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Adiposity and cancer survival: a systematic review and meta-analysis

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Abstract

Purpose

The increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies examining the relationship of visceral, subcutaneous, and overall adiposity to cancer survival. To summarize this emerging body of literature, we conducted a systematic review and meta-analysis of imaging-measured as well as anthropometric proxies for adipose tissue distribution and cancer survival across a wide range of cancer types.

Methods

Using keywords related to adiposity, cancer, and survival, we conducted a systematic search of the literature in PubMed and MEDLINE, Embase, and Web of Science Core Collection databases from database inception to 30 June 2021. We used a random-effect method to calculate pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) within each cancer type and tested for heterogeneity using Cochran’s Q test and the I2 test.

Results

We included 203 records for this review, of which 128 records were utilized for quantitative analysis among 10 cancer types: breast, colorectal, gastroesophageal, head and neck, hepatocellular carcinoma, lung, ovarian, pancreatic, prostate, and renal cancer. We found that imaging-measured visceral, subcutaneous, and total adiposity were not significantly associated with increased risk of overall mortality, death from primary cancer, or cancer progression among patients diagnosed with these 10 cancer types; however, we found significant or high heterogeneity for many cancer types. For example, heterogeneity was similarly high when the pooled HRs (95% CI) for overall mortality associated with visceral adiposity were essentially null as in 1.03 (0.55, 1.92; I2 = 58%) for breast, 0.99 (0.81, 1.21; I2 = 71%) for colorectal, versus when they demonstrated a potential increased risk 1.17 (0.85, 1.60; I2 = 78%) for hepatocellular carcinoma and 1.62 (0.90, 2.95; I2 = 84%) for renal cancer.

Conclusion

Greater adiposity at diagnosis (directly measured by imaging) is not associated with worse survival among cancer survivors. However, heterogeneity and other potential limitations were noted across studies, suggesting differences in study design and adiposity measurement approaches, making interpretation of meta-analyses challenging. Future work to standardize imaging measurements and data analyses will strengthen research on the role of adiposity in cancer survival.

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Data availability

The datasets analyzed during the current study are publicly available via applying the searching algorithm proposed in this manuscript to PubMed, Embase, and Web of Science.

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Acknowledgments

This study was supported by, in part, by grants from the National Cancer Institute: K01CA226155 (Cespedes Feliciano) and R01CA251589 (Cespedes Feliciano).

Funding

This study was supported by, in part, by grants from the National Cancer Institute: K01CA226155 and R01CA251589.

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All authors contributed to the study conception and design. EC, JK, and EMCF participated in the literature search and screening. EC and JK performed study quality assessment. EC conducted data analysis. EC and BJC drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final manuscript.

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Correspondence to Bette J. Caan.

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Cheng, E., Kirley, J., Cespedes Feliciano, E.M. et al. Adiposity and cancer survival: a systematic review and meta-analysis. Cancer Causes Control 33, 1219–1246 (2022). https://doi.org/10.1007/s10552-022-01613-7

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