Severe obesity prior to diagnosis limits survival in colorectal cancer patients evaluated at a large cancer centre

Abstract

Background:In contrast to the consistent evidence for obesity and colorectal cancer (CRC) risk, the impact of obesity in CRC patients is less clear. In a well-characterised cohort of CRC patients, we prospectively evaluated class I and class II obesity with survival outcomes.Methods:The CRC patients (N=634) were followed from the date of diagnosis until disease progression/first recurrence (progression-free survival (PFS)) or death (overall survival (OS)). Body mass index (BMI) was calculated from reported usual weight prior to diagnosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated in models adjusted for clinicopathologic, treatment, and lifestyle factors.Results:Over a median follow-up of 4 years, 208 (33%) patients died and 235 (37%) recurred or progressed. Class II obesity, as compared with either overweight or normal weight, was associated with an increased risk of death (HR and 95% CI: 1.55 (0.97–2.48) and 1.65 (1.02–2.68), respectively), but no clear association was observed with PFS. In analyses restricted to patients who presented as stages I–III, who reported stable weight, or who were aged <50 years, obesity was associated with a significant two- to five-fold increased risk of death.Conclusions:In CRC patients evaluated at a large cancer centre, severely obese patients experienced worse survival outcomes independent of many other factors.

The relationship between body mass index changes during chemotherapy and prognosis of patients with advanced colorectal cancer

“…Innominato et al [18] reported that weight loss during chemotherapy was closely related to poor prognosis. Daniel et al [36] observed that weight change did not correlate with PFS, which is in agreement with our results; however, Lee et al [37] found that weight gain during therapy was associated with unfavorable survivor rates. These results differ from ours, and in our study, ΔBMI could be used to predict OS rates in patients with CRC.…”

The Obesity Paradox in Cancer: a Review

“…There have been mixed findings in incident cancer populations where there has been exploration for the obesity paradox, with the paradox being observed in some studies [ 8 – 11 , 13 – 15 , 23 ], but not in all [ 24 – 26 ]. Consequently, there have been attempts to unify the conflicting results in the literature with systematic reviews on adiposity and cancer survival [ 27 – 30 ] but with inconsistent summaries.…”

Adult Overweight and Survival from Breast and Colorectal Cancer in Swedish Women

“…BMI was furthermore significantly associated with both disease-free and overall survival and constituted an independent prognostic determinant in clinical trial participants receiving adjuvant chemotherapy (23). Similarly, a recent U.S. study showed that obese patients with stage I to III disease had a 2-fold increased risk of death as compared with overweight patients (24). This was even more pronounced for patients who reported a stable weight (from pre-to peridiagnostic).…”