A systematic review and meta-analysis assessing the impact of body mass index on long-term survival outcomes after surgery for colorectal cancer

Simillis, Constantinos; Taylor, Beth; Ahmad, Ayesha; Lal, Nikhil; Afxentiou, Thalia; Powar, Michael; Smyth, Elizabeth; Fearnhead, Nicola; Wheeler, James M.; Davies, Richard J.

doi:10.1016/j.ejca.2022.05.020

Cited by 13 publications

(9 citation statements)

References 97 publications

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“…The BMI ≥ 35 kg/m 2 group classified as having grades 2 and 3 obesity was associated with significantly higher all-cause mortality, whereas a BMI of 30–35 kg/m 2 (grade 1 obesity) was not associated with mortality. 22 Moreover, a recent meta-analysis reported that being underweight (BMI < 18.5 kg/m 2 ) or having class II/III obesity (BMI > 35 kg/m 2 ) at the time of colorectal cancer surgery may result in worse long-term survival outcomes, 23 which is similar to the results of our study. Thus, our results suggest that patients with class II/III obesity (BMI > 35 kg/m 2 ) need to optimize BMI before undergoing major cancer surgery.…”

Section: Discussionsupporting

confidence: 89%

Preoperative Body Mass Index, Waist Circumference, and Mortality After Major Cancer Surgery: A Nationwide Cohort Study in Korea

Oh,

Song

2023

J Korean Med Sci

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Background Body mass index (BMI) and waist circumference (WC) were used to evaluate nutritional status and obesity. We aimed to examine whether preoperative BMI or WC was associated with mortality after cancer surgery. Methods This population-based cohort study used data extracted from the National Health Insurance Service database of South Korea. We included adult patients who underwent major cancer surgery with curative intent between January 1, 2016, and December 31, 2020. Results A total of 87,220 patients were included in the final analysis, and 1,374 (1.6%) died within 90 days after cancer surgery. In the multiple logistic regression model, the BMI < 18.5/kg/m 2 and > 35 kg/m 2 groups showed 1.98-fold (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.58–2.49; P < 0.001) and 2.60-fold (OR, 2.60; 95% CI, 1.25–5.40; P < 0.001) higher 90-day mortality after cancer surgery than did the BMI 18.5–24.9 kg/m 2 group. The 25.0–29.9 kg/m 2 ( P = 0.144) and 30.0–34.9 kg/m 2 ( P = 0.105) BMI groups did not show significant differences compared to the BMI 18.5–24.9 kg/m 2 group. Compared with the normal WC group, the high ( P = 0.052) and very high ( P = 0.232) WC groups also did not show significant differences in terms of 90-day mortality. Conclusions Preoperative BMI < 18.5 kg/m 2 and > 35 kg/m 2 is associated with an elevated risk of 90-day mortality after major cancer surgery. However, preoperative WC was not significantly associated with 90-day mortality after cancer surgery.

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Section: Discussionsupporting

confidence: 89%

Preoperative Body Mass Index, Waist Circumference, and Mortality After Major Cancer Surgery: A Nationwide Cohort Study in Korea

Oh,

Song

2023

J Korean Med Sci

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“…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 25–27 . Recently, a meta‐analysis has shown specifically in rectal cancer, patients with a BMI≥ 25 were found to have significantly better overall survival compared to patients with a BMI < 25 28 . In our cohort, patients with a BMI≥25 achieved a good TRG, and on univariable and multivariable logistic regression it was found to be an independent predictor of good TRG.…”

Section: Discussionsupporting

confidence: 79%

“…AUC, area under the curve compared to patients with a BMI < 25. 28 In our cohort, patients with a BMI≥25 achieved a good TRG, and on univariable and multivariable logistic regression it was found to be an independent predictor of good TRG. Consistent with our findings, Lee et al also showed a BMI≥25…”

Section: F I G U R Ementioning

confidence: 51%

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

Bedrikovetski

Traeger

Vather

et al. 2022

Asia-Pac J Clncl Oncology

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Background Patients who have a good clinical and/or pathologic response to neoadjuvant chemoradiotherapy (nCRT) for rectal cancer have better long‐term outcomes and can potentially be spared morbid surgery. This study aimed to identify pretreatment clinical and biochemical predictors of response to neoadjuvant treatment for rectal cancer. Methods Patients undergoing neoadjuvant therapy for rectal cancer between 2007 and 2022 were retrospectively included. Those patients who achieved a complete clinical response were offered a nonoperative management strategy and the remaining patients underwent surgical resection. The primary endpoint was tumor regression grade (TRG) based on radiological imaging (mrTRG) or pathology (pTRG). Patient response was classified as good (mrTRG 1–2 or pTRG 0–1) versus poor (mrTRG 3–4 or pTRG 2–3). Logistic regression was performed to determine predictors of TRG. Results A total of 984 patients with rectal cancer were identified of which 274 met the inclusion criteria. Of 274 patients, 228 (83%) underwent surgical resection. A good TRG response was observed in 119 (41%) patients, and a complete response was achieved in 53 (17%) patients. On univariable and multivariable logistic regression, clinical T2 stage and body mass index of ≥25 kg/m2 were significant predictors of a good TRG. Clinical T2 stage and a personalised total neoadjuvant therapy regimen were significant predictors of complete response. Conclusion Clinical T2 stage and a BMI≥25 kg/m2 were predictors of good response to neoadjuvant therapy for rectal cancer. Future prospective studies are required to confirm these findings and evaluate their potential use in better targeting of nCRT.

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“…There may exist a systematic selection of patients with higher BMI (≥ 30 kg/m 2 ) in case of higher UICC stage (UICC ≥ 2) and with a worse performance status (≥ 1) to the RAS group. This selection could result in a higher postoperative complication rate and impaired long-term survival (29,30). As the Lash algorithm of cancer recurrence excludes patients having recurrent disease withing 180 days after primary surgery, the generalizability of the results can be discussed since the time-at-risk does not represent the entire inclusion period.…”

Section: Discussionmentioning

confidence: 99%

Surgical stress response and long-term survival in robot-assisted versus laparoscopic surgery for colon cancer: a propensity matched nationwide cohort study

Cuk,

Rosen,

Mashkoor

et al. 2024

Preprint

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Purpose This study investigates the potential correlation between the surgical stress response and long-term survival in patients undergoing treatment for colon cancer using either RAS (robot-assisted surgery) or LAS (laparoscopic surgery), and whether this correlation is influenced by the surgical approach. The primary objective was to assess the association between postoperative CRP response and recurrence-free survival in RAS compared to LAS. Secondary endpoints included all-cause mortality and time-to-recurrence. Methods This Danish nationwide cohort study included patients diagnosed with UICC stage I-III colon cancer who underwent either RAS or LAS between 2010 and 2018. We employed the Cox proportional regression model to analyze the time-to-event outcomes for both primary and secondary endpoints in patients exhibiting either a low postoperative CRP response (< 80 mg/L) or a high CRP response (CRP ≥ 80 mg/L). Results A total of 3,484 patients were included in the study, with 490 (14.1%) undergoing RAS and 2,994 (85.9%) undergoing LAS. The median follow-up time was 32.5 months (IQR = 21.0-48.7) for the RAS group and 35.4 months (IQR = 22.8-50.9) for the LAS group. In the RAS group, a lower CRP response (CRP < 80 mg/L) was not associated with improved recurrence-free survival (HR = 0.78, 95% CI [0.53-1.13], p = 0.184), all-cause mortality (HR = 0.76, 95% CI [0.46-1.26], p = 0.282), or time-to-recurrence (HR = 0.64, 95% CI [0.49-1.06], p = 0.079). Conclusion The postoperative CRP response was not significantly associated with improved long-term survival outcomes in patients undergoing RAS or LAS for UICC stage I-III colon cancer.

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A systematic review and meta-analysis assessing the impact of body mass index on long-term survival outcomes after surgery for colorectal cancer

Cited by 13 publications

References 97 publications

Preoperative Body Mass Index, Waist Circumference, and Mortality After Major Cancer Surgery: A Nationwide Cohort Study in Korea

Preoperative Body Mass Index, Waist Circumference, and Mortality After Major Cancer Surgery: A Nationwide Cohort Study in Korea

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

Surgical stress response and long-term survival in robot-assisted versus laparoscopic surgery for colon cancer: a propensity matched nationwide cohort study

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