Body mass index-based predictions and personalized clinical strategies for colorectal cancer in the context of PPPM

Abstract

Currently colorectal cancer (CRC) is the third most prevalent cancer worldwide. Body mass index (BMI) is frequently used in CRC screening and risk assessment to quantitatively evaluate weight. However, the impact of BMI on clinical strategies for CRC has received little attention. Within the framework of the predictive, preventive, and personalized medicine (3PM/PPPM), we hypothesized that BMI stratification would affect the primary, secondary, and tertiary care options for CRC and we conducted a critical evidence-based review. BMI dynamically influences CRC outcomes, which helps avoiding adverse treatment effects. The outcome of surgical and radiation treatment is adversely affected by overweight (BMI ≥ 30) or underweight (BMI < 20). A number of interventions, such as enhanced recovery after surgery and robotic surgery, can be applied to CRC at all levels of BMI. BMI-controlling modalities such as exercise, diet control, nutritional therapy, and medications may be potentially beneficial for patients with CRC. Patients with overweight are advised to lose weight through diet, medication, and physical activity while patients suffering of underweight require more focus on nutrition. BMI assists patients with CRC in better managing their weight, which decreases the incidence of adverse prognostic events during treatment. BMI is accessible, noninvasive, and highly predictive of clinical outcomes in CRC. The cost-benefit of the PPPM paradigm in developing countries can be advanced, and the clinical benefit for patients can be improved with the promotion of BMI-based clinical strategy models for CRC.

Keywords: BMI (body mass index); Colorectal cancer; ERAS (enhanced recovery after surgery); Obesity; Predictive, preventive and personalized medicine (3PM/PPPM); SMI (skeletal muscle index); Weight management.

Fig. 1

BMI-based integrated management in the context of PPPM. According to the culture and medical level of the patient, the multi-cancer and obesity domains are used as an extension of the evidence to develop a PPPM for patients with CRC based on BMI. Abbreviation: BMI, body mass index; CRC, colorectal cancer; CHM, Chinese herbal medicine; PPPM, predictive, preventive, and personalized medicine