. Schwartz MD & Ginger E. Holt MD

  2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Yanna Song MS

Authors
  1. Vignesh K. Alamanda BS
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  2. David C. Moore MD
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  3. Yanna Song MS
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  4. Herbert S. Schwartz MD
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  5. Ginger E. Holt MD
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Corresponding author

Correspondence to Ginger E. Holt MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Alamanda, V.K., Moore, D.C., Song, Y. et al. Obesity Does Not Affect Survival Outcomes in Extremity Soft Tissue Sarcoma. Clin Orthop Relat Res 472, 2799–2806 (2014). https://doi.org/10.1007/s11999-014-3714-7

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  • DOI: https://doi.org/10.1007/s11999-014-3714-7

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