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The impact of body mass index on oncological outcomes in colorectal cancer patients with curative intent

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Abstract

Background

Excess body weight is associated with a risk of several malignancies, including colon cancer. However, the oncological significance of evaluating body mass index (BMI) preoperatively in colorectal cancer (CRC) patients undergoing curative surgery has not been fully evaluated.

Methods

Clinicopathological findings including BMI and laboratory data [carcinoembryonic antigen (CEA) and neutrophil/lymphocyte ratio (NLR)] from 358 curative CRC patients (open surgery group: n = 157; laparoscopic surgery group: n = 201) were assessed as indicators of survival outcome. BMI <20 was defined as underweight in both groups.

Results

Not all categories of pathological findings were associated with BMI in both groups. Patients with BMI <20 showed significant poorer overall survival (OS) in the open surgery group. In addition, patients with BMI <20 in the laparoscopic surgery group were also significantly worse in OS and disease-free survival (DFS). Furthermore, multivariate analysis demonstrated that BMI was validated as independent predictors for OS and DFS in both groups. BMI had a significant negative correlation with NLR, which reflects host immune response in both groups.

Conclusions

Lower BMI is a promising predictor of recurrence and prognosis in curative CRC patients.

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References

  1. Renehan AG, Tyson M, Egger M et al (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371:569–578

    Article  PubMed  Google Scholar 

  2. Gilbert CA, Slingerland JM (2013) Cytokines, obesity, and cancer: new insights on mechanisms linking obesity to cancer risk and progression. Annu Rev Med 64:45–57

    Article  CAS  PubMed  Google Scholar 

  3. Calle EE, Kaaks R (2004) Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 4:579–591

    Article  CAS  PubMed  Google Scholar 

  4. Matsuda M, Shimomura I (2013) Increased oxidative stress in obesity: implications for metabolic syndrome, diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Obes Res Clin Pract 7:e330–e341

    Article  PubMed  Google Scholar 

  5. Sparano JA, Wang M, Zhao F et al (2012) Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer (Phila) 118:5937–5946

    Article  CAS  Google Scholar 

  6. Ho T, Gerber L, Aronson WJ et al (2012) Obesity, prostate-specific antigen nadir, and biochemical recurrence after radical prostatectomy: biology or technique? Results from the SEARCH database. Eur Urol 62:910–916

    Article  PubMed  PubMed Central  Google Scholar 

  7. Leroy J, Ananian P, Rubino F et al (2005) The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg 241:69–76

    PubMed  PubMed Central  Google Scholar 

  8. Nitori N, Hasegawa H, Ishii Y et al (2009) Impact of visceral obesity on short-term outcome after laparoscopic surgery for colorectal cancer: a single Japanese center study. Surg Laparosc Endosc Percutan Tech 19:324–327

    Article  PubMed  Google Scholar 

  9. Park JW, Lim SW, Choi HS et al (2010) The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians. Surg Endosc 24:1679–1685

    Article  PubMed  Google Scholar 

  10. Schwandner O, Farke S, Schiedeck TH et al (2004) Laparoscopic colorectal surgery in obese and nonobese patients: do differences in body mass indices lead to different outcomes? Surg Endosc 18:1452–1456

    Article  CAS  PubMed  Google Scholar 

  11. Lascano CA, Kaidar-Person O, Szomstein S et al (2006) Challenges of laparoscopic colectomy in the obese patient: a review. Am J Surg 192:357–365

    Article  PubMed  Google Scholar 

  12. Takeuchi K, Kuwano H, Tsuzuki Y et al (2004) Clinicopathological characteristics of poorly differentiated adenocarcinoma of the colon and rectum. Hepatogastroenterology 51:1698–1702

    PubMed  Google Scholar 

  13. Sugao Y, Yao T, Kubo C et al (1997) Improved prognosis of solid-type poorly differentiated colorectal adenocarcinoma: a clinicopathological and immunohistochemical study. Histopathology (Oxf) 31:123–133

    Article  CAS  Google Scholar 

  14. Hyngstrom JR, Hu CY, Xing Y et al (2012) Clinicopathology and outcomes for mucinous and signet ring colorectal adenocarcinoma: analysis from the National Cancer Data Base. Ann Surg Oncol 19:2814–2821

    Article  PubMed  PubMed Central  Google Scholar 

  15. Giakoustidis A, Neofytou K, Khan AZ et al (2015) Neutrophil to lymphocyte ratio predicts pattern of recurrence in patients undergoing liver resection for colorectal liver metastasis and thus the overall survival. J Surg Oncol 111:445–450

    Article  PubMed  Google Scholar 

  16. Chang Z, Zheng J, Ma Y et al (2014) The neutrophil-to-lymphocyte ratio as a predictor for recurrence of colorectal liver metastases following radiofrequency ablation. Med Oncol 31:855

    Article  PubMed  Google Scholar 

  17. Shibutani M, Maeda K, Nagahara H et al (2013) A high preoperative neutrophil-to-lymphocyte ratio is associated with poor survival in patients with colorectal cancer. Anticancer Res 33:3291–3294

    PubMed  Google Scholar 

  18. Kalantar-Zadeh K, Horwich TB, Oreopoulos A et al (2007) Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care 10:433–442

    Article  PubMed  Google Scholar 

  19. Flegal KM, Kit BK, Orpana H et al (2013) Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 309:71–82

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Hakimi AA, Furberg H, Zabor EC et al (2013) An epidemiologic and genomic investigation into the obesity paradox in renal cell carcinoma. J Natl Cancer Inst 105:1862–1870

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Sinicrope FA, Foster NR, Yothers G et al (2013) Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer (Phila) 119:1528–1536

    Article  CAS  Google Scholar 

  22. Fridlender ZG, Albelda SM (2012) Tumor-associated neutrophils: friend or foe? Carcinogenesis (Oxf) 33:949–955

    Article  CAS  Google Scholar 

  23. Fridman WH, Pages F, Sautes-Fridman C et al (2012) The immune contexture in human tumours: impact on clinical outcome. Nat Rev Cancer 12:298–306

    Article  CAS  PubMed  Google Scholar 

  24. Wein A, Hahn EG, Merkel S et al (2000) Adjuvant chemotherapy for stage II (Dukes’ B) colon cancer: too early for routine use. Eur J Surg Oncol 26:730–732

    Article  CAS  PubMed  Google Scholar 

  25. Haller DG (1995) An overview of adjuvant therapy for colorectal cancer. Eur J Cancer 31A:1255–1263

    Article  CAS  PubMed  Google Scholar 

  26. Benson AB 3rd, Schrag D, Somerfield MR et al (2004) American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22:3408–3419

    Article  PubMed  Google Scholar 

  27. Schmoll HJ, Van Cutsem E, Stein A et al (2012) ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol 23:2479–2516

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Tsu, Mie, 514-8507, Japan

    Yuji Toiyama, Junichiro Hiro, Tadanobu Shimura, Hiroyuki Fujikawa, Masaki Ohi, Koji Tanaka, Yasuhiro Inoue, Yasuhiko Mohri & Masato Kusunoki

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  1. Yuji Toiyama
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  2. Junichiro Hiro
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  3. Tadanobu Shimura
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  4. Hiroyuki Fujikawa
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  5. Masaki Ohi
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  6. Koji Tanaka
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  7. Yasuhiro Inoue
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  8. Yasuhiko Mohri
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  9. Masato Kusunoki
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Correspondence to Yuji Toiyama.

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The authors have no conflicts of interest to disclose.

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Toiyama, Y., Hiro, J., Shimura, T. et al. The impact of body mass index on oncological outcomes in colorectal cancer patients with curative intent. Int J Clin Oncol 21, 1102–1110 (2016). https://doi.org/10.1007/s10147-016-1016-7

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  • DOI: https://doi.org/10.1007/s10147-016-1016-7

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