Body Mass Index and Weight Loss in Metastatic Colorectal Cancer in CALGB (Alliance)/SWOG 80405

Abstract

Background In nonmetastatic colorectal cancer, overweight and mild-to-moderately obese patients experience improved outcomes compared with other patients. Obesity’s influence on advanced or metastatic colorectal cancer (mCRC) is relatively unexplored. Methods We conducted a prospective body mass index (BMI) companion study in Cancer and Leukemia Group B (now Alliance)/SWOG 80405, a phase III metastatic colorectal cancer (mCRC) treatment trial. BMI was measured at trial registration. Primary and secondary endpoints were overall and progression-free survival, respectively. To minimize confounding by poor and rapidly declining health, we used Cox proportional hazards regression to adjust for known prognostic factors, comorbidities, physical activity, and weight loss during the 6 months prior to study entry. We also examined weight loss prior to enrollment as an independent predictor of patient outcome. All statistical tests were two-sided. Results Among 2323 patients with mCRC, there were no statistically significant associations between BMI and overall or progression-free survival (adjusted Ptrend = .12 and .40, respectively). Weight loss during the 6 months prior to study entry was associated with shorter overall and progression-free survival; compared with individuals with stable weight ±4.9%, individuals with weight loss greater than 15% experienced an adjusted hazard ratio of 1.52 for all-cause mortality (95% confidence interval [CI] = 1.26 to 1.84; Ptrend < .001) and of 1.23 for disease progression or death (95% CI = 1.02 to 1.47; Ptrend = .006). Conclusions In this prospective study of patients with mCRC, BMI at time of first-line chemotherapy initiation was not associated with patient outcome. Weight loss prior to study entry was associated with increased risk of patient mortality and disease progression.

Impact of Obesity on Quality of Life, Psychological Distress, and Coping on Patients with Colon Cancer

“…Whereas Speed‐Andrews et al detected evidence of a relation between decreasing BMI and improved quality of life and better cancer prognosis in 2009 [49], we have not noticed differences in quality of life between the obese and nonobese cohorts. Although obesity increases the incidence of colorectal cancer, studies on the association between weight change and prognosis are inconsistent [50, 51]. Our results indicate that weight loss contributes 6.7% to recurrence, although there may be confounding factors associated with weight loss, as well as the cancer itself.…”

Association of Prediagnosis Obesity and Postdiagnosis Aspirin With Survival From Stage IV Colorectal Cancer

“…Specifically, patients with normal prediagnosis BMI were more likely to experience weight gain and had a lower likelihood of death compared with those with an overweight or obese prediagnosis BMI. Two recent clinical trial analyses found weight loss in late-stage CRC patients early in treatment or within 6 months prior to study enrollment independently projected poor outcomes, supporting the notion of weight loss as a potential indicator of disease progression and/or treatment toxicity. In contrast, several meta-analyses found a survival benefit among patients with postdiagnosis overweight BMI .…”

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

“…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).…”

“…However, there are still unresolved problems regarding the prognostic value of BMI in CRC. On the one hand, the BMI criteria to group patients have been inconsistent in previous studies; for example, Guercio et al ( 13 ) divided patients into 5 subgroups [<21 (underweight), 21–24.9 (normal), 25–29.9, 30–34.9 and 35 kg/m 2 ], as did Chiu et al ( 11 ); however, in the latter study, underweight (<18.50 kg/m 2 ) and normal weight (18.50-24.99 kg/m 2 ) patients were not in line with those in the former study. Furthermore, Song et al found that 20.2 kg/m 2 was the best discrimination point for survival ( 12 ).…”

“…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.…”