Influence of Obesity on the Course of Malignant Neoplastic Disease in Patients After Pulmonary Metastasectomy

Abstract

Abstract. Background (82.1±83.5 months vs. 43.0±44.4, p<0.01 and 110.7±81.3 months vs. 69.9±52.9 p<0.005, respectively). Survival after pulmonary metastasectomy was 27.2±25.6 months and was longer in obese and overweight patients than in normal weight patients (20.2±18.4 months vs. 29.4±26.5, p<0.05). Conclusion: Being obese or overweight is a favorable prognostic factor in patients after surgical resection of lung metastases of different malignancies.With the increasing epidemic of obesity in the world, the incidence of malignancies related to obesity also increases (1). Obesity-related cancers include breast cancer in postmenopausal women, colon cancer, cancer of the lower esophagus, gastric cancer, liver cancer, gall bladder cancer, pancreatic cancer, uterine cancer, ovarian cancer and renal cancer (2). Obesity is also associated with increased risk of metastases, including lung metastases, in some cancers (3).In the course of some malignancies a paradoxical phenomenon has been observed, indicating that obesity may be an oncogenic factor and -at the same time -may constitute a favorable prognostic factor (4, 5). The dual and opposite influence of obesity on the course of the same disease has been called the obesity paradox and has been described in some chronic diseases, including cardiovascular (6) and cerebrovascular diseases (7). These paradoxical effects of obesity may occur also in patients with metastases, including patients with malignancies not related to obesity. In a recent large-scale study of 4,010 cancer patients in good general condition, with distant metastases, median OS was twice as high in obese patients as in normal weight patients (8). However, there are also reports stating that there is no beneficial effect of obesity on metastatic neoplastic disease (9-11).The problem of the influence of obesity on the course of metastatic malignancies has not yet been unequivocally explained. Especially, there are no studies on the influence of obesity on survival of patients with operable lung metastases. Therefore, this study was undertaken to evaluate the long-term outcome of surgical treatment of obese and non-obese patients who after resection of primary neoplasm had lung metastases removed. Materials and MethodsData from 99 patients who had a resection of lung metastasis from different primary malignancies between 2001 and 2016 were analyzed. The study was retrospective, and the condition for including patients in the study was access to anesthesia documentation containing body weight and height prior to performing pulmonary metastasectomy. Analysis was performed in the groups depending on body mass index (BMI). Underweight was diagnosed when the BMI 197

The Role of Obesity in Early and Long-Term Outcomes after Surgical Excision of Lung Oligometastases from Colorectal Cancer

“…Obesity was also found, through multivariate analysis, to be an independent risk factor for death. Our results are in accordance with the only other article assessing the role of obesity and overweight on survival after pulmonary metastasectomy [6]: the authors analyzed a population of patients submitted to resection of oligometastases from several primary tumors and found a difference both in OS and DFI, suggesting that obesity induces a slower progression of neoplastic disease after resection of the primary tumor. Quite interestingly, their results were not affected by the lower percentage of radical resections in the group of obese patients [6].…”

“…Our results are in accordance with the only other article assessing the role of obesity and overweight on survival after pulmonary metastasectomy [6]: the authors analyzed a population of patients submitted to resection of oligometastases from several primary tumors and found a difference both in OS and DFI, suggesting that obesity induces a slower progression of neoplastic disease after resection of the primary tumor. Quite interestingly, their results were not affected by the lower percentage of radical resections in the group of obese patients [6]. These results are in line with a recent large retrospective study on patients with metastatic cancer treated with radiotherapy, where Tsang and colleagues found overweight and obesity to be independent predictors of better OS [3].…”

“…Nonetheless, evidence is controversial and a recent pooled analysis confirmed high BMI to be a positive prognostic factor only in the male sex [5]. The experience in the context of lung oligometastases seems to remark a potential protective effect of obesity over cancer progression, but evidence is still limited [6]. On the other hand, the impact of obesity on the incidence of post-operative complications in this subgroup of patients has never been specifically investigated.…”

Delaware’s 1999-2017 Leading Causes of Death Information Illustrates Its Obesity and Obesity-Related Life-Limiting Disease Burdens

“…In spite of the 2017 prevalence of adult obesity data showing that only 18.4% of Delaware men were obese compared to 27.2% of its women (Christopher et al, 2017; Hales et al, 2017), the Figure 3 male and female age-adjusted mortality rates exhibits a fluctuating pattern with a serious hike in 1999–2017 death rates for males (79.87%), where obesity was present in the deceased but not necessarily listed as the underlying cause of death. This jump in age-adjusted moratlity for Delawarean males can be rationalized due to the harmful implications of visceral fat (Centers for Disease Control and Prevention, 2016b; D’Souza, Li, Gannon, & Wentzien, 2019; D’Souza, 2018; D’Souza et al, 2018, 2019; D’Souza et al, 2015; D’Souza et al, 2015; D’Souza et al, 2017; Flegal, 2006; Flegal et al., 2007; Guh et al, 2009; Kopelman, 2007; Malnick & Knobler, 2006; Martí, 2016; O’Malley et al., 2005; O’Neill & O’Driscoll, 2015; Pi-Sunyer, 2009; Rudisill et al, 2016; Rzechonek et al, 2018; Siegel et al, 2019).…”

“…The CDC WONDER database includes certifying cause of death categories (Centers for Disease Control and Prevention, 2016b; Park et al, 2018) using the Tenth Revision of the International Classification of Diseases (ICD-10) coding (Gonzalez & Chiodo, 2015; WHO, 2010). ICD-10 coding reporting errors (D’Souza, 2018; McGivern, Shulman, Carney, Shapiro, & Bundock, 2017; Pritt, Hardin, Richmond, & Shapiro, 2005) are well known, but together with research on the increased US waist size (Bentham et al, 2017; Hales et al, 2018) has generated valuable awareness on the negative impacts (D’Souza, Li, Gannon, & Wentzien, 2019; Jia & Lubetkin, 2005; Johnson et al, 2014; Leonard et al, 2015; Masters et al, 2013; Singh, Kochanek, & MacDorman, 1996; Tomlinson, Erskine, Morse, Winwood, & Onambélé-Pearson, 2016; Tomlinson, Erskine, Winwood, Morse, & Onambélé, 2014) of the nation’s waistline on human health (Centers for Disease Control and Prevention, 2016b; D’Souza, Li, Gannon, & Wentzien, 2019; D’Souza, 2018; D’Souza et al, 2018; D’Souza et al, 2015; D’Souza et al, 2015; D’Souza et al, 2019; D’Souza et al, 2017; Flegal, 2006; Flegal, Graubard, Williamson, & Gail, 2007; Guh et al, 2009; Kopelman, 2007; Malnick & Knobler, 2006; Martí, 2016; O’Malley et al, 2005; O’Neill & O’Driscoll, 2015; Pi-Sunyer, 2009; Rudisill, Charlton, Booth, & Gulliford, 2016; Rzechonek et al, 2018; Siegel, Miller, & Jemal, 2019).…”