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. 2016 Jan 10;34(2):144-50.
doi: 10.1200/JCO.2015.61.6441. Epub 2015 Oct 26.

Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database

Lindsay A Renfro  1 , Fotios Loupakis  2 , Richard A Adams  2 , Matthew T Seymour  2 , Volker Heinemann  2 , Hans-Joachim Schmoll  2 , Jean-Yves Douillard  2 , Herbert Hurwitz  2 , Charles S Fuchs  2 , Eduardo Diaz-Rubio  2 , Rainer Porschen  2 , Christophe Tournigand  2 , Benoist Chibaudel  2 , Alfredo Falcone  2 , Niall C Tebbutt  2 , Cornelis J A Punt  2 , J Randolph Hecht  2 , Carsten Bokemeyer  2 , Eric Van Cutsem  2 , Richard M Goldberg  2 , Leonard B Saltz  2 , Aimery de Gramont  2 , Daniel J Sargent  2 , Heinz-Josef Lenz  2
Affiliations

Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database

Lindsay A Renfro et al. J Clin Oncol. .

Abstract

Purpose: In recent retrospective analyses of early-stage colorectal cancer (CRC), low and high body mass index (BMI) scores were associated with worsened outcomes. Whether BMI is a prognostic or predictive factor in metastatic CRC (mCRC) is unclear.

Patients and methods: Individual data from 21,149 patients enrolled onto 25 first-line mCRC trials during 1997 to 2012 were pooled. We assessed both prognostic and predictive effects of BMI on overall survival and progression-free survival, and we accounted for patient and tumor characteristics and therapy type (targeted v nontargeted).

Results: BMI was prognostic for overall survival (P < .001) and progression-free survival (P < .001), with an L-shaped pattern. That is, risk of progression and/or death was greatest for low BMI; risk decreased as BMI increased to approximately 28 kg/m(2), and then it plateaued. Relative to obese patients, patients with a BMI of 18.5 kg/m(2) had a 27% increased risk of having a PFS event (95% CI, 20% to 34%) and a 50% increased risk of death (95% CI, 43% to 56%). Low BMI was associated with poorer survival for men than women (interaction P < .001). BMI was not predictive of treatment effect.

Conclusion: Low BMI is associated with an increased risk of progression and death among the patients enrolled on the mCRC trials, with no increased risk for elevated BMI, in contrast to the adjuvant setting. Possible explanations include negative effects related to cancer cachexia in patients with low BMI, increased drug delivery or selection bias in patients with high BMI, and potential for an interaction between BMI and molecular signaling pathways.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Risk of (A) death overall, (B) progression or death overall, and (C) death by sex on the relative hazard scale. Shaded regions indicate 95% confidence bands for risk of outcomes as a function of body mass index (BMI). HR, hazard ratio.
Fig 2.
Fig 2.
Risk of (A) death and (B) progression on death as a function of body mass index (BMI) for patients enrolled onto the N9741 trial.
See this image and copyright information in PMC

References

    1. International Agency for Research on Cancer, World Health Organization. GLOBOCAN 2012: Estimated cancer incidence, mortality, and prevalence worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.
    1. Larsson SC, Wolk A. Obesity and colon and rectal cancer risk: A meta-analysis of prospective studies. Am J Clin Nutr. 2007;86:556–565. - PubMed
    1. Sinicrope FA, Foster NR, Sargent DJ, et al. Obesity is an independent prognostic variable in colon cancer survivors. Clin Cancer Res. 2010;16:1884–1893. - PMC - PubMed
    1. Sinicrope FA, Foster NR, Yothers G, et al. Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer. 2013;119:1528–1536. - PMC - PubMed
    1. Dignam JJ, Polite BN, Yothers G, et al. Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst. 2006;15:1647–1654. - PubMed

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