Obesity as an independent predictive factor for pathologic complete response after neoadjuvant chemoradiation in rectal cancer

Abstract

Purpose The predictive role of obesity on pathologic complete response (pCR) after neoadjuvant chemoradiation (nCRT) in rectal cancer remains controversial. This study aimed to evaluate the association between obesity and pathologic response in patients with rectal cancer following nCRT. Methods A total of 320 patients with primary rectal cancer who underwent curative resection after nCRT between January 2010 and September 2014 were enrolled in this study. Obesity was defined as body mass index of ≥25 kg/m 2 . Clinicopathologic characteristics were analyzed to identify independent predictive factors for pCR. Results Among the included patients, 23.4% (n = 75) were obese, and 14.7% (n = 47) showed pCR. Baseline characteristics were generally similar between obese and nonobese patients, except that women (P = 0.001) and cT2 tumors (P = 0.001) were more common in the obese group. Multivariate logistic regression analysis revealed that obesity (odds ratio [OR] = 2.051; 95% confidence interval [CI], 1.009–4.168), cT2 (OR, 3.614; 95% CI, 1.166–11.202), and pretreatment carcinoembryonic antigen <5 ng/mL (OR, 2.921; 95% CI, 1.365–6.253) were independent predictors for pCR. Obesity was not associated with disease-free survival or local recurrence-free survival. Conclusion Obesity was an independent predictive factor for pCR following nCRT in rectal cancer, but was not associated with recurrence. Further studies are needed to clarify the association between obesity and prognosis of rectal cancer after nCRT.

Clinical and biochemical predictors of tumor response after neoadjuvant therapy in rectal cancer

“…11,[22][23][24] A BMI cut-off point of ≥25 kg/m 2 was used to categorize obesity in our cohort, which is also consistent with prior studies. [25][26][27] Recently, a meta-analysis has shown specifically in rectal cancer, patients with a BMI≥ 25 were found to have significantly better overall survival…”

<p>PCSK1 Overexpression in Rectal Cancer Correlates with Poor Response to Preoperative Chemoradiotherapy and Prognosis</p>

“…[31][32][33][34] Lee et al recently reported obesity as an independent negative predictive factor for complete response to CCRT in rectal cancer. 35,36 As we known, tumor response could reflects early response to treatments and related to late response outcomes including recurrence and survival. Many studies also indicate that obesity is a common risk factor for cardiovascular disease and is an indicator of poor prognosis in multiple cancer types.…”

Adipositas aus viszeralonkologischer Perspektive

“…Hinsichtlich des Einflusses einer Adipositas auf eine neoadjuvante Radiochemotherapie beim lokal fortgeschrittenen Rektumkarzinom zeigen sich inkonsistente Ergebnisse. Eine aktuelle Publikation von Lee et al mit 320 eingeschlossenen Patienten beschreibt eine höhere Rate vollständiger Remission bei übergewichtigen Patienten (25,3 % BMI > 25 kg/m 2 vs. 11,4 % BMI < 25 kg/m 2 ) [37], wohingegen andere Untersuchungen das Gegenteil mit niedrigeren Komplettremissionsraten und seltenerem Schließmuskelerhalt beschreiben. Eine Untersuchung mit 522 Patienten, die bei lokal fortgeschrittenem Rektumkarzinom eine neoadjuvante Radiochemotherapie und anschließende OP erhielten, zeigte hinsichtlich des Downstagings (31,8% BMI > 30 kg/m 2 vs. 60,2% BMI < 30 kg/m 2 ) und der Tumorregression, dass adipöse Patienten schlechter auf die Therapie ansprachen [38].…”