Abstract
Purpose
Abdominal adipose distribution may be associated with tumor growth, but its impact on gastric carcinoma survival after neo-adjuvant therapies is uncertain. This retrospective study was to determine the association linking BMI and CT-measured fat parameters to the survival in advanced gastric cancer patients who underwent preoperative chemotherapy.
Methods
Eighty-four consecutive patients with locally advanced gastric cancer who received neo-adjuvant chemotherapy and following gastrectomy were identified between January 2005 and June 2008. CT parameters were measured retrospectively on the CT images obtained before chemotherapy initiation. Subcutaneous fat thicknesses of the anterior, lateral, and posterior abdominal wall (ASFT, LSFT, and PSFT) represented subcutaneous fat. Intraperitoneal fat thickness (IFT) and retro-renal fat thickness represented visceral fat. Association linking BMI and CT factors to overall survival was evaluated with survival analysis.
Results
ASFT and PSFT above the median value (i.e., high ASFT and PSFT) were associated with longer OS (P = 0.001; 0.003). Conversely, high IFT and high IFT/PSFT were associated with shorter OS (P = 0.003; 0.003) and DFS (P < 0.001; 0.004). By multivariate analysis, high IFT and PSFT were independently associated with OS (HR 2.94, 95 % CI 1.54–5.60; 0.38, 95 % CI 0.21–0.71) and DFS (HR 3.28, 95 % CI 1.55–6.93; 0.42, 95 % CI 0.21–0.82). BMI was not significant for OS and DFS.
Conclusions
This study provided the first evidence that IFT, ASFT, and PSFT measured before neo-adjuvant chemotherapy were likely to be useful predictive biomarkers for survival of advanced gastric cancer patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ajani JA et al (2013) Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. J Natl Compr Cancer Netw JNCCN 11:531–546
Aleman JO, Eusebi LH, Ricciardiello L, Patidar K, Sanyal AJ, Holt PR (2014) Mechanisms of obesity-induced gastrointestinal neoplasia. Gastroenterology 146:357–373. doi:10.1053/j.gastro.2013.11.051
Bazzocchi A, Diano D, Battista G (2012) How fat is fat? Lancet 380:e1. doi:10.1016/S0140-6736(11)61925-9
Bianchini F, Kaaks R, Vainio H (2002) Overweight, obesity, and cancer risk. Lancet Oncol 3:565–574
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348:1625–1638. doi:10.1056/NEJMoa021423
Cao Y (2007) Angiogenesis modulates adipogenesis and obesity. J Clin Investig 117:2362–2368. doi:10.1172/JCI32239
Cecchini S, Cavazzini E, Marchesi F, Sarli L, Roncoroni L (2011) Computed tomography volumetric fat parameters versus body mass index for predicting short-term outcomes of colon surgery. World J Surg 35:415–423. doi:10.1007/s00268-010-0888-3
Demark-Wahnefried W et al (2012) The role of obesity in cancer survival and recurrence. Cancer Epidemiol Biomarkers Prev 21:1244–1259. doi:10.1158/1055-9965.EPI-12-0485
Fox CS et al (2007) Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 116:39–48. doi:10.1161/CIRCULATIONAHA.106.675355
Gaujoux S et al (2012) Impact of obesity and body fat distribution on survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg Oncol 19:2908–2916. doi:10.1245/s10434-012-2301-y
Grabsch HI, Tan P (2013) Gastric cancer pathology and underlying molecular mechanisms. Dig Surg 30:150–158. doi:10.1159/000350876
Griggs JJ, Sabel MS (2008) Obesity and cancer treatment: weighing the evidence. J Clin Oncol 26:4060–4062. doi:10.1200/JCO.2008.17.4250
Guiu B et al (2010) Visceral fat area is an independent predictive biomarker of outcome after first-line bevacizumab-based treatment in metastatic colorectal cancer. Gut 59:341–347. doi:10.1136/gut.2009.188946
House MG et al (2008) Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 12:270–278. doi:10.1007/s11605-007-0421-7
Hsing AW et al (2000) Body size and prostate cancer: a population-based case–control study in China. Cancer Epidemiol Biomarkers Prev 9:1335–1341
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90. doi:10.3322/caac.20107
Jung M et al (2014) Perirenal fat surface area as a risk factor for morbidity after elective colorectal surgery. Dis Colon Rectum 57:201–209. doi:10.1097/DCR.0000000000000029
Ladoire S et al (2011) Visceral fat area as a new independent predictive factor of survival in patients with metastatic renal cell carcinoma treated with antiangiogenic agents. Oncologist 16:71–81. doi:10.1634/theoncologist.2010-0227
Li D, Morris JS, Liu J, Hassan MM, Day RS, Bondy ML, Abbruzzese JL (2009) Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA 301:2553–2562. doi:10.1001/jama.2009.886
Maurovich-Horvat P, Massaro J, Fox CS, Moselewski F, O’Donnell CJ, Hoffmann U (2007) Comparison of anthropometric, area- and volume-based assessment of abdominal subcutaneous and visceral adipose tissue volumes using multi-detector computed tomography. Int J Obes 31:500–506. doi:10.1038/sj.ijo.0803454
Medina-Franco H, Contreras-Saldivar A, Ramos-De La Medina A, Palacios-Sanchez P, Cortes-Gonzalez R, Ugarte JA (2004) Surgery for stage IV gastric cancer. Am J Surg 187:543–546. doi:10.1016/j.amjsurg.2003.12.045
Miyazawa-Hoshimoto S, Takahashi K, Bujo H, Hashimoto N, Yagui K, Saito Y (2005) Roles of degree of fat deposition and its localization on VEGF expression in adipocytes. Am J Physiol Endocrinol Metab 288:E1128–E1136. doi:10.1152/ajpendo.00003.2004
Moore LL, Bradlee ML, Singer MR, Splansky GL, Proctor MH, Ellison RC, Kreger BE (2004) BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. Int J Obes Relat Metab Disord 28:559–567. doi:10.1038/sj.ijo.0802606
Ohki T et al (2009) Visceral fat accumulation is an independent risk factor for hepatocellular carcinoma recurrence after curative treatment in patients with suspected NASH. Gut 58:839–844. doi:10.1136/gut.2008.164053
Piazuelo MB, Correa P (2013) Gastric cancer: overview. Colomb Med 44:192–201
Pischon T et al (2006) Body size and risk of colon and rectal cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst 98:920–931. doi:10.1093/jnci/djj246
Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371:569–578. doi:10.1016/S0140-6736(08)60269-X
Sakai T, Maekawa T, Mikami K, Kuramochi H, Noda S (2009) Short-term outcomes of colon surgery are better predicted by fat volumetric parameters than by the BMI. This study has provided new elements for discussion on the impact of visceral and subcutaneous adiposity in laparoscopic and traditional colon surgery. Int Surg 94:370–372. doi:10.1007/s00268-010-0888-3
Smith DD, Schwarz RR, Schwarz RE (2005) Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol 23:7114–7124. doi:10.1200/JCO.2005.14.621
Tokunaga K, Matsuzawa Y, Ishikawa K, Tarui S (1983) A novel technique for the determination of body fat by computed tomography. Int J Obes 7:437–445
Tuma RS et al (2006) Sometimes size doesn’t matter: reevaluating RECIST and tumor response rate endpoints. J Natl Cancer Inst 98:1272–1274
Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE (2006) Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol 24:2903–2909. doi:10.1200/JCO.2005.05.0245
Yoshizumi T et al (1999) Abdominal fat: standardized technique for measurement at CT. Radiology 211:283–286. doi:10.1148/radiology.211.1.r99ap15283
Yuan C et al (2013) Prediagnostic body mass index and pancreatic cancer survival. J Clin Oncol 31:4229–4234. doi:10.1200/JCO.2013.51.7532
Acknowledgments
This work was supported by the National Basic Research Program of China (973 Program) (Grant No. 2011CB707705), National Natural Science Foundation of China (Grant Nos. 81471640, 81371715), the Capital Health Research and Development of Special Foundation (Grant No. 2011-2015-02), Beijing Health System High Level Health Technical Personnel Training Plan (Grant No. 2013-3-083), and the Capital Special Project for Featured Clinical Application (Grant No. Z121107001012115).
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding authors
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Li, XT., Tang, L., Chen, Y. et al. Visceral and subcutaneous fat as new independent predictive factors of survival in locally advanced gastric carcinoma patients treated with neo-adjuvant chemotherapy. J Cancer Res Clin Oncol 141, 1237–1247 (2015). https://doi.org/10.1007/s00432-014-1893-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-014-1893-y