Ovarian cancer is the most lethal of all gynecologic malignancies, responsible for high mortality rates worldwide. On a global scale, it ranks as the fifth most prevalent cause of cancer-related mortalities among women, exhibiting a five-year survival rate of approximately 46.5% (Cancer Statistics Review, 1975-2012 – Previous Version – SEER Cancer Statistics Review, n.d.; Malvezzi et al., 2016). In Iraq, ovarian cancer is the seventh most prevalent female cancer, with an incidence rate of 3.81 per 100,000 women, as reported by the Iraqi Cancer Registry (Al-Asadi, 2025). The most prevalent form of this disease, epithelial ovarian cancer (EOC), accounts for approximately 90% of cases and comprises diverse histopathological subtypes, including serous, mucinous, endometrioid, and clear cell carcinomas (Kurman et al., 2014). These neoplasms originate from the ovarian surface epithelium and share embryological origins with primary peritoneal carcinoma (Scully, 1999).

In its nascent stages, EOC frequently manifests with an asymptomatic profile, presenting instead with nonspecific symptoms such as abdominal distension, bloating, and urinary urgency (Abraham & Gulley, 2019; Goff et al., 2007). This clinical presentation often results in delayed diagnosis and a poor prognosis. A multitude of risk factors have been identified as contributing to the development of EOC, including age, family history, genetic predisposition—such as mutations in the BRCA1 and BRCA2 genes and Lynch syndrome—parity, hormonal factors, and lifestyle influences such as the consumption of high-fat diets and obesity (Satagopan et al., 2002; Shulman, 2010).  

Obesity, defined as a BMI of ≥30 kg/m², has been identified as a significant global public health concern and a modifiable risk factor associated with an increased risk of various cancers, including endometrial, breast, and colorectal cancers (Calle et al., 2003; Phelps et al., 2024). The role of obesity in the development and prognosis of EOC remains a subject of controversy. The extant literature on the subject is inconclusive, with some studies reporting no significant impact of obesity on ovarian cancer survival (Matthews et al., 2009; Moysich et al., 2007), while others suggest poorer outcomes in obese patients (Pavelka et al., 2006).

Given the increasing global and regional prevalence of obesity, this study aims to comprehensively evaluate the effect of BMI on clinicopathological features and survival outcomes in patients with EOC. The findings of this study will contribute valuable insights into the development of personalized cancer care strategies. Recent systematic reviews and meta-analyses have sought to elucidate the role of obesity in ovarian cancer prognosis, yielding equivocal results. Aune et al. (2016) reported an association between higher BMI and increased ovarian cancer mortality. However, other pooled analyses suggest inconsistent survival effects depending on cancer subtype, stage, and treatment context. The discordant outcomes underscore the necessity for context-specific inquiries, particularly among underrepresented populations such as Iraqi women. The objective of this study is to evaluate the impact of BMI on survival rates and clinicopathological features in patients diagnosed with epithelial ovarian cancer in Iraq.

The present study examined the relationship between body mass index (BMI) and survival outcomes in Iraqi patients with epithelial ovarian cancer (EOC). Our findings align with the conclusions of several prior studies, which also found no statistically significant association between BMI and median survival (Matthews et al., 2009; Moysich et al., 2007). While overweight and obese patients were more likely to present with advanced-stage disease (FIGO III–IV), BMI demonstrated no statistically significant association with histopathological subtype, tumor grade, or completeness of debulking surgery. However, a substantial trend toward reduced survival in obese patients was observed. Specifically, the median survival period decreased by over 30 months between patients with normal weight and those with obesity. This finding may have clinical relevance despite not reaching statistical significance, likely due to the study’s limited sample size (Bae et al., 2014; Protani et al., 2012). This finding indicates that while obesity may contribute to delayed presentation, it does not independently affect ovarian cancer prognosis when standard treatment protocols are applied. These findings imply that, while BMI does not function as an independent predictor in the present analysis, it may nevertheless exert a substantial influence on survival outcomes, potentially through indirect pathways such as treatment tolerance, comorbid conditions, or delayed diagnosis. It is imperative that future prospective studies be conducted with larger samples and comorbidity-adjusted models in order to elucidate this relationship.

In contrast to the findings of this study, some research has indicated a more unfavorable prognosis for obese patients (Bandera et al., 2017; Pavelka et al., 2006). These discrepancies may be attributable to variations in study design, patient populations, sample sizes, or confounding factors such as comorbidities. The present study’s strengths include a well-defined cohort and comprehensive follow-up. However, the study’s limitations include its retrospective design, relatively small sample size, and lack of data on comorbid conditions that might influence survival.

The elevated prevalence of advanced disease at presentation among obese patients in our cohort underscores the significance of implementing early detection strategies and awareness campaigns targeting at-risk populations. Moreover, the findings of this study lend support to the prevailing practices in which standard treatment protocols—including optimal cytoreductive surgery and full-dose taxane/platinum chemotherapy—remain unchanged based on BMI alone, in contrast to the recommendations outlined by international guidelines (e.g., ASCO, NCCN) (Wright et al., 2016).

While obesity has been associated with delayed diagnosis and higher disease burden, its impact on EOC prognosis requires further investigation. Large, prospective multicenter studies that incorporate comprehensive data on comorbidities and treatment adherence are necessary to further examine this relationship. Maintaining a healthy weight should be regarded as a pivotal public health concern, with implications for both cancer prevention and the promotion of overall health.