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. 2022 Jul;41(7):1600-1604.
doi: 10.1016/j.clnu.2022.05.016. Epub 2022 May 27.

The association of abdominal adiposity with premature discontinuation of postoperative chemotherapy in colon cancer

Justin C Brown  1 , Jeffrey A Meyerhardt  2 , Elizabeth M Cespedes Feliciano  3 , En Cheng  3 , Bette J Caan  3
Affiliations

The association of abdominal adiposity with premature discontinuation of postoperative chemotherapy in colon cancer

Justin C Brown et al. Clin Nutr. 2022 Jul.

Abstract

Background & aims: Patients with colon cancer who prematurely discontinue postoperative chemotherapy may have an increased risk of disease recurrence and death. This study tested the hypothesis that the quantity and distribution of abdominal adipose tissue predict premature chemotherapy discontinuation.

Methods: This cohort study included 533 patients with stage II-III colon cancer who initiated a planned regimen of 24-weeks of 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy. The primary exposures were body mass index (BMI) and computed tomography-derived abdominal adiposity measures (e.g., visceral, subcutaneous, and intramuscular adipose tissue). The primary endpoint was premature chemotherapy discontinuation, defined as receiving <6 cycles of FOLFOX. Generalized linear models quantified the relative risk (RR) of premature chemotherapy discontinuation adjusted for age, sex, cancer stage, height, and muscle area, using two-sided statistical tests.

Results: Forty-two patients [7.9% (95% CI: 5.7, 10.5)] prematurely discontinued chemotherapy. Visceral adipose tissue [RR: 3.27 (95% CI: 1.26, 8.49)] and intramuscular adipose tissue [RR: 2.79 (95% CI: 1.09, 7.12)] were statistically significantly associated with an increased risk of premature chemotherapy discontinuation. BMI [RR: 2.07 (95% CI: 0.75, 5.73)] and subcutaneous adipose tissue [RR: 2.32 (95% CI: 0.91, 5.94)] were not statistically significantly associated with premature chemotherapy discontinuation.

Conclusion: Among patients with stage II-III colon cancer who initiate postoperative chemotherapy, excess visceral and intramuscular adiposity may be risk factors for the premature discontinuation of chemotherapy.

Keywords: Adverse event; Chemotherapy dosing; Obesity; Pharmacology.

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Conflict of interest statement

Conflict of interest Dr. Brown reports receiving grants from the National Cancer Institute and the American Institute for Cancer Research during the conduct of the study. Dr. Cespedes Feliciano reports receiving grants from the National Cancer Institute during the conduct of the study. Dr. Meyerhardt reports receiving grants from the National Cancer Institute during the conduct of the study and reports receiving consulting fees from Cota Healthcare, and Taiho during the 36 months before publication (all fees <$5000). Dr. Caan reports receiving grants from the National Cancer Institute during the conduct of the study. All other authors report no disclosures.

Figures

Figure 1.
Figure 1.
Restricted cubic spline estimates of premature chemotherapy discontinuation on the relative risk scale as a function of body mass index (Panel A); visceral adipose tissue area (Panel B); subcutaneous adipose tissue area (Panel C); and intramuscular adipose tissue (Panel D). Relative risk (RR) estimates in the text are the contrast of the 5th and 95th percentiles. Shaded regions indicate 95% confidence bands for risk of premature chemotherapy discontinuation. Estimates are adjusted for age, sex, cancer stage, height, and muscle area. Note distinct x-axis scales; y-axis plotted on the logarithmic scale.
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References

    1. Gill S, Loprinzi CL, Sargent DJ, Thome SD, Alberts SR, Haller DG, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol. 2004;22(10):1797–806. - PubMed
    1. Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004;350(23):2343–51. - PubMed
    1. Grothey A, Sobrero AF, Shields AF, Yoshino T, Paul J, Taieb J, et al. Duration of Adjuvant Chemotherapy for Stage III Colon Cancer. N Engl J Med. 2018;378(13):1177–88. - PMC - PubMed
    1. Andre T, Meyerhardt J, Iveson T, Sobrero A, Yoshino T, Souglakos I, et al. Effect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA collaboration): final results from a prospective, pooled analysis of six randomised, phase 3 trials. Lancet Oncol. 2020;21(12):1620–9. - PMC - PubMed
    1. Webster-Clark M, Keil AP, Sanoff HK, Sturmer T, Westreich D, Lund JL. Introducing longitudinal cumulative dose to describe chemotherapy patterns over time: Case study of a colon cancer trial. Int J Cancer. 2021;149(2):394–402. - PubMed

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