Visceral Obesity May Affect Oncologic Outcome in Patients with Colorectal Cancer

Abstract

Purpose

Obesity is closely related to the development of colorectal cancer as well as other metabolic complications. We investigated the prognostic significance of visceral obesity and body mass index (BMI) in 161 resectable colorectal cancer patients.

Methods

Ratios of visceral fat area (VFA) to subcutaneous fat area (SFA) were measured from the digital images of patients’ computed tomography taken before the surgery, and patients were divided into those with high and those with low VFA/SFA ratio according to the degree of proportional visceral adiposity, and into an overweight and a normal-weight group according to their preoperative BMI.

Results

The overweight group showed a borderline decrease in cumulative disease-free survival compared to the normal-weight group (P = 0.064). Patients with high VFA/SFA ratio (more than 50 percentiles) had significantly lower cumulative disease-free survival rate compared to patients with low VFA/SFA ratio (P = 0.008). BMI and visceral adiposity showed no influence on overall survival of patients.

Conclusion

Increased visceral adiposity was a significant predictor of disease-free survival in patients with resectable colorectal cancer. The prognostic significance of visceral adiposity should further be determined in a larger set of patients.

This is a preview of subscription content, log in to check access.

Fig. 1
FIG. 2

References

  1. 1.

    Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288:1723–7.

    PubMed  Article  Google Scholar 

  2. 2.

    Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005; 365:1415–28.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 2004; 4:579–91.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Bianchini F, Kaaks R, Vainio H. Overweight, obesity, and cancer risk. Lancet Oncol 2002; 3:565–74.

    PubMed  Article  Google Scholar 

  5. 5.

    Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348:1625–38.

    PubMed  Article  Google Scholar 

  6. 6.

    Schoen RE, Tangen CM, Kuller LH, et al. Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst 1999; 91:1147–54.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Murphy TK, Calle EE, Rodriguez C, et al. Body mass index and colon cancer mortality in a large prospective study. Am J Epidemiol 2000; 152:847–54.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    IARC. Weight control and physical activityed. Lyon: IARC; Oxford: Oxford University Press [distributor], 2002

  9. 9.

    Karelis AD, St-Pierre DH, Conus F, et al. Metabolic and body composition factors in subgroups of obesity: what do we know? J Clin Endocrinol Metab 2004; 89:2569–75.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Otake S, Takeda H, Suzuki Y, et al. Association of visceral fat accumulation and plasma adiponectin with colorectal adenoma: evidence for participation of insulin resistance. Clin Cancer Res 2005; 11:3642–6.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Cowey SL, Quast M, Belalcazar LM, et al. Abdominal obesity, insulin resistance, and colon carcinogenesis are increased in mutant mice lacking gastrin gene expression. Cancer 2005; 103:2643–53.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Chlebowski RT, Aiello E, McTiernan A. Weight loss in breast cancer patient management. J Clin Oncol 2002; 20:1128–43.

    PubMed  Article  Google Scholar 

  13. 13.

    Berclaz G, Li S, Price KN, et al. Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience. Ann Oncol 2004; 15:875–84.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Tartter PI, Slater G, Papatestas AE, et al. Cholesterol, weight, height, Quetelet’s index, and colon cancer recurrence. J Surg Oncol 1984; 27:232–5.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Meyerhardt JA, Catalano PJ, Haller DG, et al. Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 2003; 98:484–95.

    PubMed  Article  Google Scholar 

  16. 16.

    Warren M, Schreiner PJ, Terry JG. The relation between visceral fat measurement and torso level–is one level better than another? The Atherosclerosis Risk in Communities Study, 1990–1992. Am J Epidemiol 2006; 163:352.

    PubMed  Article  Google Scholar 

  17. 17.

    Giovannucci E, Ascherio A, Rimm EB, et al. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med 1995; 122:327–34.

    PubMed  CAS  Google Scholar 

  18. 18.

    Katsuki A, Sumida Y, Urakawa H, et al. Increased visceral fat and serum levels of triglyceride are associated with insulin resistance in Japanese metabolically obese, normal weight subjects with normal glucose tolerance. Diabetes Care 2003; 26:2341–4.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Dusserre E, Moulin P, Vidal H. Differences in mRNA expression of the proteins secreted by the adipocytes in human subcutaneous and visceral adipose tissues. Biochim Biophys Acta 2000; 1500:88–96.

    PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sang-Kyung Choi MD, PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Moon, H., Ju, Y., Jeong, C. et al. Visceral Obesity May Affect Oncologic Outcome in Patients with Colorectal Cancer. Ann Surg Oncol 15, 1918–1922 (2008). https://doi.org/10.1245/s10434-008-9891-4

Download citation

Key Words

  • Colorectal cancer
  • Prognosis
  • Obesity
  • Visceral obesity
  • Recurrence