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Pavone M, Goglia M, Taliento C, Lecointre L, Bizzarri N, Fanfani F, Fagotti A, Scambia G, Marescaux J, Querleu D, Seeliger B, Akladios C. Obesity paradox: is a high body mass index positively influencing survival outcomes in gynecological cancers? A systematic review and meta-analysis. Int J Gynecol Cancer 2024; 34:1253-1262. [PMID: 38642923 DOI: 10.1136/ijgc-2023-005252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE Obesity represents an exponentially growing preventable disease leading to different health complications, particularly when associated with cancer. In recent years, however, an 'obesity paradox' has been hypothesized where obese individuals affected by cancer counterintuitively show better survival rates. The aim of this systematic review and meta-analysis is to assess whether the prognosis in gynecological malignancies is positively influenced by obesity. METHODS This study adheres to PRISMA guidelines and is registered with PROSPERO. Studies reporting the impact of a body mass index (BMI) of >30 kg/m2 compared with <30 kg/m2 in patients with gynecological cancers listed in PubMed, Google Scholar and ClinicalTrials.gov were included in the analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2) was used for quality assessment of the selected articles. RESULTS Twenty-one studies were identified for the meta-analysis, including 14 108 patients with cervical, ovarian, or endometrial cancer. There was no benefit in 5-year overall survival for obese patients compared with non-obese patients (OR 1.2, 95% CI 1.00 to 1.44, p=0.05; I2=71%). When pooling for cancer sub-groups, there were no statistically significant differences in 5-year overall survival in patients with cervical cancer and 5-year overall survival and progression-free survival in patients with ovarian cancer. For obese women diagnosed with endometrial cancer, a significant decrease of 44% in 5-year overall survival (p=0.01) was found, with no significant difference in 5-year disease-free survival (p=0.78). CONCLUSION According to the results of the present meta-analysis, a BMI of ≥30 kg/m2 does not have a positive prognostic effect on survival compared with a BMI of <30 kg/m2 in women diagnosed with gynecological cancers. The existence of the 'obesity paradox' in other fields, however, suggests the importance of further investigations with prospective studies.
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Affiliation(s)
- Matteo Pavone
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Research Institute against Digestive Cancer, IRCAD France, Strasbourg, France
| | - Marta Goglia
- Research Institute against Digestive Cancer, IRCAD France, Strasbourg, France
- Department of Medical and Surgical Science and Translational Medicine, Faculty of Medicine and Psycology, Sapienza University of Rome, Rome, Italy
| | - Cristina Taliento
- Department of Obstetrics and Gynecology, University Hospital Ferrara, Ferrara, Italy
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Lise Lecointre
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Department of Gynecology, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Jacques Marescaux
- Research Institute against Digestive Cancer, IRCAD France, Strasbourg, France
| | - Denis Querleu
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Barbara Seeliger
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Department of Digestive and Endocrine Surgery, The University Hospitals of Strasbourg, Strasbourg, France
| | - Chérif Akladios
- Department of Gynecology, Hôpitaux universitaires de Strasbourg, Strasbourg, France
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Tohidinezhad F, Zegers CML, Vaassen F, Dijkstra J, Anten M, Van Elmpt W, De Ruysscher D, Dekker A, Eekers DBP, Traverso A. Predicting the risk of neurocognitive decline after brain irradiation in adult patients with a primary brain tumor. Neuro Oncol 2024; 26:1467-1478. [PMID: 38595122 PMCID: PMC11300005 DOI: 10.1093/neuonc/noae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Deterioration of neurocognitive function in adult patients with a primary brain tumor is the most concerning side effect of radiotherapy. This study aimed to develop and evaluate normal-tissue complication probability (NTCP) models using clinical and dose-volume measures for 6-month, 1-year, and 2-year Neurocognitive Decline (ND) postradiotherapy. METHODS A total of 219 patients with a primary brain tumor treated with radical photon and/or proton radiotherapy (RT) between 2019 and 2022 were included. Controlled oral word association test, Hopkins verbal learning test-revised, and trail making test were used to objectively measure ND. A comprehensive set of potential clinical and dose-volume measures on several brain structures were considered for statistical modeling. Clinical, dose-volume and combined models were constructed and internally tested in terms of discrimination (area under the curve, AUC), calibration (mean absolute error, MAE), and net benefit. RESULTS Fifty percent, 44.5%, and 42.7% of the patients developed ND at 6-month, 1-year, and 2-year time points, respectively. The following predictors were included in the combined model for 6-month ND: age at radiotherapy > 56 years (OR = 5.71), overweight (OR = 0.49), obesity (OR = 0.35), chemotherapy (OR = 2.23), brain V20 Gy ≥ 20% (OR = 3.53), brainstem volume ≥ 26 cc (OR = 0.39), and hypothalamus volume ≥ 0.5 cc (OR = 0.4). Decision curve analysis showed that the combined models had the highest net benefits at 6-month (AUC = 0.79, MAE = 0.021), 1-year (AUC = 0.72, MAE = 0.027), and 2-year (AUC = 0.69, MAE = 0.038) time points. CONCLUSIONS The proposed NTCP models use easy-to-obtain predictors to identify patients at high risk of ND after brain RT. These models can potentially provide a base for RT-related decisions and post-therapy neurocognitive rehabilitation interventions.
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Affiliation(s)
- Fariba Tohidinezhad
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Catharina M L Zegers
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Femke Vaassen
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jeanette Dijkstra
- Department of Medical Psychology, School for Mental Health and Neurosciences (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Monique Anten
- Department of Neurology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wouter Van Elmpt
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daniëlle B P Eekers
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alberto Traverso
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
- School of Medicine, Libera Università Vita-Salute San Raffaele, Milan, Italy
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Jiménez-Cortegana C, Gutiérrez-García C, Sánchez-Jiménez F, Vilariño-García T, Flores-Campos R, Pérez-Pérez A, Garnacho C, Sánchez-León ML, García-Domínguez DJ, Hontecillas-Prieto L, Palazón-Carrión N, De La Cruz-Merino L, Sánchez-Margalet V. Impact of obesity‑associated myeloid‑derived suppressor cells on cancer risk and progression (Review). Int J Oncol 2024; 65:79. [PMID: 38940351 PMCID: PMC11251741 DOI: 10.3892/ijo.2024.5667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
Obesity is a chronic disease caused by the accumulation of excessive adipose tissue. This disorder is characterized by chronic low‑grade inflammation, which promotes the release of proinflammatory mediators, including cytokines, chemokines and leptin. Simultaneously, chronic inflammation can predispose to cancer development, progression and metastasis. Proinflammatory molecules are involved in the recruitment of specific cell populations in the tumor microenvironment. These cell populations include myeloid‑derived suppressor cells (MDSCs), a heterogeneous, immature myeloid population with immunosuppressive abilities. Obesity‑associated MDSCs have been linked with tumor dissemination, progression and poor clinical outcomes. A comprehensive literature review was conducted to assess the impact of obesity‑associated MDSCs on cancer in both preclinical models and oncological patients with obesity. A secondary objective was to examine the key role that leptin, the most important proinflammatory mediator released by adipocytes, plays in MDSC‑driven immunosuppression Finally, an overview is provided of the different therapeutic approaches available to target MDSCs in the context of obesity‑related cancer.
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Affiliation(s)
- Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Cristian Gutiérrez-García
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Flora Sánchez-Jiménez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Teresa Vilariño-García
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Rocio Flores-Campos
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Antonio Pérez-Pérez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Carmen Garnacho
- Department of Normal and Pathological Histology and Cytology, School of Medicine, University of Seville, 41009 Seville, Spain
| | - Maria L. Sánchez-León
- Oncology Service, Virgen Macarena University Hospital, School of Medicine, University of Seville, 41009 Seville, Spain
| | - Daniel J. García-Domínguez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Lourdes Hontecillas-Prieto
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Natalia Palazón-Carrión
- Oncology Service, Virgen Macarena University Hospital, School of Medicine, University of Seville, 41009 Seville, Spain
| | - Luis De La Cruz-Merino
- Oncology Service, Virgen Macarena University Hospital, School of Medicine, University of Seville, 41009 Seville, Spain
- Institute of Biomedicine of Seville, Virgen Macarena University Hospital, CSIC, University of Seville, Seville 41013, Spain
| | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Institute of Biomedicine of Seville, Virgen Macarena University Hospital, CSIC, University of Seville, Seville 41013, Spain
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Atkins K, Cairns B, Schneider A, Charles A. An evaluation of the "Obesity Paradox" in isolated blunt abdominal trauma in the United States. Injury 2024; 55:111612. [PMID: 38759489 PMCID: PMC11179957 DOI: 10.1016/j.injury.2024.111612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/23/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The obesity paradox theorizes a survival benefit in trauma patients secondary to the cushioning effect of adiposity. We aim to evaluate the impact of body mass index (BMI) on abdominal injury severity, morbidity, and mortality in adults with isolated, blunt abdominal trauma in the United States. METHODS We reviewed the National Trauma Data Bank (2013-2021) for adults sustaining isolated, blunt abdominal trauma stratified by BMI. We performed a doubly robust, augmented inverse-propensity weighted multivariable logistic regression to estimate the average treatment effect (ATE) of BMI on mortality and the presence of abdominal organ injury. RESULTS 36,350 patients met the inclusion criteria. In our study, 41.4 % of patients were normal-weight (BMI 18.5-24.9), 20.6 % were obese (BMI 30-39.9), and 4.7 % were severely obese (BMI≥40). In these cohorts, the abdominal abbreviated injury scale (AIS) was 2 (2 -3). Obese and severely obese patients had significantly reduced presence of pancreas, spleen, liver, kidney, and small bowel injuries. The predicted probability of abdominal AIS severity decreased significantly with increasing BMI. Crude mortality was significantly higher in obese (1.3 %) and severely obese patients (1.3 %) compared to normal-weight patients (0.7 %). Obese and severely obese patients demonstrated non-statistically significant changes in the mortality of +26.4 % (ATE 0.264, 95 %CI -0.108-0.637, p = 0.164) and +55.5 % (ATE 0.555, 95 %CI -0.284-1.394, p = 0.195) respectively, compared to normal weight patients. CONCLUSION BMI may protect against abdominal injury in adults with isolated, blunt abdominal trauma. Mortality did not decrease in association with increasing BMI, as this may be offset by the increase in co-morbidities in this population.
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Affiliation(s)
- Kathryn Atkins
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Bruce Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Andrew Schneider
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, USA.
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Zhang MY, Othus M, McMillen K, Erba HP, Garcia-Manero G, Pagel JM, Sorror ML, Percival MEM. Association between class III obesity and overall survival in previously untreated younger patients with acute myeloid leukemia enrolled on SWOG S1203. Leukemia 2024; 38:1488-1493. [PMID: 38830960 DOI: 10.1038/s41375-024-02288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024]
Abstract
There has been ongoing debate on the association between obesity and outcomes in acute myeloid leukemia (AML). Currently few studies have stratified outcomes by class I obesity, class II obesity, and class III obesity, and a more nuanced understanding is becoming increasingly important with the rising prevalence of obesity. We examined the association between body mass index (BMI) and outcomes in previously untreated AML in younger patients (age ≤60) enrolled in SWOG S1203 (n = 729). Class III obesity was associated with an increased rate of early death (p = 0.004) and worse overall survival (OS) in multivariate analysis (hazard ratio (HR) 2.48, 95% confidence interval (CI) 1.62-3.80 versus normal weight). Class III obesity was also associated with worse OS after allogeneic hematopoietic cell transplant (HR 2.37, 95% CI 1.24-4.54 versus normal weight). These findings highlight the unique risk of class III obesity in AML, and the importance of further investigation to better characterize this patient population.
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Affiliation(s)
- Michelle Y Zhang
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Megan Othus
- SWOG Statistical and Data Management Center, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Kerry McMillen
- Fred Hutchinson Medical Nutrition Therapy Services, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | | | - Mohamed L Sorror
- Department of Medicine, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Mary-Elizabeth M Percival
- Department of Medicine, University of Washington, Seattle, WA, USA.
- Fred Hutchinson Cancer Center, Seattle, WA, USA.
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6
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Shen T, Sun S, Li W, Wang X, Gao Y, Yang Q, Cai J. Association between body mass index and lymph node metastasis among women with cervical cancer: a systematic review and network meta-analysis. Arch Gynecol Obstet 2024:10.1007/s00404-024-07528-9. [PMID: 38858322 DOI: 10.1007/s00404-024-07528-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/22/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE Lymph node status is a determinant of survival in patients with early-stage cervical cancer. However, the relationship between obesity and lymph node status remains unclear. Therefore, this systematic review aims to evaluate the correlation between body mass index (BMI) and lymph node metastasis in cervical cancer. METHODS Cohort studies through six databases were reviewed until December 2021. Odds ratios (ORs) for lymphatic metastasis were estimated using random-effects models and network meta-analysis. BMI groups for lymph node metastasis were ranked. Heterogeneities were assessed using I2. Subgroup analyses were performed to determine possible sources of heterogeneity. RESULTS No significant difference was found between obese (BMI ≥ 25) and non-obese patients (BMI < 25) (OR = 1.01; 95% CI 0.69-1.47; P = 0.97). In subgroup analyses, obesity was associated with higher risk among the Americans and advanced-stage patients. The grouping analysis based on BMI and the rankogram values revealed that the '35 ≤ BMI' group had the highest risk of lymph node metastasis. CONCLUSION Although there were no significant differences in lymph node metastasis between obese and non-obese cervical cancer patients in overall analysis, patients with BMI ≥ 35 were at significantly higher risk of lymph node metastasis.
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Affiliation(s)
- Tiantian Shen
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Si Sun
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wenhan Li
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaoman Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yumei Gao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qiang Yang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Percival ME, Zhang M, Othus M, McMillen K, Erba H, Garcia-Manero G, Pagel J, Sorror M. Association between class III obesity and overall survival in previously untreated younger patients with acute myeloid leukemia enrolled on SWOG S1203. RESEARCH SQUARE 2024:rs.3.rs-4020184. [PMID: 38559108 PMCID: PMC10980157 DOI: 10.21203/rs.3.rs-4020184/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
There has been ongoing debate on the association between obesity and outcomes in acute myeloid leukemia (AML). Currently there are few studies that have stratified outcomes by class I obesity, class II obesity, and class III obesity; and a more nuanced understanding is becoming increasingly important with the rising prevalence of obesity. We examined the association between body mass index (BMI) and outcomes in previously untreated AML in younger patients (age ≤60) enrolled in SWOG S1203 (n=729). Class III obesity was associated with an increased rate of early death (p=0.004) and worse overall survival (OS) in multivariate analysis (hazard ratio (HR) 2.48, 95% confidence interval (CI) 1.62-3.80 versus normal weight). Class III obesity was also associated with worse OS after allogeneic hematopoietic cell transplant (HR 2.37, 95% CI 1.24-4.54 versus normal weight). These findings highlight the unique risk of class III obesity in AML, and the importance of further investigation to better characterize this patient population.
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Tanaka T, Miwa K, Shimotsuura Y, Nagasu S, Shigyou H, Hirota K, Koya S, Akagi Y, Kawaguchi T. High intramuscular adipose tissue content was a favorable prognostic factor in patients with advanced gastric cancer treated with nivolumab monotherapy. J Gastroenterol Hepatol 2023; 38:1760-1767. [PMID: 37225648 DOI: 10.1111/jgh.16239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Nivolumab extends the overall survival (OS) of patients with advanced gastric cancer (AGC). Intramuscular adipose tissue (IMAT) is associated with the prognosis of patients with various cancers. We investigated the effect of IMAT on OS in patients with AGC treated with nivolumab. METHODS We enrolled patients with AGC treated with nivolumab (n = 58, 67 years old, men/women 40/18). The subjects were classified into long-term or short-term survival groups according to the median value. The IMAT was evaluated using computed tomography scans at the umbilical level. The decision tree algorithm was employed to reveal the profile associated with prognosis. RESULTS In decision tree analysis, immune-related adverse events (irAEs) were the first divergence variable, and prolonged survival was observed in 100% of patients with irAEs (profile 1). However, long survival was observed in 38% of patients with no irAEs. Among these patients, IMAT was identified as the second divergence variable, and long survival was observed in 63% of patients with high IMAT (profile 2). In patients with low IMAT, only 21% showed prolonged survival (profile 3). Median OS was 717 days (95% confidence interval [CI], 223 to not reached) in profile 1, 245 days (95% CI, 126 to 252) in profile 2, and 132 days (95% CI, 69 to 163) in profile 3. CONCLUSION Immune-related adverse events and high IMAT were favorable factors for OS in patients with AGC treated with nivolumab. Thus, along with irAEs, skeletal muscle quality is important in managing patients with AGC treated with nivolumab.
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Affiliation(s)
- Toshimitsu Tanaka
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Keisuke Miwa
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yasutaka Shimotsuura
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Sachiko Nagasu
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hirona Shigyou
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Keisuke Hirota
- Division of Rehabilitation, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Shunji Koya
- Division of Rehabilitation, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Yang Y, Chen D, Zhong D, Yi Z. Association of body mass index with survival in U.S. cancer survivors: a cross-sectional study of NHANES 1999-2018. Front Oncol 2023; 13:1180442. [PMID: 37251930 PMCID: PMC10213672 DOI: 10.3389/fonc.2023.1180442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background Understanding the association between relative mortality with body mass index (BMI) may aid clinicians in making suitable clinical decisions. Our study evaluated the impact of BMI on mortality among cancer survivors. Methods We used data from the US National Health and Nutrition Examination Surveys (NHANES) spanning from 1999 to 2018. Relevant mortality data were retrieved up until December 31, 2019. Adjusted Cox models were employed to examine the association of BMI with the risks for total and cause-specific mortality. Results Among 4135 cancer survivors, 1486 (35.9%) were obese (21.0% class 1 obesity [BMI 30-< 35 kg/m2], 9.2% class 2 obesity [BMI 35 -< 40 kg/m2], 5.7% class 3 obesity [BMI ≥ 40 kg/m2]), 1475(35.7%) were overweight (BMI 25-< 30 kg/m2). During an average follow-up of 8.9 years (35895 person-years), a total of 1361 deaths were reported (cancer 392; 356 cardiovascular disease [CVD]; 613, non-cancer, non-CVD). In multivariable models, underweight participants (BMI < 18.5 kg/m2) were associated with significantly higher risks of cancer-specific (HR, 3.31; 95% CI, 1.37-8.03, P=0.01) and CVD cause (HR, 3.18; 95% CI, 1.44-7.02, P < 0.001) mortality compared to individuals with normal weight. Being overweight was associated with significantly lower risks of non-cancer, non-CVD cause mortality (HR, 0.66; 95% CI, 0.51-0.87, P < 0.001). Class 1 obesity was associated with significantly reduced risks of all-cause (HR, 0.78; 95% CI, 0.61-0.99, P = 0.04), and non-cancer, non-CVD cause (HR, 0.60; 95% CI, 0.42-0.86, P = 0.01) mortality. A higher risk of CVD-related mortality (HR, 2.35; 95% CI, 1.07-5.18, P = 0.03) was observed in class 3 obesity cases. Lower risks of all-cause mortality were detected in men (overweight, HR, 0.76; 95% CI, 0.59-0.99, P=0.04; class 1 obesity, HR, 0.69; 95% CI, 0.49-0.98, P = 0.04) but not in woman, in never-smokers (class 1 obesity, HR, 0.61; 95% CI, 0.41-0.90, P=0.01) and former smokers (overweight, HR, 0.77; 95% CI, 0.60-0.98, P=0.04) but not in current smokers; in obesity-related cancer (class 2 obesity, HR, 0.49; 95% CI, 0.27-0.89, P=0.01) but not in non-obesity-related cancers. Conclusions In the United States, cancer survivors with overweight or moderate obesity (class 1 or class 2 obesity) demonstrated a lower risk of all-cause and noncancer, non-CVD cause mortality.
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Affiliation(s)
- Yi Yang
- Department of Gastroenterology, Jinhua People’s Hospital, Jinhua, Zhejiang, China
| | - Dan Chen
- Department of Gastroenterology, Jinhua People’s Hospital, Jinhua, Zhejiang, China
| | - Dingfu Zhong
- Department of Gastroenterology, Jinhua People’s Hospital, Jinhua, Zhejiang, China
| | - Zongbi Yi
- Hubei Key Laboratory of Tumor Biological Behaviors, Department of Radiation and Medical Oncology, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China
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10
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Simati S, Kokkinos A, Dalamaga M, Argyrakopoulou G. Obesity Paradox: Fact or Fiction? Curr Obes Rep 2023:10.1007/s13679-023-00497-1. [PMID: 36808566 DOI: 10.1007/s13679-023-00497-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE OF REVIEW Obesity is related to several comorbidities such as type 2 diabetes mellitus, cardiovascular disease, heart failure, and various types of cancers. While the detrimental effect of obesity in both mortality and morbidity has been well established, the concept of the obesity paradox in specific chronic diseases remains a topic of continuous interest. In the present review, we examine the controversial issues around the obesity paradox in certain conditions such as cardiovascular disease, several types of cancer and chronic obstructive pulmonary disease, and the factors that may confound the relation between obesity and mortality. RECENT FINDINGS We refer to the obesity paradox when particular chronic diseases exhibit an interesting "paradoxical" protective association between the body mass index (BMI) and clinical outcomes. This association, however, may be driven by multiple factors among which the limitations of the BMI itself; the unintended weight loss precipitated by chronic illness; the various phenotypes of obesity, i.e., sarcopenic obesity or the athlete's obesity phenotype; and the cardiorespiratory fitness levels of the included patients. Recent evidence highlighted that previous cardioprotective medications, obesity duration, and smoking status seem to play a role in the obesity paradox. The obesity paradox has been described in a plethora of chronic diseases. It cannot be emphasized enough that the incomplete information received from a single BMI measurement may interfere with outcomes of studies arguing in favor of the obesity paradox. Thus, the development of carefully designed studies, unhampered by confounding factors, is of great importance.
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Affiliation(s)
- Stamatia Simati
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko Hospital, Athens, 115 27, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko Hospital, Athens, 115 27, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, Athens, 11527, Greece
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11
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Lim DM, Lee H, Eom K, Kim YH, Kim S. Bioinformatic analysis of the obesity paradox and possible associated factors in colorectal cancer using TCGA cohorts. J Cancer 2023; 14:322-335. [PMID: 36860923 PMCID: PMC9969588 DOI: 10.7150/jca.80977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/07/2023] [Indexed: 02/04/2023] Open
Abstract
Colorectal cancer (CRC) is a common malignancy worldwide and the second leading cause of cancer-related deaths. Obesity is an important determinant of CRC incidence; however, obese patients have also shown better long-term survival than non-obese patients, suggesting that the development and progression of CRC are associated with different mechanisms. This study compares the expression of genes, tumor-infiltrating immune cells, and intestinal microbiota between high- and low-body mass index (BMI) patients at the time of CRC diagnosis. The results revealed that high-BMI patients with CRC have better prognosis, higher levels of resting CD4+ T cells, lower levels of T follicular helper cells, and different levels of intratumoral microbiota than low-BMI patients. Our study highlights that tumor-infiltrating immune cells and intratumoral microbe diversity are major features of the obesity paradox in CRC.
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Affiliation(s)
- Dong Min Lim
- Interdisciplinary Program of Genomic Data Science, Pusan National University, Yangsan 50612, Korea
| | - Hyunsu Lee
- Department of Medical Informatics, School of Medicine, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Kisang Eom
- Department of Physiology, School of Medicine, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Yun Hak Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea.,Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Korea.,✉ Corresponding authors: Shin Kim, M.D., Ph.D. Department of Immunology, School of Medicine, Keimyung University, Dalseo-gu, Daegu 42601, Republic of Korea. TEL: +82-53-258-7359; Fax: +82-53-258-7355; E-mail: ; Yun Hak Kim, M.D., Ph.D. Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Korea. TEL: +82-51-510-8091; Fax: +82-51-510-8049; E-mail:
| | - Shin Kim
- Department of Immunology, School of Medicine, Keimyung University, Dalseo-gu, Daegu 42601, Republic of Korea.,Institute of Medical Science, Keimyung University, Dalseo-gu, Daegu 42601, Republic of Korea.,Institute for Cancer Research, Keimyung University Dongsan Medical Center, Dalseo-gu, Daegu 42601, Republic of Korea.,✉ Corresponding authors: Shin Kim, M.D., Ph.D. Department of Immunology, School of Medicine, Keimyung University, Dalseo-gu, Daegu 42601, Republic of Korea. TEL: +82-53-258-7359; Fax: +82-53-258-7355; E-mail: ; Yun Hak Kim, M.D., Ph.D. Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Korea. TEL: +82-51-510-8091; Fax: +82-51-510-8049; E-mail:
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12
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Tralongo AC, Caspani F, Proserpio I, Volpi L, Campiotti L. Body mass index (BMI) influence on Cetuximab-induced antibody-dependent cellular cytotoxicity in advanced colon cancer. Intern Emerg Med 2023; 18:297-303. [PMID: 36357605 PMCID: PMC9883300 DOI: 10.1007/s11739-022-03124-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/02/2022] [Indexed: 11/12/2022]
Abstract
To date, we do not know if the excess of the body mass index (BMI) improves or worsens the outcomes in colorectal cancer treatment, and the correlation between BMI and prognosis remains unclear. A recent study in vitro showed a significant negative correlation between BMI and Cetuximab-induced antibody-dependent cellular cytotoxicity. On these bases, we tried to analyze the potential correlation between BMI and survival in patients affected by metastatic colorectal cancer (mCRC) and treated with Cetuximab. Retrospective data were collected from 132 patients affected by mCRC treated with Cetuximab in monotherapy or association with chemotherapy between January 2007 and October 2019. The cohort of patients was divided into different groups according to the World Health Organization (WHO) BMI classification: underweight (BMI < 18.59), normal weight (BMI 18.5-24.9,) overweight (BMI 25-29.9), and obese (BMI > 30), and we observed the influence of BMI on survival and treatment response. Patients with BMI ≥ 25 had statistically significantly better survival than patients BMI < 25 (19 vs 10 months, p = 0.025). Dividing the sample into the four WHO BMI categories, the best survival rates were seen in the overweight and obese subgroups (18 and 26 months respectively, p < 0.01). The multivariate analysis confirmed BMI as the only parameter able to influence survival. No correlation between BMI and treatment response was seen between BMI ≥ 25 and BMI ≤ 24 groups (p = 0.14). Our experience suggests that mild obese and overweight patients treated with Cetuximab could experience a better survival. We also observed that among normal weight, overweight, and mild obese patients, there is a better response to immunochemotherapy in comparison with underweight patients, but this difference does not reach a significative statistical value.
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Affiliation(s)
| | - Francesca Caspani
- Medical Oncology Unit, ASST Settelaghi, University of Pavia, Varese, Italy
| | | | - Lisa Volpi
- Sub-Intensive Care Unit, ASST Settelaghi, Varese, Italy
| | - Leonardo Campiotti
- Department of Medicine and Surgery, University of Insubria, Viale Luigi Borri 57, 21100, Varese-Como, Italy.
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Prognosis of older patients with newly diagnosed AML undergoing antileukemic therapy: A systematic review. PLoS One 2022; 17:e0278578. [PMID: 36469519 PMCID: PMC9721486 DOI: 10.1371/journal.pone.0278578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 11/20/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The prognostic value of age and other non-hematological factors in predicting outcomes in older patients with newly diagnosed acute myeloid leukemia (AML) undergoing antileukemic therapy is not well understood. We performed a systematic review to determine the association between these factors and mortality and health-related quality of life or fatigue among these patients. METHODS We searched Medline and Embase through October 2021 for studies in which researchers quantified the relationship between age, comorbidities, frailty, performance status, or functional status; and mortality and health-related quality of life or fatigue in older patients with AML receiving antileukemic therapy. We assessed the risk of bias of the included studies using the Quality in Prognostic Studies tool, conducted random-effects meta-analyses, and assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS We included 90 studies. Meta-analysis showed that age (per 5-year increase, HR 1.16 95% CI 1.11-1.21, high-quality evidence), comorbidities (Hematopoietic Cell Transplantation-specific Comorbidity Index: 3+ VS less than 3, HR 1.60 95% CI 1.31-1.95, high-quality evidence), and performance status (Eastern Cooperative Oncology Group/ World Health Organization (ECOG/WHO): 2+ VS less than 2, HR 1.63 95% CI 1.43-1.86, high-quality evidence; ECOG/WHO: 3+ VS less than 3, HR 2.00 95% CI 1.52-2.63, moderate-quality evidence) were associated with long-term mortality. These studies provided inconsistent and non-informative results on short-term mortality (within 90 days) and quality of life. CONCLUSION High-quality or moderate-quality evidence support that age, comorbidities, performance status predicts the long-term prognosis of older patients with AML undergoing antileukemic treatment.
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14
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Exploring the Relationship between Obesity, Metabolic Syndrome and Neuroendocrine Neoplasms. Metabolites 2022; 12:metabo12111150. [DOI: 10.3390/metabo12111150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/13/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Obesity is a major burden for modern medicine, with many links to negative health outcomes, including the increased incidence of certain cancer types. Interestingly, some studies have supported the concept of an “Obesity Paradox”, where some cancer patients living with obesity have been shown to have a better prognosis than non-obese patients. Neuroendocrine neoplasms (NENs) are malignancies originating from neuroendocrine cells, in some cases retaining important functional properties with consequences for metabolism and nutritional status. In this review, we summarize the existing evidence demonstrating that obesity is both a risk factor for developing NENs as well as a good prognostic factor. We further identify the limitations of existing studies and further avenues of research that will be necessary to optimize the metabolic and nutritional status of patients living with NENs to ensure improved outcomes.
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15
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Aleixo GF, Sheu M, Mirzai S, Majhail NS. Prognostic Impact of Adiposity in Hematological Malignancies: A Systematic Review and Meta-analysis. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2022; 22:726-734. [DOI: 10.1016/j.clml.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 04/08/2023]
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16
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Li Y, Li C, Wu G, Yang W, Wang X, Duan L, Niu L, Chen J, Zhang Y, Zhou W, Liu J, Hong L, Fan D. The obesity paradox in patients with colorectal cancer: a systematic review and meta-analysis. Nutr Rev 2022; 80:1755-1768. [PMID: 35182150 DOI: 10.1093/nutrit/nuac005] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Obesity is widely regarded as an established risk factor for colorectal cancer (CRC). However, recent studies have shown that lower mortality and better cancer-specific survival were observed in CRC patients with elevated body mass index (BMI), an example of the obesity paradox, which is the inverse correlation between obesity and mortality in some populations. OBJECTIVE The aim of this systematic review and meta-analysis was to investigate the association between BMI and CRC outcomes. DATA SOURCES PubMed, Web of Science, MEDLINE, the Cochrane Library, and Embase databases were searched for relevant articles published from inception to December 31, 2020. STUDY SELECTION Studies comparing the prognosis of CRC patients with obesity or overweight with that of normal-weight CRC patients were eligible. DATA EXTRACTION Data were extracted by 2 reviewers independently; differences were resolved by a third reviewer. BMI was classified according to WHO categories. DATA ANALYSIS To assess the prognostic effects of different BMI categories in CRC patients, hazard ratios and 95%CIs of overall survival, disease-free survival, and cancer-specific survival were extracted from included articles. RESULTS Sixteen studies (55 391 patients in total) were included. Higher BMI was significantly associated with more favorable CRC outcomes. Compared with normal-weight patients, underweight patients had worse overall survival (HR = 1.26; 95%CI, 1.15-1.37) and disease-free survival (HR = 1.19; 95%CI, 1.11-1.27, while patients with overweight had better overall survival (HR = 0.92; 95%CI, 0.86-0.99), disease-free survival (HR = 0.96; 95%CI, 0.93-1.00), and cancer-specific survival (HR = 0.86; 95%CI, 0.76-0.98). Patients with morbid obesity had worse overall survival (HR = 1.12; 95%CI, 1.02-1.22) and disease-free survival (HR = 1.15; 95%CI, 1.07-1.24) than normal-weight patients. There was no significant difference in cancer-specific survival between patients with obesity (HR = 0.94; 95%CI, 0.76-1.16) and patients with normal weight, nor between patients with underweight and patients with normal weight (HR = 1.14; 95%CI, 0.82-1.58). CONCLUSIONS CRC patients with a higher BMI appear to have reduced mortality compared with normal-weight CRC patients, even though higher BMI/obesity is an established determinant for the development of CRC. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020202320.
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Affiliation(s)
- Yiding Li
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Chenhan Li
- College of Life Science, Northwest University, Xi'an, Shaanxi Province, China
| | - Guiling Wu
- Key Laboratory of Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Wanli Yang
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases , Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Xiaoqian Wang
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province , China
| | - Lili Duan
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an , Shaanxi Province, China
| | - Liaoran Niu
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University , Xi'an, Shaanxi Province, China
| | - Junfeng Chen
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yujie Zhang
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Wei Zhou
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Jinqiang Liu
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Liu Hong
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases , Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Daiming Fan
- the State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province, China
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Skrypnyk IМ, Maslova GS, Lymanets TV, Skrypnyk RІ. THE OVERWEIGHT AND OBESITY ROLE IN THE OCCURRENCE OF CHEMOTHERAPY-INDUCED HEPATOTOXIC REACTIONS IN PATIENTS WITH ACUTE MYELOID LEUKEMIA. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1506-1511. [PMID: 35907224 DOI: 10.36740/wlek202206114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To investigate the frequency of development and nature of cytostatic-induced hepatotoxic reactions in patients with acute myeloid leukemia (AML) with overweight and obesity during remission induction сhemotherapy (CT). PATIENTS AND METHODS Materials and methods: We examined 25 patients with newly diagnosed acute leukemia (AL), of which 56% (14/25) were men, 44% (11/25) were women. Depending on the body mass index (BMI), patients were divided into groups: I (n=10) - patients with AML and BMI of 18.5-24.9 kg/m2; IІ (n=15) - patients with AML and BMI ≥25.0 kg/m2. The biochemical blood analysis was evaluated twice: before and on the 56th day of CT, which included alanine-, aspartate-aminotransferases, gamma-glutamyltranspeptidase (GGT), alkaline phosphatase (ALP), total protein and total bilirubin. RESULTS Results: In patients with AML and normal BMI, CT conduction increased the risk of GGT (RR=3.00; 95% CI=1.14-7.91; p<0.05) and ALP activity impairment (RR=2.67; 95% CI=0.98-7.22; p>0.05). The presence of overweight and obesity in patients with AML of group II led to significant risk of increase the GGT (RR=3.00; 95% CI=1.46-6.14; p<0.05) and ALP activity (RR=4.00; 95% CI=1.41-11.35; p<0.05) during CT. GGT and ALP activity in the blood serum of group II patients after CT exceeded the baseline data in 2.4 times (p<0.0001) and 1.6 times (p=0.0007), respectively. CONCLUSION Conclusions: The remission induction CT of AML is accompanied by the risk of cytostatic-induced liver injury. The presence of overweight, obesity and primary disorders of biochemical liver tests due to the oncohematological disease influence are the risk factors for hepatotoxic reactions development during CT.
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18
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Guo H, Zhao W, Wang A, Li M, Ma H, Wang F, Wang Q, Ba X. The value of sex-specific abdominal visceral fat as measured via CT as a predictor of clear renal cell carcinoma T stage. Adipocyte 2021; 10:285-292. [PMID: 34014795 PMCID: PMC8143252 DOI: 10.1080/21623945.2021.1924957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Although much is known about how adipose tissue affects the development of clear cell renal carcinoma (ccRCC), little information is available for the utility of sex-specific abdominal visceral fat composition as a predictor of clear cell renal carcinoma (ccRCC) T stage. We conducted CT-based sex-specific abdominal fat measurements in ccRCC patients to assess whether VFA distribution could predict the ccRCC T stage. In total, 253 patients (182 males and 71 females) from our hospital with pathologically confirmed ccRCC (178 low T-stage and 75 high T-stage) were retrospectively reviewed for the present study. Computed tomography (CT) scans were assessed using ImageJ to differentiate between the visceral and subcutaneous fat areas (VFA and SFA), after which the relative VFA (rVFA) and total fat area (TFA) were computed. The relationships between these fat area-related variables, patient age, sex, and BMI, and ccRCC T stage were then evaluated through univariate and multivariate logistic regression analysis to clarify the association between general or sex-specific abdominal visceral fat and T stage. Following adjustment for age, males with high T stage ccRCC exhibited an increased rVFA as compared to males with low T stage ccRCC, with the same relationship being observed among females. This association between rVFA and high T stage was confirmed through both univariate and multivariate models. As thus, sex-specific visceral fat composition is a reliable independent predictor that can identify both male and female patients with high T stage ccRCC.
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Affiliation(s)
- Hao Guo
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Wenlei Zhao
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Aijie Wang
- Department of Radiology, Yaitai Shan Hospital, Yantai, China
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine, The First Affilicated Hospital of Shandong First Medical University, Jinan, China
| | - Heng Ma
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Fang Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xinru Ba
- Department of Radiology, Yaitai Shan Hospital, Yantai, China
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19
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Gallo M, Adinolfi V, Barucca V, Prinzi N, Renzelli V, Barrea L, Di Giacinto P, Ruggeri RM, Sesti F, Arvat E, Baldelli R, Arvat E, Colao A, Isidori A, Lenzi A, Baldell R, Albertelli M, Attala D, Bianchi A, Di Sarno A, Feola T, Mazziotti G, Nervo A, Pozza C, Puliani G, Razzore P, Ramponi S, Ricciardi S, Rizza L, Rota F, Sbardella E, Zatelli MC. Expected and paradoxical effects of obesity on cancer treatment response. Rev Endocr Metab Disord 2021; 22:681-702. [PMID: 33025385 DOI: 10.1007/s11154-020-09597-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
Obesity, whose prevalence is pandemic and continuing to increase, is a major preventable and modifiable risk factor for diabetes and cardiovascular diseases, as well as for cancer. Furthermore, epidemiological studies have shown that obesity is a negative independent prognostic factor for several oncological outcomes, including overall and cancer-specific survival, for several site-specific cancers as well as for all cancers combined. Yet, a recently growing body of evidence suggests that sometimes overweight and obesity may associate with better outcomes, and that immunotherapy may show improved response among obese patients compared with patients with a normal weight. The so-called 'obesity paradox' has been reported in several advanced cancer as well as in other diseases, albeit the mechanisms behind this unexpected relationship are still not clear. Aim of this review is to explore the expected as well as the paradoxical relationship between obesity and cancer prognosis, with a particular emphasis on the effects of cancer therapies in obese people.
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Affiliation(s)
- Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Via Genova, 3, 10126, Turin, Italy.
| | - Valerio Adinolfi
- Endocrinology and Diabetology Unit, ASL Verbano Cusio Ossola, Domodossola, Italy
| | - Viola Barucca
- Oncology Unit, Department of Oncology and Medical Specialities, AO San Camillo-Forlanini, Rome, Italy
| | - Natalie Prinzi
- ENETS Center of Excellence, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori Milano, Milan, Italy
| | - Valerio Renzelli
- Department of Experimental Medicine, AO S. Andrea, Sapienza University of Rome, Rome, Italy
| | - Luigi Barrea
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School of Naples, Naples, Italy
| | - Paola Di Giacinto
- Endocrinology Unit, Department of Oncology and Medical Specialities, AO San Camillo-Forlanini, Rome, Italy
| | - Rosaria Maddalena Ruggeri
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico G. Martino, Messina, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Via Genova, 3, 10126, Turin, Italy
| | - Roberto Baldelli
- Endocrinology Unit, Department of Oncology and Medical Specialities, AO San Camillo-Forlanini, Rome, Italy
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Abstract
Cancer is a leading cause of death worldwide. Sex influences cancer in a bewildering variety of ways. In some cancer types, it affects prevalence; in others, genomic profiles, response to treatment, or mortality. In some, sex seems to have little or no influence. How and when sex influences cancer initiation and progression remain a critical gap in our understanding of cancer, with direct relevance to precision medicine. Here, we note several factors that complicate our understanding of sex differences: representativeness of large cohorts, confounding with features such as ancestry, age, obesity, and variability in clinical presentation. We summarize the key resources available to study molecular sex differences and suggest some likely directions for improving our understanding of how patient sex influences cancer behavior.
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Affiliation(s)
- Chenghao Zhu
- Department of Human Genetics, University of California, Los Angeles, CA, USA
- Department of Urology, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- Institute for Precision Health, University of California, Los Angeles, CA, USA
| | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, CA, USA
- Department of Urology, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- Institute for Precision Health, University of California, Los Angeles, CA, USA
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21
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The Impact of Obesity on Renal Trauma Outcome: An Analysis of the National Trauma Data Bank from 2013 to 2016. World J Surg 2021; 45:3633-3642. [PMID: 34370056 PMCID: PMC8351221 DOI: 10.1007/s00268-021-06275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND The obesity paradox has been recently demonstrated in trauma patients, where improved survival was associated with overweight and obese patients compared to patients with normal weight, despite increased morbidity. Little is known whether this effect is mediated by lower injury severity. We aim to explore the association between body mass index (BMI) and renal trauma injury grade, morbidity, and in-hospital mortality. METHODS A retrospective cohort of adults with renal trauma was conducted using 2013-2016 National Trauma Data Bank. Multiple regression analyses were used to assess outcomes of interest across BMI categories with normal weight as reference, while adjusting for relevant covariates including kidney injury grade. RESULTS We analyzed 15181 renal injuries. Increasing BMI above normal progressively decreased the risk of high-grade renal trauma (HGRT). Subgroup analysis showed that this relationship was maintained in blunt injury, but there was no association in penetrating injury. Overweight (OR 1.02, CI 0.83-1.25, p = 0.841), class I (OR 0.92, CI 0.71-1.19, p = 0.524), and class II (OR 1.38, CI 0.99-1.91, p = 0.053) obesity were not protective against mortality, whereas class III obesity (OR 1.46, CI 1.03-2.06, p = 0.034) increased mortality odds. Increasing BMI by category was associated with a stepwise increase in odds of acute kidney injury, cardiovascular events, total hospital length of stay (LOS), intensive care unit LOS, and ventilator days. CONCLUSIONS Increasing BMI was associated with decreased risk of HGRT in blunt trauma. Overweight and obesity were associated with increased morbidity but not with a protective effect on mortality. The obesity paradox does not exist in kidney trauma when injury grade is accounted for.
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22
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Ramdass V, Caskey E, Sklarz T, Ajmeri S, Patel V, Balogun A, Pomary V, Hall J, Qari O, Tripathi R, Hunter K, Roy S. Association Between Obesity and Cancer Mortality: An Internal Medicine Outpatient Clinic Perspective. J Clin Med Res 2021; 13:377-386. [PMID: 34394780 PMCID: PMC8336943 DOI: 10.14740/jocmr4543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 11/11/2022] Open
Abstract
Background Obesity is one of the leading preventable causes of cancer that has a causal relationship with cancers of esophagus, breast and colon. Paradoxically, there are studies demonstrating that obesity is associated with improved survival in cancer patients. The aim of our study was to investigate the association of obesity and cancer mortality in adult patients. Methods Retrospective medical record review of 784 adult patients was performed who had a diagnosis of cancer and who were seen in our outpatient Internal Medicine Clinic between January 1, 2019 and December 31, 2019. Results Forty-three (5.2%) patients were cancer non-survivors and 741 (94.8%) were cancer survivors. The mean age of the cancer non-survivors group was significantly higher than that of the cancer survivors (78.7 vs. 68.0 years, respectively; P < 0.001). For every unit increase in age, there was 7.6% increased odds of cancer death (95% confidence interval (CI): 3-12%) (P = 0.001). Average body mass index (BMI) of the patients in the cancer non-survivors group was significantly lower than that of the cancer survivors group (25.0 vs. 28.1 kg/m2; P = 0.008). Non-obese patients had 4.9 times greater odds of cancer death (95% CI: 1.51 - 15.81) (P = 0.008). The mean glycosylated hemoglobin (HbA1c) was significantly higher in the cancer non-survivors group compared to the cancer survivors group (7.1% vs. 6.0%; P < 0.001), and for every unit increase in HbA1c there was 1.6 times greater odds of cancer death (95% CI: 1.14 - 2.23) (P = 0.006). Patients with peripheral artery disease (PAD) had 3.5 times greater odds of cancer death compared to those without PAD (95% CI: 1.18 - 10.19) (P = 0.023). Conclusions Non-obese patients with cancer had higher odds of cancer death. Rising HbA1c, increasing age, and presence of PAD were associated with increased cancer mortality.
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Affiliation(s)
- Vede Ramdass
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA.,Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Elizabeth Caskey
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Tammarah Sklarz
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Saaniya Ajmeri
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Vaishali Patel
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | | | - Victor Pomary
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Jillian Hall
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Omar Qari
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Rahul Tripathi
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Satyajeet Roy
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA.,Cooper Medical School of Rowan University, Camden, NJ, USA
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23
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Desharnais L, Walsh LA, Quail DF. Exploiting the obesity-associated immune microenvironment for cancer therapeutics. Pharmacol Ther 2021; 229:107923. [PMID: 34171329 DOI: 10.1016/j.pharmthera.2021.107923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/11/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
Obesity causes chronic low-grade inflammation and leads to changes in the immune landscape of multiple organ systems. Given the link between chronic inflammatory conditions and cancer, it is not surprising that obesity is associated with increased risk and worse outcomes in many malignancies. Paradoxically, recent epidemiological studies have shown that high BMI is associated with increased efficacy of immune checkpoint inhibitors (ICI), and a causal relationship has been demonstrated in the preclinical setting. It has been proposed that obesity-associated immune dysregulation underlies this observation by inadvertently creating a favourable microenvironment for increased ICI efficacy. The recent success of ICIs in obese cancer patients raises the possibility that additional immune-targeted therapies may hold therapeutic value in this context. Here we review how obesity affects the immunological composition of the tumor microenvironment in ways that can be exploited for cancer immunotherapies. We discuss existing literature supporting a beneficial role for obesity during ICI therapy in cancer patients, potential opportunities for targeting the innate immune system to mitigate chronic inflammatory processes, and how to pinpoint obese patients who are most likely to benefit from immune interventions without relying solely on body mass index. Given that the incidence of obesity is expanding on an international scale, we propose that understanding obesity-associated inflammation is necessary to reduce cancer mortalities and capitalize on novel therapeutic opportunities in the era of cancer immunotherapy.
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Affiliation(s)
- Lysanne Desharnais
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, QC, Canada; Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Logan A Walsh
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, QC, Canada; Department of Human Genetics, McGill University, Montreal, QC, Canada.
| | - Daniela F Quail
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, QC, Canada; Department of Physiology, Faculty of Medicine, McGill University, Montreal, QC, Canada; Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC, Canada.
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24
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Jiménez-Cortegana C, López-Saavedra A, Sánchez-Jiménez F, Pérez-Pérez A, Castiñeiras J, Virizuela-Echaburu JA, de la Cruz-Merino L, Sánchez-Margalet V. Leptin, Both Bad and Good Actor in Cancer. Biomolecules 2021; 11:913. [PMID: 34202969 PMCID: PMC8235379 DOI: 10.3390/biom11060913] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/04/2021] [Accepted: 06/12/2021] [Indexed: 02/06/2023] Open
Abstract
Leptin is an important regulator of basal metabolism and food intake, with a pivotal role in obesity. Leptin exerts many different actions on various tissues and systems, including cancer, and is considered as a linkage between metabolism and the immune system. During the last decades, obesity and leptin have been associated with the initiation, proliferation and progression of many types of cancer. Obesity is also linked with complications and mortality, irrespective of the therapy used, affecting clinical outcomes. However, some evidence has suggested its beneficial role, called the "obesity paradox", and the possible antitumoral role of leptin. Recent data regarding the immunotherapy of cancer have revealed that overweight leads to a more effective response and leptin may probably be involved in this beneficial process. Since leptin is a positive modulator of both the innate and the adaptive immune system, it may contribute to the increased immune response stimulated by immunotherapy in cancer patients and may be proposed as a good actor in cancer. Our purpose is to review this dual role of leptin in cancer, as well as trying to clarify the future perspectives of this adipokine, which further highlights its importance as a cornerstone of the immunometabolism in oncology.
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Affiliation(s)
- Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain; (C.J.-C.); (A.L.-S.); (F.S.-J.); (A.P.-P.)
| | - Ana López-Saavedra
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain; (C.J.-C.); (A.L.-S.); (F.S.-J.); (A.P.-P.)
| | - Flora Sánchez-Jiménez
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain; (C.J.-C.); (A.L.-S.); (F.S.-J.); (A.P.-P.)
| | - Antonio Pérez-Pérez
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain; (C.J.-C.); (A.L.-S.); (F.S.-J.); (A.P.-P.)
| | - Jesús Castiñeiras
- Urology Service, Virgen Macarena University Hospital, University of Seville, 41009 Sevilla, Spain;
| | - Juan A. Virizuela-Echaburu
- Medical Oncology Service, Virgen Macarena University Hospital, University of Seville, 41009 Sevilla, Spain; (J.A.V.-E.); (L.d.l.C.-M.)
| | - Luis de la Cruz-Merino
- Medical Oncology Service, Virgen Macarena University Hospital, University of Seville, 41009 Sevilla, Spain; (J.A.V.-E.); (L.d.l.C.-M.)
| | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain; (C.J.-C.); (A.L.-S.); (F.S.-J.); (A.P.-P.)
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25
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Unintentional Weight Loss as a Marker of Malignancy Across Body Weight Categories. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Griggs JJ, Bohlke K, Balaban EP, Dignam JJ, Hall ET, Harvey RD, Hecht DP, Klute KA, Morrison VA, Pini TM, Rosner GL, Runowicz CD, Shayne M, Sparreboom A, Turner S, Zarwan C, Lyman GH. Appropriate Systemic Therapy Dosing for Obese Adult Patients With Cancer: ASCO Guideline Update. J Clin Oncol 2021; 39:2037-2048. [PMID: 33939491 DOI: 10.1200/jco.21.00471] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To provide recommendations for appropriate dosing of systemic antineoplastic agents in obese adults with cancer. METHODS A systematic review of the literature collected evidence regarding dosing of chemotherapy, immunotherapy, and targeted therapies in obese adults with cancer. PubMed and the Cochrane Library were searched for randomized controlled trials, meta-analyses, or cohort studies published from November 1, 2010, through March 27, 2020. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS Sixty studies, primarily retrospective, were included in the review. Overall, the evidence supported previous findings that obese adult patients tolerate full, body-size-based dosing of chemotherapy as well as nonobese patients. Fewer studies have addressed the dosing of targeted therapies and immunotherapies in relation to safety and efficacy in obese patients. RECOMMENDATIONS The Panel continues to recommend that full, weight-based cytotoxic chemotherapy doses be used to treat obese adults with cancer. New to this version of the guideline, the Panel also recommends that full, approved doses of immunotherapy and targeted therapies be offered to obese adults with cancer. In the event of toxicity, the consensus of the Panel is that dose modifications of systemic antineoplastic therapies should be handled similarly for obese and nonobese patients. Important areas for future research include the impact of sarcopenia and other measures of body composition on optimal antineoplastic dosing, and more customized dosing based on pharmacokinetic or pharmacogenetic factors.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Evan T Hall
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA
| | | | - Diane P Hecht
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Vicki A Morrison
- University of Minnesota Hennepin County Medical Center, Minneapolis, MN
| | | | | | - Carolyn D Runowicz
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | | | | | | | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA
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27
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Abstract
Objective The obesity paradox is the association of increased survival for overweight and obese patients compared to normal and underweight patients, despite an increased risk of morbidity. The obesity paradox has been demonstrated in many disease states but has yet to be studied in trauma. The objective of this study is to elucidate the presence of the obesity paradox in trauma patients by evaluating the association between BMI and outcomes. Methods Using the 2014–2015 National Trauma Database (NTDB), adults were categorized by WHO BMI category. Logistic regression was used to assess the odds of mortality associated with each category, adjusting for statistically significant covariables. Length of stay (LOS), ICU LOS and ventilator days were also analyzed, adjusting for statistically significant covariables. Results A total of 415,807 patients were identified. Underweight patients had increased odds of mortality (OR 1.378, p < 0.001 95% CI 1.252–1.514), while being overweight had a protective effect (OR 0.916, p = 0.002 95% CI 0.867–0.968). Class I obesity was not associated with increased mortality compared to normal weight (OR 1.013, p = 0.707 95% CI 0.946–1.085). Class II and Class III obesity were associated with increased mortality risk (Class II OR 1.178, p = 0.001 95% CI 1.069–1.299; Class III OR 1.515, p < 0.001 95% CI 1.368–1.677). Hospital and ICU LOS increased with each successive increase in BMI category above normal weight. Obesity was associated with increased ventilator days; Class I obese patients had a 22% increase in ventilator days (IRR 1.217 95% CI 1.171–1.263), and Class III obese patients had a 54% increase (IRR 1.536 95% CI 1.450–1.627). Conclusion The obesity paradox exists in trauma patients. Further investigation is needed to elucidate what specific phenotypic aspects confer this benefit and how these can enhance patient care. Level of evidence Level III, prognostic study
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28
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THE EFFECT OF DOXORUBICIN-INDUCED OXIDATIVE STRESS ON RESISTANCE OF INTESTINAL MUCOSA. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-1-75-221-224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Yang Z, Wei X, Pan Y, Min Z, Xu J, Yu B. Colon cancer combined with obesity indicates improved survival- research on relevant mechanism. Aging (Albany NY) 2020; 12:23778-23794. [PMID: 33197880 PMCID: PMC7762486 DOI: 10.18632/aging.103972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
Obesity contributes to the incidence of various tumors, including colon cancer. However, the impact of obesity on patients’ survival and related mechanisms remains unclear. Multi-omics data of 227 cases of colon cancer patients combined with clinical characteristics data were acquired from The Cancer Genome Atlas (TCGA) database. We confirmed obesity as an independent prognostic factor for improved overall survival of colon cancer patients. We demonstrated that hypoxia pathways were repressed in obese patients by regulating miR-210. Immune checkpoints PD-1 and LAG3 were also downregulated in obese patients, which indicated enhanced immune surveillance. The frequency of PIK3CA and KRAS mutations was decreased in obese patients. The sites and types of TP53 mutation were alternated in obesity patients. In conclusion, our research demonstrated the potential mechanisms of prolonged survival in colon cancer patients combined with obesity, which may provide potential value for improving the prognosis of colon cancer.
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Affiliation(s)
- Zhou Yang
- Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, China
| | - Xiyi Wei
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210009, Jiangsu, China
| | - Yitong Pan
- Department of Bioinformatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211116, China
| | - Zhijun Min
- Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, China
| | - Jingyuan Xu
- Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, China.,Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Bo Yu
- Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, China.,Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai 201399, China
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30
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The Role of Obesity in Early and Long-Term Outcomes after Surgical Excision of Lung Oligometastases from Colorectal Cancer. J Clin Med 2020; 9:jcm9113566. [PMID: 33167545 PMCID: PMC7694523 DOI: 10.3390/jcm9113566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Obesity correlates with better outcomes in many neoplastic conditions. The aim of this study was to assess its role in the prognosis and morbidity of patients submitted to resection of lung oligometastases from colorectal cancer. Seventy-six patients undergoing a first pulmonary metastasectomy were retrospectively included in the study. Seventeen (22.3%) were obese (body mass index (BMI) >30 kg/m2). Assessed outcomes were overall survival, time to recurrence, and incidence of post-operative complications. Median follow-up was 33 months (IQR 16-53). At follow-up, 37 patients (48.6%) died, whereas 39 (51.4%) were alive. A significant difference was found in the 3-year overall survival (obese 80% vs. non-obese 56.8%, p = 0.035). Competing risk analysis shows that the cumulative incidence of recurrence was not different between the two groups. Multivariate analysis reveals that the number of metastases (p = 0.028), post-operative pneumonia (p = 0.042), and DFS (p = 0.007) were significant predictors of death. Competing risk regression shows that no independent risk factor for recurrence has been identified. The complication rate was not different between the two groups (17.6% vs. 13.6%, p = 0.70). Obesity is a positive prognostic factor for survival after pulmonary metastasectomy for colorectal cancer. Overweight patients do not experience more post-operative complications. Our results need to be confirmed by large multicenter studies.
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31
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Wang J, Li J, Li M, Hou L, Zhu P, Du X, Zhou M, Zhu C. Association between dynamic obesity and mortality in patients with first-ever ischemic stroke: A hospital-based prospective study. Medicine (Baltimore) 2020; 99:e22243. [PMID: 32957370 PMCID: PMC7505300 DOI: 10.1097/md.0000000000022243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/08/2020] [Accepted: 08/18/2020] [Indexed: 02/05/2023] Open
Abstract
Although obesity is an established risk factor of primary stroke, the association between obesity and post-stroke mortality remains unclear. The aim of this study was to investigate the association between dynamic obesity status and mortality in survivors of their first stroke in China.Of 775 patients with first-ever ischemic stroke included in a longitudinal study, 754 patients were included in this study and categorized into 4 categories of body mass index (BMI) (underweight, normal weight, overweight, and obese) and 2 categories of waist circumference (WC) (normal WC and abdominal obesity) according to standard Chinese criteria. The mortality information and obesity status were obtained via telephone follow-up every 3 months, beginning in 2010 through 2016. Time-dependent Cox proportional hazards models were used to estimate the unadjusted and adjusted hazard ratios (HRs) for the relationship between all-cause mortality and dynamic obesity status.Of 754 patients, 60.87% were male, and the overall mean age was 61.45 years. After adjusting for possible confounders, significant inverse associations were identified between BMI and WC and all-cause mortality. Compared with those with normal BMI or WC, those with abdominal obesity or overweight had a significantly lower risk of all-cause mortality (HR and 95% confidence intervals [CIs]: .521 [.303-.897] and 0.545 [.352-.845], respectively), whereas patients with underweight had the highest risk and those with obesity had lower risk of mortality, though it was not statistically significant (1.241 [.691-2.226] and .486 [.192-1.231], respectively).Overweight and abdominal obesity were paradoxically associated with reduced risk of mortality in patients who survived their first-ever ischemic stroke in China. Future prospective studies must look at evaluating the role of obesity in different stroke subtypes and devise appropriate weight-management strategies for optimal prognoses in secondary prevention in these survivors.
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Affiliation(s)
- Ju Wang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing
| | - Jijie Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan
- Institution of West China Second University Hospital, Sichuan University
| | - Mier Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan
| | - Lisha Hou
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan
| | - Ping Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan
| | - Xudong Du
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan
| | - Muke Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan
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Van de Louw A, Zhu X, Frankenfield D. Obesity and malnutrition in critically ill patients with acute myeloid leukemia: Prevalence and impact on mortality. Nutrition 2020; 79-80:110956. [PMID: 32862120 DOI: 10.1016/j.nut.2020.110956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/28/2020] [Accepted: 07/04/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Obese patients have an increased risk of developing acute myeloid leukemia (AML), which in turn predisposes to malnutrition. Obesity has been associated with improved survival in critically ill patients (obesity paradox), but this effect seems to disappear when adjusting for malnutrition. How obesity and malnutrition interplay to affect mortality in critically ill patients with AML has not been addressed and was the objective of this study. METHODS This was a retrospective chart review of adult patients with AML who were admitted to the medical intensive care unit and had a nutrition consultation between 2011 and 2018. Demographic characteristics, comorbidities, severity scores, and laboratory parameters, as well as data on vital organ support, hospital mortality, and long-term survival were collected. Obesity was defined by a body mass index of ≥30 kg/m2 and malnutrition per the American Society for Parenteral and Enteral Nutrition criteria. Patients were compared based on nutrition and weight status, and hospital and long-term mortality were analyzed with logistic regression and Kaplan-Meier curves. RESULTS We included 145 patients (57% obese, 30% malnourished) in the study. As time from AML diagnosis elapsed, obesity was less frequent and malnutrition more prevalent, with 25% of obese patients also presenting with malnutrition. Hospital mortality was 40% and associated with malnutrition in nonobese patients (odds ratio: 5.1; 95% confidence interval, 1.3-21.8; P = 0.02) and sequential organ failure assessment severity score (odds ratio: 1.5; 95% confidence interval, 1.3-1.7; P < 0.0001). Sensitivity analyses confirmed the association between malnutrition, but not obesity, and hospital mortality. Obese malnourished patients had lower long-term survival, but this was not significant (P = 0.25). CONCLUSIONS Critically ill patients with AML have a high prevalence of malnutrition and obesity, which are sometimes associated. Malnutrition, but not obesity, was associated with hospital mortality.
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Affiliation(s)
- Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine, Penn State Health Hershey Medical Center, Hershey, Pennsylvania.
| | - Xijun Zhu
- Division of Pulmonary and Critical Care Medicine, Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | - David Frankenfield
- Department of Clinical Nutrition, Penn State Health Hershey Medical Center, Hershey, Pennsylvania
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Lee DH, Giovannucci EL. The Obesity Paradox in Cancer: Epidemiologic Insights and Perspectives. Curr Nutr Rep 2020; 8:175-181. [PMID: 31129887 DOI: 10.1007/s13668-019-00280-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Controversy exists whether excess body fatness (measured by body mass index (BMI)) is associated with better cancer survival ("obesity paradox"). Here, we review the obesity paradox in cancer research and discuss potential explanations and future research directions. RECENT FINDINGS Overweight and obese cancer patients have better survival for diverse cancers. This apparent obesity paradox may be largely explained by methodological limitations including reverse causation, selection bias, confounding, and reliance of BMI as a measure of adiposity in cancer patients. A growing number of studies show promising evidence that precisely quantified body composition can provide important prognostic information in cancer care, such that low muscle and high adiposity are associated with worse clinical outcomes in cancer patients. The term obesity paradox in cancer, implying a causally beneficial role of adiposity, is misleading. Understanding the role of muscle and adiposity may reduce the confusion and inform precision oncology care.
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Affiliation(s)
- Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Immuno-Metabolism and Microenvironment in Cancer: Key Players for Immunotherapy. Int J Mol Sci 2020; 21:ijms21124414. [PMID: 32575899 PMCID: PMC7352562 DOI: 10.3390/ijms21124414] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 12/16/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have changed therapeutic algorithms in several malignancies, although intrinsic and secondary resistance is still an issue. In this context, the dysregulation of immuno-metabolism plays a leading role both in the tumor microenvironment (TME) and at the host level. In this review, we summarize the most important immune-metabolic factors and how they could be exploited therapeutically. At the cellular level, an increased concentration of extracellular adenosine as well as the depletion of tryptophan and uncontrolled activation of the PI3K/AKT pathway induces an immune-tolerant TME, reducing the response to ICIs. Moreover, aberrant angiogenesis induces a hypoxic environment by recruiting VEGF, Treg cells and immune-suppressive tumor associated macrophages (TAMs). On the other hand, factors such as gender and body mass index seem to affect the response to ICIs, while the microbiome composition (and its alterations) modulates both the response and the development of immune-related adverse events. Exploiting these complex mechanisms is the next goal in immunotherapy. The most successful strategy to date has been the combination of antiangiogenic drugs and ICIs, which prolonged the survival of patients with non-small-cell lung cancer (NSCLC) and hepatocellular carcinoma (HCC), while results from tryptophan pathway inhibition studies are inconclusive. New exciting strategies include targeting the adenosine pathway, TAMs and the microbiota with fecal microbiome transplantation.
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Garg T, Young AJ, O'Keeffe-Rosetti M, McMullen CK, Nielsen ME, Murphy TE, Kirchner HL. Association between metabolic syndrome and recurrence of nonmuscle-invasive bladder cancer in older adults. Urol Oncol 2020; 38:737.e17-737.e23. [PMID: 32409197 DOI: 10.1016/j.urolonc.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Nonmuscle-invasive bladder cancer (NMIBC) disproportionately affects older adults who often have coexisting chronic conditions such as metabolic syndrome (MetS). Although prior research suggests that MetS is a risk factor for NMIBC, limited data exists on whether MetS is associated with NMIBC recurrence. Our objective was to evaluate the association between MetS and recurrence in older adults treated for NMIBC. METHODS We identified 1,485 older (age ≥60 years) NMIBC patients (American Joint Committee on Cancer Stage ≤1) from 2community-based health systems. Using data from the health systems' electronic medical record, MetS was defined as the presence of three of the following: diagnosis codes indicating hypertension, hyperlipidemia, diabetes, or body mass index >30. Follow up time was determined by date of the last follow up in the tumor registry and censored at 10 years. Cox proportional hazards regression of time to recurrence that accounts for the competing risk of death included adjustment for age, sex, smoking status, health system, NMIBC stage/grade, tumor size, and number of specimens with cancer. RESULTS Overall, 341 patients (23%) met MetS criteria. Median follow up was 5.9 years and 582 patients (39.2%) died. Patients with MetS were more frequently male (84.2%), and mostly current/former smokers (82.6%). By 10 years, 34.1% of the cohort had experienced a recurrence. After accounting for the competing risk of death, there was no association between MetS and time to recurrence (adjusted hazard ratio, 0.88, 95% confidence interval 0.70-1.11, P = 0.28). Patients without MetS had more 0a/low grade recurrences (49.1% vs. 41.4%), though differences were not significant. CONCLUSION We found no association between MetS and risk of NMIBC recurrence in this large, multisite cohort of older adults with NMIBC. In order to design personalized care for older NMIBC patients, future research is needed to evaluate associations between common chronic conditions and a variety of oncologic outcomes.
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Affiliation(s)
- Tullika Garg
- Department of Urology, Geisinger, Danville, PA; Department of Population Health Sciences, Geisinger, Danville, PA.
| | | | | | - Carmit K McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Matthew E Nielsen
- Department of Urology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; Department of Epidemiology, Health Policy, and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | - Terrence E Murphy
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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Lester ELW, Dvorak JE, Maluso PJ, Bendjemil S, Messer T, Poulakidas S, Bokhari F. Obesity Paradox in the Burn Patient. J Burn Care Res 2020; 41:30-32. [DOI: 10.1093/jbcr/irz173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Despite the fact that obesity is a known risk factor for comorbidities and complications, there is evidence suggesting a survival advantage for patients classified by body mass index (BMI) as overweight or obese. Investigated in various clinical areas, this “Obesity Paradox” has yet to be explored in the burn patient population. We sought to clarify whether this paradigm exists in burn patients. Data collected on 519 adult patients admitted to an American Burn Association Verified Burn Center between 2009 and 2017 was utilized. Univariable and multivariable logistic regression were used to determine the association between in-hospital mortality and BMI classifications (underweight <18.5 kg/m2, normal 18.5 to 24.9 kg/m2, overweight 25–29.9 kg/m2, obesity class I 30 to 34.9 kg/m2, obesity class II 35 to 39.9 kg/m2, and extreme obesity >40 kg/m2). For every kg/m2 increase in BMI, the odds of death decreased, with an adjusted odds ratio of 0.856 (95% confidence interval [CI] 0.767 to 0.956). When adjusted for total BSA (TBSA), being obesity class I was associated with an adjusted odds ratio of mortality of 0.0166 (95% CI 0.000332 to 0.833). The adjusted odds ratio for mortality for underweight patients was 4.13 (95% CI 0.416 to 41.055). There was no statistically significant difference in odds of mortality between the normal and overweight BMI categories. In conclusion, the obesity paradox exists in burn care: further investigation is needed to elucidate what specific phenotypic aspects confer this benefit and how these can enhance the care of burn patients.
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Obesity survival paradox in cancer patients: Results from the Physical Frailty in older adult cancer patients (PF-EC) study. Clin Nutr 2019; 38:2806-2812. [DOI: 10.1016/j.clnu.2018.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 11/28/2018] [Accepted: 12/07/2018] [Indexed: 11/21/2022]
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Dhakal P, Lyden E, Lee A, Michalski J, Al-Kadhimi ZS, Maness LJ, Gundabolu K, Bhatt VR. Effects of Obesity on Overall Survival of Adults With Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e131-e136. [PMID: 32029396 DOI: 10.1016/j.clml.2019.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/14/2019] [Accepted: 11/01/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The role of obesity in prognosis of acute myeloid leukemia (AML) is debatable. Our retrospective study aimed to determine the effect of obesity on overall survival (OS) in AML. PATIENTS AND METHODS AML patients diagnosed at University of Nebraska Medical Center were divided into 3 groups according to body mass index (BMI): normal (18.5-25 kg/m2) or underweight (< 18.5 kg/m2); overweight (25-30 kg/m2); and obese (≥ 30 kg/m2). Chi-square test, Kruskal-Wallis test, and ANOVA were used to examine the association of BMI with baseline characteristics. Mann-Whitney test was used for pairwise comparisons of hematopoietic cell transplantation (HCT) comorbidity index. Bonferroni correction was used to adjust P values. OS, defined as time from diagnosis to death from any cause, was determined by the Kaplan-Meier method; comparisons of survival curves were done using log-rank test. Cox regression analysis was performed to detect the effect of BMI on OS. RESULTS Of 314 patients, 38% were obese, 68% received intensive chemotherapy, and 30% underwent HCT. Patient characteristics for all BMI groups were similar except greater HCT comorbidity index in obese patients. Actual body weight was used to calculate the chemotherapy dose in 92% of obese patients. The rates of receipt of HCT in normal, overweight, and obese groups were 33%, 32%, and 25%, respectively (P = .6). One-year OS values for normal/underweight, overweight, and obese groups was 42%, 45%, and 39%, respectively (P = .31). On multivariate analysis, obesity was associated with worse OS compared to normal-weight (hazard ratio = 0.6; 95% confidence interval, 0.4-0.9; P = .03) but not overweight patients. CONCLUSION Obesity confers worse prognosis in AML. Differences in OS were not the result of differences in chemotherapy dose or receipt of HCT.
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Affiliation(s)
- Prajwal Dhakal
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE.
| | - Elizabeth Lyden
- Department of Biostatics, University of Nebraska Medical Center, Omaha, NE
| | - Andrea Lee
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Joel Michalski
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Zaid S Al-Kadhimi
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Lori J Maness
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Krishna Gundabolu
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Vijaya Raj Bhatt
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
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Caan BJ, Cespedes Feliciano EM, Kroenke CH. The Importance of Body Composition in Explaining the Overweight Paradox in Cancer-Counterpoint. Cancer Res 2019; 78:1906-1912. [PMID: 29654153 DOI: 10.1158/0008-5472.can-17-3287] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/28/2017] [Accepted: 01/24/2018] [Indexed: 12/21/2022]
Abstract
Despite a greater risk of cancer associated with higher BMI, overweight (BMI 25-<30 kg/m2) and class I obese (BMI 30-<35 kg/m2) patients often have a paradoxically lower risk of overall mortality after a cancer diagnosis, a phenomenon called the "obesity paradox." Only when patients exceed a BMI ≥35 kg/m2 are elevations in mortality risk consistently noted. This paradox has been dismissed as the result of methodologic bias, which we will describe and debate here. However, even if such bias influences associations, there is growing evidence that body composition may in part explain the paradox. This phenomenon may more accurately be described as a BMI paradox. That is, BMI is a poor proxy for adiposity and does not distinguish muscle from adipose tissue, nor describe adipose tissue distribution. Low muscle mass is associated with higher risk of recurrence, overall and cancer-specific mortality, surgical complications, and treatment-related toxicities. Patients with who are overweight or obese have on average higher levels of muscle than their normal-weight counterparts. Also, there is some evidence that patients with moderate levels of subcutaneous adipose tissue may have lower mortality. More research utilizing body composition is needed to clarify the effects of adiposity on cancer mortality. Cancer Res; 78(8); 1906-12. ©2018 AACR.
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Affiliation(s)
- Bette J Caan
- Division of Research, Kaiser Permanente, Oakland, California.
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Lyros O, Moulla Y, Mehdorn M, Schierle K, Sucher R, Dietrich A. Coincidental Detection of Gastrointestinal Stromal Tumors During Laparoscopic Bariatric Procedures—Data and Treatment Strategy of a German Reference Center. Obes Surg 2019; 29:1858-1866. [DOI: 10.1007/s11695-019-03782-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Brown JC, Cespedes Feliciano EM, Caan BJ. The evolution of body composition in oncology-epidemiology, clinical trials, and the future of patient care: facts and numbers. J Cachexia Sarcopenia Muscle 2018; 9:1200-1208. [PMID: 30637983 PMCID: PMC6351674 DOI: 10.1002/jcsm.12379] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
There is growing interest from the oncology community to understand how body composition measures can be used to improve the delivery of clinical care for the 18.1 million individuals diagnosed with cancer annually. Methods that distinguish muscle from subcutaneous and visceral adipose tissue, such as computed tomography (CT), may offer new insights of important risk factors and improved prognostication of outcomes over alternative measures such as body mass index. In a meta-analysis of 38 studies, low muscle area assessed from clinically acquired CT was observed in 27.7% of patients with cancer and associated with poorer overall survival [hazard ratio: 1.44, 95% CI: 1.32-1.56]. Therapeutic interventions such as lifestyle and pharmacotherapy that modify all aspects of body composition and reduce the incidence of poor clinical outcomes are needed in patients with cancer. In a meta-analysis of six randomized trials, resistance training exercise increased lean body mass assessed from dual-energy X-ray absorptiometry [mean difference (MD): +1.07 kg, 95% CI: 0.76-1.37; P < 0.001] and walking distance [MD: +143 m, 95% CI: 70-216; P < 0.001] compared with usual care control in patients with non-metastatic cancer. In a meta-analysis of five randomized trials, anamorelin (a ghrelin agonist) significantly increased lean body mass [MD: +1.10 kg, 95% CI: 0.35-1.85; P = 0.004] but did not improve handgrip strength [MD: 0.52 kg, 95% CI: -0.09-1.13; P = 0.09] or overall survival compared with placebo [HR: 0.99, 95% CI: 0.85-1.14; P = 0.84] in patients with advanced or metastatic cancer. Early screening to identify individuals with occult muscle loss, combined with multimodal interventions that include lifestyle therapy with resistance exercise training and dietary supplementation combined with pharmacotherapy, may be necessary to provide a sufficient stimulus to prevent or slow the cascade of tissue wasting. Rapid, cost-efficient, and feasible methods to quantify muscle and adipose tissue distribution are needed if body composition assessment is to be integrated into large-scale clinical workflows. Fully automated analysis of body composition from clinically acquired imaging is one example. The study of body composition is one of the most provocative areas in oncology that offers tremendous promise to help patients with cancer live longer and healthier lives.
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Affiliation(s)
- Justin C Brown
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Bette J Caan
- Kaiser Permanente Northern California, Oakland, CA, USA
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Filliatre-Clement L, Broseus J, Muller M, Hosseini K, Rotonda C, Schirmer L, Roth-Guepin G, Bonmati C, Feugier P, Béné MC, Perrot A. Serum albumin or body mass index: Which prognostic factor for survival in patients with acute myeloblastic leukaemia? Hematol Oncol 2018; 37:80-84. [PMID: 30105853 DOI: 10.1002/hon.2543] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/04/2018] [Accepted: 07/20/2018] [Indexed: 11/06/2022]
Abstract
Obesity has been associated with an increased risk of developing acute myeloblastic leukaemia (AML). The outcome of AML patients could thus be dependent on their nutritional status that can be evaluated by the simple measurement of serum albumin (SA) and body mass index (BMI). These two parameters could have a value as prognostic factors to guide patients' management. We evaluated the association between SA levels, BMI, and survival, evaluated as overall survival (OS) and event-free survival. Furthermore, we investigated the association between BMI, SA, and other prognostic factors of interest in AML. This retrospective single-center study included 159 patients diagnosed with AML at Nancy Hospital between 2005 and 2013, treated with aracytine and anthracycline. Forty-four percent of patients presented with normal weight while 56% were obese/overweight. Serum albumin levels were <30 g/L for 49 patients, and ≥30 g/L for 110. Thirty-four patients with low SA levels were also obese. Favourable OS was associated with SA levels ≥30 g/L (HR = 0.467; 95% CI 0.230-0.946; P = .034) but was not impacted by the BMI. Serum albumin levels appear to be an independent prognostic factor in AML and a better parameter than BMI for evaluating the nutritional status of patients at diagnosis.
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Affiliation(s)
| | - Julien Broseus
- Hematology Biology Department, Nancy University Hospital, Vandoeuvre les Nancy, France.,INSERM U 1256, Lorraine University, Vandoeuvre les Nancy, France
| | - Marc Muller
- Genetics Department, Nancy University Hospital, Vandoeuvre les Nancy, France
| | - Kossar Hosseini
- Platform of Clinical Research Support PARC, Nancy University Hospital, Vandoeuvre les Nancy, France
| | | | - Luciane Schirmer
- Hematology Department, Nancy University Hospital, Vandoeuvre les Nancy, France
| | | | - Caroline Bonmati
- Hematology Department, Nancy University Hospital, Vandoeuvre les Nancy, France
| | - Pierre Feugier
- Hematology Department, Nancy University Hospital, Vandoeuvre les Nancy, France
| | | | - Aurore Perrot
- Hematology Department, Nancy University Hospital, Vandoeuvre les Nancy, France.,INSERM U 1256, Lorraine University, Vandoeuvre les Nancy, France
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Dombrowski L, Mohassel L. Outcomes in obese patients undergoing induction therapy for acute leukemia. J Oncol Pharm Pract 2018; 25:1058-1065. [PMID: 29726788 DOI: 10.1177/1078155218772329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity continues to be a growing epidemic in the United States. Guidelines published by American Society of Clinical Oncology in 2012 recommend dosing chemotherapy using actual body weight. However, the guidelines do not provide guidance for patients with hematologic malignancies. The objective of this study was to evaluate outcomes in obese patients undergoing induction chemotherapy for acute leukemia versus nonobese patients using actual body weight dosing. This single center retrospective chart review from November 2012 to August 2016 evaluated newly diagnosed leukemia patients who received induction chemotherapy dosed on actual body weight. The primary outcome was rate of complete remission following induction chemotherapy between obese patients versus nonobese patients. Secondary outcomes included time to absolute neutrophil count and platelet recovery, incidence of febrile neutropenia, clinical or microbiological infections, early (0-15 days) and in-hospital mortality, and overall survival at six months. Obese patients had similar rates of complete remission versus nonobese patients with acute myeloid leukemia (60% vs. 61.9%; p = 0.86) and acute lymphoblastic leukemia (87.5% vs. 92.8%; p = 0.31). Obese patients with acute myeloid leukemia were more likely to receive re-induction chemotherapy following 14-day bone marrow biopsy vs. nonobese patients (53.3% vs. 23.2%; p = 0.019). There were no significant differences in secondary outcomes in either group when comparing obese versus nonobese patients. Obese patients have similar rates of complete remission compared to nonobese patients following induction chemotherapy in acute leukemia. Continued research is needed to determine optimal dosing and long-term outcomes in this patient population.
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Abstract
Although higher body mass index (BMI) increases the incidence of many cancers, BMI can also exhibit a null or U-shaped relationship with survival among patients with existing disease; this association of higher BMI with improved survival is termed the obesity paradox. This review discusses possible explanations for the obesity paradox, the prevalence and consequences of low muscle mass in cancer patients, and future research directions. It is unlikely that methodological biases, such as reverse causality or confounding, fully explain the obesity paradox. Rather, up to a point, higher BMI may truly be associated with longer survival in cancer patients. This is due, in part, to the limitations of BMI, which scales weight to height without delineating adipose tissue distribution or distinguishing between adipose and muscle tissue. Thus, cancer patients with higher BMIs often have higher levels of protective muscle. We assert that more precise measures of body composition are required to clarify the relationship of body size to cancer outcomes, inform clinical decision-making, and help tailor lifestyle interventions.
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Affiliation(s)
| | - Candyce H Kroenke
- Division of Research, Kaiser Permanente, Oakland, California 94612, USA; , ,
| | - Bette J Caan
- Division of Research, Kaiser Permanente, Oakland, California 94612, USA; , ,
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Trestini I, Carbognin L, Bonaiuto C, Tortora G, Bria E. The obesity paradox in cancer: clinical insights and perspectives. Eat Weight Disord 2018; 23:185-193. [PMID: 29492860 DOI: 10.1007/s40519-018-0489-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/12/2018] [Indexed: 01/06/2023] Open
Abstract
A series of evidence demonstrated that obesity represents an established risk factor for an increase in the incidence of multiple cancer types and for poor cancer survival. Nevertheless, recent studies suggested that, in a series of cancers, patients with a normal body mass index (BMI) have worse outcomes than obese patients. This phenomenon, named 'obesity paradox' or 'reverse epidemiology' in cancer, is not well understood and presents controversial aspects. Therefore, this review aims to explore the available studies concerning the relationship between obesity and cancer incidence or survival and to highlight the hypothetical explanations and the methodological framework. In this regard, we underline the limits of BMI as a potential marker of adiposity and the relevance to assessing body composition, beyond the body size. Further studies are needed to define the impact of obesity in cancer patients, to tailor weight management after cancer diagnosis and to hopefully improve overall clinical outcome.
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Affiliation(s)
- Ilaria Trestini
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, P.le L.A. Scuro 10, 37124, Verona, Italy
| | - Luisa Carbognin
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, P.le L.A. Scuro 10, 37124, Verona, Italy
| | - Clelia Bonaiuto
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, P.le L.A. Scuro 10, 37124, Verona, Italy
| | - Giampaolo Tortora
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, P.le L.A. Scuro 10, 37124, Verona, Italy
| | - Emilio Bria
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, P.le L.A. Scuro 10, 37124, Verona, Italy.
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Harada K, Doki N, Miyazaki Y, Wakita A, Ohtake S, Takada S, Komatsu H, Kubo K, Takeshita A, Adachi Y, Kiyoi H, Yamaguchi T, Yoshida M, Naoe T, Ohashi K. Clinical impact of underweight status at diagnosis on elderly patients with acute myeloid leukemia: a retrospective study of JALSG GML200. Ann Hematol 2018; 97:1481-1483. [PMID: 29497807 DOI: 10.1007/s00277-018-3281-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kaito Harada
- Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Noriko Doki
- Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Atsushi Wakita
- Department of Hematology, Nagoya City East Medical Center, Nagoya, Japan
| | - Shigeki Ohtake
- Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, Japan
| | - Satoru Takada
- Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Hirokazu Komatsu
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kohmei Kubo
- Department of Hematology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Akihiro Takeshita
- Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoko Adachi
- Department of Internal Medicine, Kobe Central Hospital of Insurance, Kobe, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Minoru Yoshida
- Fourth Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomoki Naoe
- National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Kazuteru Ohashi
- Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Influence of body mass index on incidence and prognosis of acute myeloid leukemia and acute promyelocytic leukemia: A meta-analysis. Sci Rep 2017; 7:17998. [PMID: 29269861 PMCID: PMC5740068 DOI: 10.1038/s41598-017-18278-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 12/08/2017] [Indexed: 12/11/2022] Open
Abstract
Previous studies have demonstrated an association between high body mass index (BMI) and acute myeloid leukemias (AML), particularly acute promyelocytic leukemia (APL). However, the effect of obesity and overweight on the incidence of AML is not supported by all studies, and the relationship between obesity and prognosis of AML and APL has not been established. Thus, we conducted a meta-analysis to determine the role of BMI on the risk and clinical outcome of AML, including APL. Twenty-six eligible studies enrolling 12,971 AML (including 866 APL) patients were retrieved and analyzed. Overweight and obesity was associated with an increased incidence of AML (relative risk [RR], 1.23; 95% confidence interval [CI], 1.12–1.35; P < 0.001). High BMI did not significantly affect overall survival (OS) (hazard ratio [HR], 0.97; 95% CI, 0.92–1.03; P = 0.323) or disease-free survival (HR, 0.98; 95% CI, 0.88–1.10; P = 0.755) in patients with non-APL AML. By contrast, APL patients with high BMI had shorter OS (HR, 1.77; 95% CI, 1.26–2.48; P = 0.001) and a higher risk of differentiation syndrome (HR, 1.53; 95% CI, 1.03–2.27, P = 0.04). Overall, our findings suggest that patients with overweight or obesity have a higher incidence of AML, and high BMI is a predictor of adverse clinical outcomes in APL.
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Underweight status at diagnosis is associated with poorer outcomes in adult patients with acute myeloid leukemia: a retrospective study of JALSG AML 201. Ann Hematol 2017; 97:73-81. [PMID: 29196987 DOI: 10.1007/s00277-017-3156-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/17/2017] [Indexed: 12/25/2022]
Abstract
Recent studies have described various impacts of obesity and being overweight on acute myeloid leukemia (AML) outcomes in adult patients, but little is known about the impact of being underweight. We compared the outcomes of underweight patients to those of normal weight and overweight patients. Adult patients with AML who registered in the JALSG AML201 study (n = 1057) were classified into three groups: underweight (body mass index [BMI] < 18.5, n = 92), normal weight (BMI 18.5-25, n = 746), and overweight (BMI ≥ 25, n = 219). With the exception of age and male/female ratio, patient characteristics were comparable among the three groups. Rates of complete remission following induction chemotherapy were similar among the three groups (p = 0.68). We observed a significant difference in overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) between underweight and normal weight patients (3-year OS 34.8 vs. 47.7%, p = 0.01; DFS 28.6 vs. 39.8%, p = 0.02; 1-year NRM 6.2 vs. 2.6%, p = 0.05), but not between underweight and overweight patients. In multivariate analysis, underweight was an independent adverse prognostic factor for OS (p < 0.01), DFS (p = 0.01), and NRM (p = 0.04). During the first induction chemotherapy, the incidences of documented infection (DI) and severe adverse events (AEs) were higher in underweight patients than those in normal weight patients (DI 16 vs. 8.1%, p = 0.04; AE 36 vs. 24%, p = 0.05). In conclusion, underweight was an independent adverse prognostic factor for survival in adult AML patients.
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Nagel G, Weber D, Fromm E, Erhardt S, Lübbert M, Fiedler W, Kindler T, Krauter J, Brossart P, Kündgen A, Salih HR, Westermann J, Wulf G, Hertenstein B, Wattad M, Götze K, Kraemer D, Heinicke T, Girschikofsky M, Derigs HG, Horst HA, Rudolph C, Heuser M, Göhring G, Teleanu V, Bullinger L, Thol F, Gaidzik VI, Paschka P, Döhner K, Ganser A, Döhner H, Schlenk RF. Epidemiological, genetic, and clinical characterization by age of newly diagnosed acute myeloid leukemia based on an academic population-based registry study (AMLSG BiO). Ann Hematol 2017; 96:1993-2003. [PMID: 29090343 PMCID: PMC5691091 DOI: 10.1007/s00277-017-3150-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/16/2017] [Indexed: 11/04/2022]
Abstract
We describe genetic and clinical characteristics of acute myeloid leukemia (AML) patients according to age from an academic population-based registry. Adult patients with newly diagnosed AML at 63 centers in Germany and Austria were followed within the AMLSG BiO registry (NCT01252485). Between January 1, 2012, and December 31, 2014, data of 3525 patients with AML (45% women) were collected. The median age was 65 years (range 18-94). The comparison of age-specific AML incidence rates with epidemiological cancer registries revealed excellent coverage in patients < 70 years old and good coverage up to the age of 80. The distribution according to the European LeukemiaNet (ELN) risk categorization from 2010 was 20% favorable, 31% intermediate-1, 28% intermediate-2, and 21% adverse. With increasing age, the relative but not the absolute prevalence of patients with ELN favorable and intermediate-1 risk (p < 0.001), with activating FLT3 mutations (p < 0.001), with ECOG performance status < 2 (p < 0.001), and with HCT-CI comorbidity index < 3 (p < 0.001) decreased. Regarding treatment, obesity and favorable risk were associated with an intensive treatment, whereas adverse risk, higher age, and comorbidity index > 0 were associated with non-intensive treatment or best supportive care. The AMLSG BiO registry provides reliable population-based distributions of genetic, clinical, and treatment characteristics according to age.
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Affiliation(s)
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
| | - D Weber
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - E Fromm
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - S Erhardt
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - M Lübbert
- Department of Internal Medicine I, Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - W Fiedler
- Department of Internal Medicine II, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - T Kindler
- Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
| | - J Krauter
- Department of Internal Medicine III, Hospital Braunschweig, Braunschweig, Germany
| | - P Brossart
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - A Kündgen
- Department of Hematology, Oncology and Clinical Immunology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - H R Salih
- Department of Internal Medicine II, University Hospital of Tübingen, Tübingen, Germany
| | - J Westermann
- Department of Hematology, Oncology and Tumor Immunology, Charité - Campus Virchow Clinic, Berlin, Germany
| | - G Wulf
- Department of Hematology and Oncology, University Hospital of Göttingen, Göttingen, Germany
| | - B Hertenstein
- Department of Internal Medicine I, Hospital Bremen-Mitte, Bremen, Germany
| | - M Wattad
- Department of Hematology and Oncology, Hospital Essen-Werden, Essen, Germany
| | - K Götze
- Department of Internal Medicine III, University Hospital Klinikum rechts der Isar, Munich, Germany
| | - D Kraemer
- Department of Oncology and Hematology, Hospital Oldenburg, Oldenburg, Germany
| | - T Heinicke
- Department of Hematology and Oncology, University Hospital of Magdeburg, Magdeburg, Germany
| | - M Girschikofsky
- Department of Hematology and Oncology, Hospital Elisabethinen Linz, Linz, Austria
| | - H G Derigs
- Department of Internal Medicine III, Hospital Frankfurt-Hoechst, Frankfurt, Germany
| | - H A Horst
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - C Rudolph
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - G Göhring
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - V Teleanu
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - L Bullinger
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - F Thol
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - V I Gaidzik
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - P Paschka
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - K Döhner
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - A Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - R F Schlenk
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg, Germany
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50
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Lee DH, Jacobs DR, Park HY, Carpenter DO. A role of low dose chemical mixtures in adipose tissue in carcinogenesis. ENVIRONMENT INTERNATIONAL 2017; 108:170-175. [PMID: 28863389 DOI: 10.1016/j.envint.2017.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/07/2017] [Accepted: 08/23/2017] [Indexed: 05/15/2023]
Abstract
The Halifax project recently hypothesized a composite carcinogenic potential of the mixture of low dose chemicals which are commonly encountered environmentally, yet which are not classified as human carcinogens. A long neglected but important fact is that adipose tissue is an important exposure source for chemical mixtures. In fact, findings from human studies based on several persistent organic pollutants in general populations with only background exposure should be interpreted from the viewpoint of chemical mixtures because serum concentrations of these chemicals can be seen as surrogates for chemical mixtures in adipose tissue. Furthermore, in conditions such as obesity with dysfunctional adipocytes or weight loss in which lipolysis is increased, the amount of the chemical mixture released from adipose tissue to circulation is increased. Thus, both obesity and weight loss can enhance the chance of chemical mixtures reaching critical organs, however paradoxical this idea may be when fat mass is the only factor considered. The complicated, interrelated dynamics of adipocytes and chemical mixtures can explain puzzling findings related to body weight among cancer patients, including the obesity paradox. The contamination of fat in human diet with chemical mixtures, occurring for reasons similar to contamination of human adipose tissue, may be a missing factor which affects the association between dietary fat intake and cancer. The presence of chemical mixtures in adipose tissue should be considered in future cancer research, including clinical trials on weight management among cancer survivors.
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Affiliation(s)
- Duk-Hee Lee
- Department of Preventative Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Republic of Korea.
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Ho Yong Park
- Department of Breast and Thyroid Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - David O Carpenter
- Center for the Elimination of Minority Health Disparities, University at Albany, Albany, NY, United States; Institute for Health and the Environment, University at Albany, Rensselaer, NY, United States
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