Visceral Adiposity is a Risk Factor for Poor Prognosis in Colorectal Cancer Patients Receiving Adjuvant Chemotherapy

Lee, Chun Seng; Murphy, David J.; McMahon, Colm J.; Nolan, Bláthnaid; Cullen, Garret; Mulcahy, Hugh; Sheahan, Kieran; Barnes, Elizabeth; Fennelly, D.; Ryan, Elizabeth J.; Doherty, Glen

doi:10.1007/s12029-015-9709-0

Cited by 48 publications

(71 citation statements)

References 28 publications

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“…Another review concluded that the increase in adiposity was associated with an increase of CC-related mortality and decreased the disease-free survival of CC in women and RC in men [25]. Other papers suggested that increased VF was a signiﬁcant predictor of worst disease-free survival in patients with resectable CRC [10] and reduced overall survival in CRC patients receiving adjuvant chemotherapy [16]. In contrast, other works demonstrated that patients with higher VF tended to have better overall-survival that non-visceral obesity patients [12] and a meta-analyses concluded that there was insufficient evidence to prove the presence of a strong link between adiposity and survival [26].…”

Section: Discussionmentioning

confidence: 99%

Influence of Visceral Fat in the Outcomes of Colorectal Cancer

et al. 2018

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Aim: To determine the relationship of visceral fat (VF) with the surgical outcome of the patients with colorectal cancer (CRC) submitted to curative surgery. Methods: Retrospective analysis of all patients submitted to CRC surgery during 3 years with a minimum of 5 years of follow-up. We assessed the length of hospital stay, complications, pathologic reports, surgical re-interventions and hospital re-admissions, relapses, survival time and disease-free time. VF was calculated based on patients’ pre-operative CT-scan. The patients were divided into quartiles according to the VF area. Linear regression models and logistic regression models were used to establish a relationship between VF and all data collected. Results: The study included 199 patients (129 with colon cancer [CC] and 70 with rectal cancer). The average area of VF was 115.7 cm². Patients with CRC revealed a direct relationship between VF and postoperative complications (p = 0.043), anastomotic leakage (p = 0.009) and re-operation (p = 0.005). The subgroup of patients with CC had an inverse association between VF and lymph nodes harvested (p = 0.027). Survival analyses did not reveal significant differences. Conclusion: VF has an influence on postoperative complications, anastomotic leakage and re-operation. A negative influence of VF on lymph nodes harvested was observed on CC patients.

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Section: Discussionmentioning

confidence: 99%

Influence of Visceral Fat in the Outcomes of Colorectal Cancer

et al. 2018

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“…Three studies (Kang et al, 2012;Lee, Murphy et al, 2015;Yamamoto et al, 2012) used previously established cut-off points to discriminate patients with abnormal VAT. Although median or quartiles have been used to stratify patients, cut-off points for VAT associated with clinical significance have not been defined.…”

Section: Methodological Considerationsmentioning

confidence: 99%

“…Among the studies hereby reviewed, VAT cross-sectional area was the most commonly used index, measured in 14 studies (Gaujoux et al, 2012;Guiu et al, 2010;Kaneko et al, 2015;Kang et al, 2012;Kim, Chin, Hwang, & Jun, 2014;Ladoire et al, 2011;Lee, Jeong et al, 2015;Lee, Murphy et al, 2015;Nault et al, 2015;Naya et al, 2010;Pecorelli et al, 2016;Slaughter et al, 2014;Steffens et al, 2011;Yamamoto et al, 2012). The distance or thickness between kidney and abdominal wall musculature at the level of renal vein has been used as a proxy for quantifying VAT in seven studies (Balentine, Enriquez et al, 2010;Clark et al, 2013;Li et al, 2015;Mathur et al, 2011;Miller et al, 2012;Papoulas et al, 2015;Pausch et al, 2012), by virtue of measurement efficiency and convenience.…”

Section: Methodological Considerationsmentioning

confidence: 99%

“…Although median or quartiles have been used to stratify patients, cut-off points for VAT associated with clinical significance have not been defined. Three studies (Kang et al, 2012;Lee, Murphy et al, 2015;Yamamoto et al, 2012) used previously established cut-off points to discriminate patients with abnormal VAT. However, these cut-off points were originally developed in relation to specific clinical outcomes or within ethnicity specific cohorts (Howard et al, 2010;Oka et al, 2008;Tsujinaka et al, 2008).…”

Section: Methodological Considerationsmentioning

confidence: 99%

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Visceral adiposity and cancer survival: a review of imaging studies

et al. 2016

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Although obesity is a well-known risk factor for cancer, the association between obesity and cancer survival remains controversial. This is partially due to the inability of conventional obesity measures to directly assess adiposity or adipose tissue distribution. As a metabolic organ, visceral adipose tissue (VAT) secrets a variety of cytokines and cytokine-like factors, potentially affecting cancer survival. The objective of this review was to investigate the influence of imaging-assessed VAT on cancer survival. A total of 22 studies assessing the impact of visceral adiposity on survival were included. Negative associations between VAT and survival were more frequently observed among patients with colorectal (four of six studies) and pancreatic (three of five studies) cancers, compared to higher VAT predicting longer survival in most studies of renal cell carcinoma patients (four of five studies). Methodological limitations, including unstandardised VAT measurement methods, lack of other body composition measurement (i.e. muscle mass), small sample size and heterogeneous cohort characteristics, may explain controversial findings related to the impact of VAT on cancer survival.

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“…In particular, depletion of skeletal muscle mass, termed “sarcopenia,” is widely reported to confer a poor prognosis for patients with tumors of the gastrointestinal (GI) tract, associated with an increased rate of postoperative complications2 and impaired response to chemotherapy 1. A smaller number of studies also have reported relationships between subcutaneous or visceral adiposity and outcomes for several tumor types, including esophageal,8 pancreatic,9 and colorectal cancers 10,11. The majority of these studies have used image analysis of computed tomography (CT) scans to measure parameters of body composition, and the accuracy of this technique is now widely accepted 12.…”

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confidence: 99%

Prognostic Value of Computed Tomography: Measured Parameters of Body Composition in Primary Operable Gastrointestinal Cancers

et al. 2017

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BackgroundPrevious reports suggest that body composition parameters can be used to predict outcomes for patients with gastrointestinal (GI) cancers. However, evidence for an association with long-term survival is conflicting, with much of the data derived from patients with advanced disease. This study examined the effect of body composition on survival in primary operable GI cancer.MethodsPatients with resectable adenocarcinoma of the GI tract (esophagus, stomach, colon, rectum) between 2006 and 2014 were identified from a prospective database. Computed tomography (CT) scans were analyzed using a transverse section at L3 to calculate sex-specific body composition indices for skeletal muscle, visceral fat, and subcutaneous fat. Kaplan–Meier and log-rank analysis were used to compare unadjusted survival. Multivariate survival analyses were performed using a proportional hazards model.ResultsThe study enrolled 447 patients (191 woman and 256 men) with esophagogastric (OG) (n = 108) and colorectal (CR) (n = 339) cancer. Body composition did not predict survival for the OG cancer patients. Among the CR cancer patients, survival was shorter for those with sarcopenia (p = 0.017) or low levels of subcutaneous fat (p = 0.005). Older age (p = 0.046) and neutrophilia (p = 0.013) were associated with sarcopenia in patients with CR. Tumor stage (p = 0.033), neutrophil count (p = 0.011), and hypoalbuminemia (p = 0.023) were associated with sarcopenia in OG cancer patients. In the multivariate analysis, no single measure of body composition was an independent predictor of reduced survival.ConclusionSarcopenia and reduced subcutaneous adiposity are associated with reduced survival for patients with primary operable CR cancer. However, in this study, no parameter of body composition was an independent prognostic marker when considered with age, tumor stage, and systemic inflammation.

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Visceral Adiposity is a Risk Factor for Poor Prognosis in Colorectal Cancer Patients Receiving Adjuvant Chemotherapy

Abstract: This study shows that visceral obesity increases the likelihood of a poor prognosis in CRC patients receiving adjuvant chemotherapy thus underlying the value of lifestyle interventions to minimize visceral obesity in this patient cohort.

Cited by 48 publications

References 28 publications

Influence of Visceral Fat in the Outcomes of Colorectal Cancer

Influence of Visceral Fat in the Outcomes of Colorectal Cancer

Visceral adiposity and cancer survival: a review of imaging studies

Prognostic Value of Computed Tomography: Measured Parameters of Body Composition in Primary Operable Gastrointestinal Cancers

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