Association of Body Mass Index with Survival in Asian Patients with Colorectal Cancer

Lee, Sang‐Won; Lee, Dong Hee; Lee, Jae‐Hoon; Shin, Su‐Jin; Lee, Hye Sun; Park, Eun Jung; Baik, Seung Hyuk; Lee, Kang Young; Kang, Jeonghyun

doi:10.4143/crt.2021.656

Cited by 8 publications

(14 citation statements)

References 30 publications

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“…Based on these facts, a high CBR weighted by a high CEA was likely to be associated with poor outcomes in the patients. Second, for those with a similar concentration of CEA, a lower BMI (also indicating a high CBR) would lead to worse outcomes, which was also in line with previous observations ( 10 – 12 ). However, it is also notable that certain studies indicated that a high BMI, particularly for class I (BMI, 30–35 kg/m 2 ) and II (BMI, ≥35 kg/m 2 ) obesity, was correlated with poor survival in CRC ( 48 , 49 ).…”

Section: Discussionsupporting

confidence: 89%

“…A recent study indicated that the CEA to maximum tumor diameter ratio has prognostic value; however, the AUC of the new marker in predicting 3-year OS was reported to be only 0.704 (41). For BMI, its application in prognosis was largely blocked by inconsistent criteria and conflicting results, as aforementioned (10)(11)(12)(13)(14). Similarly, some reports indicated that combining BMI with other markers, such as lymphocyte counts, could improve the prognostic efficacy for patients with head and neck cancer who underwent radiation therapy (16).…”

Section: Discussionmentioning

confidence: 99%

“…Body mass index (BMI), which is calculated as weight in kilograms divided by height in meters squared (kg/m 2 ), is a traditional prognostic marker for numerous malignancies, including breast ( 5 ), ovarian ( 6 ), esophageal ( 7 ), lung ( 8 ) and gastric ( 9 ) cancer, as well as CRC ( 10 – 12 ). However, there are still unresolved problems regarding the prognostic value of BMI in CRC.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, Song et al found that 20.2 kg/m 2 was the best discrimination point for survival ( 12 ). In addition, the final conclusion for the role of BMI in CRC is conflicting, with some studies indicating that patients with an underweight BMI (<18.50 kg/m 2 ) would have poor survival ( 10 – 12 ), but other studies failing to reproduce these results ( 13 ) or even yielding opposite results ( 14 ). Based on this background, it is reasonable to improve the prognostic efficacy of BMI with a combination of other markers.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative carcinoembryonic antigen to body mass index ratio contributes to prognosis prediction in colorectal cancer

et al. 2022

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Both carcinoembryonic antigen (CEA) level and body mass index (BMI) are traditional prognostic markers in colorectal cancer (CRC); however, to the best of our knowledge, the value of the CEA to BMI ratio (CBR) has never been addressed. In the present study, 191 patients with CRC treated using radical resection were retrospectively included, and the significance of the CBR in predicting disease-free survival (DFS) or overall survival (OS) rates was calculated. The prognostic efficacy of the CBR in predicting OS was compared with individual CEA and BMI values. The survival differences of the subgroups were calculated by Kaplan-Meier analysis, and corresponding risk factors were then estimated by a Cox proportional hazards model. As a result, 29.84% (57/191) of the patients were assigned to the high CBR group (cut-off, ≥0.28); the CBR had a sensitivity of 56.50 and 68.90%, and a specificity of 80.60 and 80.10% for DFS and OS, respectively. Patients with a high CBR more commonly underwent laparotomy and exhibited advanced T stages, the presence of tumor deposits and advanced Tumor-Node-Metastasis stages (stage II or III). The CBR was more efficient than the CEA or BMI alone in predicting OS. In addition, patients with a high CBR presented with a significantly worse outcome than patients with a low CBR. Finally, the CBR was an independent risk factor for both DFS and OS. In conclusion, the CBR was a more robust prognostic factor in CRC, and patients with a relatively high CBR exhibited poorer survival.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative carcinoembryonic antigen to body mass index ratio contributes to prognosis prediction in colorectal cancer

et al. 2022

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“…Higher BMI could increase the risk of CRC [ 18 , 19 ], and BMI might have an impact on the outcomes and prognosis of CRC surgery [ 20 ]. BMI was also related to T2DM and metabolic diseases [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Higher body mass index was associated with better prognosis in diabetic patients with stage II colorectal cancer

et al. 2022

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Purpose The purpose of this study is to analyze the effect of body mass index (BMI) on patients with concurrent colorectal cancer (CRC) and type 2 diabetes mellitus (T2DM). Methods Patients who underwent primary radical CRC surgery from Jan 2011 to Jan 2020 were retrospectively collected. The perioperative information, overall survival (OS) and disease-free survival (DFS) were compared between the higher BMI group and the lower BMI group. Results A total of 574 patients with concurrent CRC and T2DM were included in this study. The higher BMI group had higher portion of hypertension (p < 0.01) and coronary heart disease (CHD) (p < 0.01). Furthermore, the higher BMI group had better OS (p = 0.016) and DFS (p = 0.040) than the lower BMI group in stage II CRC. In multivariate analysis, age (OS: p = 0.002, HR = 2.016, 95% CI = 1.307–3.109/ DFS: p = 0.003, HR = 1.847, 95% CI = 1.230–2.772), TNM stage (OS: p < 0.01, HR = 1.667, 95% CI = 1.281–2.169/ DFS: p = 0.001, HR = 1.545, 95% CI = 1.207–1.977), overall complications (OS: p = 0.004, HR = 1.837, 95% CI = 1.218–2.880/ DFS: p = 0.006, HR = 1.783, 95% CI = 1.184–2.686) and major complications (OS: p = 0.005, HR = 2.819, 95% CI = 1.376–5.774/ DFS: p = 0.014, HR = 2.414, 95% CI = 1.196–4.870) were independent factors of OS and DFS. Moreover, BMI (p = 0.019, HR = 0.413, 95% CI = 0.197–0.864) was an independent factor of OS in stage II CRC. Conclusion Higher BMI was associated with better OS in diabetic patients with stage II CRC.

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Post‐diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta‐analysis

Becerra‐Tomás,

Markozannes,

Cariolou

et al. 2024

Intl Journal of Cancer

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The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta‐analysis on post‐diagnosis adiposity measures (body mass index [BMI], waist circumference, waist‐to‐hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random‐effects meta‐analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta‐analyses were possible for BMI and all‐cause mortality, colorectal cancer‐specific mortality, and cancer recurrence/disease‐free survival. Non‐linear meta‐analysis indicated a reverse J‐shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all‐cause mortality; 95% and 26% for colorectal cancer‐specific mortality; and 37% and 24% for cancer recurrence/disease‐free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow‐up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity‐outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well‐designed observational studies and interventional trials are needed to provide further clarification.

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Association of Body Mass Index with Survival in Asian Patients with Colorectal Cancer

Cited by 8 publications

References 30 publications

Preoperative carcinoembryonic antigen to body mass index ratio contributes to prognosis prediction in colorectal cancer

Preoperative carcinoembryonic antigen to body mass index ratio contributes to prognosis prediction in colorectal cancer

Higher body mass index was associated with better prognosis in diabetic patients with stage II colorectal cancer

Post‐diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta‐analysis

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