Association of Obesity With Survival Outcomes in Patients With Cancer

Petrelli, Fausto; Cortellini, Alessio; Indini, Alice; Tomasello, Gianluca; Ghidini, Michele; Nigro, Olga; Salati, Massimiliano; Dottorini, Lorenzo; Iaculli, Alessandro; Varricchio, Antonio; Rampulla, Valentina; Barni, Sandro; Cabiddu, Mary; Bossi, Antonio; Ghidini, Antonio; Zaniboni, Alberto

doi:10.1001/jamanetworkopen.2021.3520

Cited by 285 publications

(206 citation statements)

References 273 publications

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“…Also, molecular mechanisms connecting obesity with PC and other urothelial cancers have been broadly established [84]. Finally, the relationship with PC outcomes met analogy criterion, as obesity has been linked for the last three decades to mortality from numerous types of cancer [11,85] and to other outcomes related to PC, for instance, the presence of metastases [86]. Therefore, objectively, several criteria for causation were met.…”

Section: Discussionmentioning

confidence: 99%

Obesity as a Risk Factor for Prostate Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of 280,199 Patients

Rivera-Izquierdo

Rojas

Martínez-Ruiz

et al. 2021

Cancers

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The aim of this study was to systematically review all evidence evaluating obesity as a prognostic factor for PC mortality. Cohort and case-control studies reporting mortality among PC patients stratified by body mass index (BMI) were included. The risk of mortality among obese patients (BMI ≥ 30) was compared with the risk for normal weight (BMI < 25) patients, pooling individual hazard ratios (HR) in random-effects meta-analyses. Reasons for heterogeneity were assessed in subgroup analyses. Dose-response associations for BMI per 5 kg/m2 change were assessed. Among 7278 citations, 59 studies (280,199 patients) met inclusion criteria. Obesity was associated with increased PC-specific mortality (HR: 1.19, 95% CI: 1.10–1.28, I2: 44.4%) and all-cause mortality (HR: 1.09, 95% CI: 1.00–1.18, I2: 43.9%). There was a 9% increase (95% CI: 5–12%, I2: 39.4%) in PC-specific mortality and 3% increase (95% CI: 1–5%, I2: 24.3%) in all-cause mortality per 5 kg/m2 increase in BMI. In analyses restricted to the higher quality subgroup (NOS ≥ 8), obesity was associated with increased PC-specific mortality (HR: 1.24, 95% CI: 1.14–1.35, I2: 0.0%) and maintained the dose-response relationship (HR: 1.11 per 5 kg/m2 increase in BMI, 95% CI: 1.07–1.15, I2: 26.6%). Obesity had a moderate, consistent, temporal, and dose-response association with PC mortality. Weight control programs may have a role in improving PC survival.

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Section: Discussionmentioning

confidence: 99%

Obesity as a Risk Factor for Prostate Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of 280,199 Patients

Rivera-Izquierdo

Rojas

Martínez-Ruiz

et al. 2021

Cancers

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“…[23][24][25][26] However, there are studies that postulate a biologic rational for the improved survival seen in obese patients with renal cell carcinoma. 13,27,28 In those studies, the authors found that patients with renal cell carcinoma and obesity had longer overall survival than patients without obesity. One hypothesis based on transcriptomic signature differences in the primary tumor and the peritumoral adipose tissue is that increased tumor angiogenesis and increased peritumoral inflammation in the perirenal white adipose tissue of obese patients contribute to their survival advantage.…”

Section: Obesity Adiposity and Cancer Risk And Prognosismentioning

confidence: 99%

“…12 Accumulating data also suggest that obesity is associated with higher rates of cancer progression, recurrence, and mortality, especially for breast, prostate, and colon cancer. 13,[16][17][18][19][20] Furthermore, cancer survivors are at higher risk of becoming obese, 21 likely because of various factors, including the use of chemotherapy, steroids, and hormonal therapy, which can accelerate weight gain. 22 Although the obesity paradox refers to studies demonstrating that obesity is associated with improved overall survival, this is more likely secondary to flaws in methodological mechanisms, such as using body mass index as an obesity measure, confounding and reverse causality.…”

Section: Obesity Adiposity and Cancer Risk And Prognosismentioning

confidence: 99%

Intermittent fasting in the prevention and treatment of cancer

Clifton

Cynthia

Fontana

et al. 2021

CA A Cancer J Clinicians

107

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Chronic caloric restriction (CR) has powerful anticarcinogenic actions in both preclinical and clinical studies but may be difficult to sustain. As an alternative to CR, there has been growing interest in intermittent fasting (IF) in both the scientific and lay community as a result of promising study results, mainly in experimental animal models. According to a survey by the International Food Information Council Foundation, IF has become the most popular diet in the last year, and patients with cancer are seeking advice from oncologists about its beneficial effects for cancer prevention and treatment. However, as discussed in this review, results from IF studies in rodents are controversial and suggest potential detrimental effects in certain oncologic conditions. The effects of IF on human cancer incidence and prognosis remain unknown because of a lack of high-quality randomized clinical trials. Preliminary studies suggest that prolonged fasting in some patients who have cancer is safe and potentially capable of decreasing chemotherapy-related toxicity and tumor growth. However, because additional trials are needed to elucidate the risks and benefits of fasting for patients with cancer, the authors would not currently recommend patients undergoing active cancer treatment partake in IF outside the context of a clinical trial. IF may be considered in adults seeking cancer-prevention benefits through means of weight management, but whether IF itself affects cancer-related metabolic and molecular pathways remains unanswered.

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“…Of note, while a large body of evidence strongly supports the notion that obesity increases the risk of incident ccRCC in the general population, elevated BMI has also been associated with better prognosis among those patients who are already diagnosed with ccRCC [ 97 , 98 , 99 ]. This “obesity paradox” is not unique to kidney cancer, having been described in other neoplasms, such as lung cancer and melanoma [ 100 , 101 , 102 ], as well as in non-neoplastic diseases, such as chronic heart failure and coronary artery disease [ 103 ]. Obesity appears to be associated with better outcomes in those patients with RCC who undergo surgical or pharmacologic treatment, with less evidence available for such an effect in patients with untreated RCC [ 104 , 105 ].…”

Section: Exploring the Link Between Obesity And Renal Cell Carcinomamentioning

confidence: 99%

Renal Lipid Metabolism Abnormalities in Obesity and Clear Cell Renal Cell Carcinoma

et al. 2021

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Clear cell renal cell carcinoma is the most common and deadly type of cancer affecting the kidney, and is characterized histologically by large intracellular lipid deposits. These deposits are thought to result from lipid metabolic reprogramming occurring in tumor cells, but the exact mechanisms and implications of these metabolic alterations are incompletely understood. Obesity is an independent risk factor for clear cell renal cell carcinoma, and is also associated with lipid accumulation in noncancerous epithelial cells of the proximal tubule, where clear cell renal cell carcinoma originates. This article explores the potential link between obesity-associated renal lipid metabolic disturbances and lipid metabolic reprogramming in clear cell renal cell carcinoma, and discusses potential implications for future research.

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Association of Obesity With Survival Outcomes in Patients With Cancer

Cited by 285 publications

References 273 publications

Obesity as a Risk Factor for Prostate Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of 280,199 Patients

Obesity as a Risk Factor for Prostate Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of 280,199 Patients

Intermittent fasting in the prevention and treatment of cancer

Renal Lipid Metabolism Abnormalities in Obesity and Clear Cell Renal Cell Carcinoma

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