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Guo X, Tang J, He H, Jian L, Qiang O, Xie Y. Body composition and inflammation variables as the potential prognostic factors in epithelial ovarian cancer treated with Olaparib. Front Oncol 2024; 14:1359635. [PMID: 38725625 PMCID: PMC11079183 DOI: 10.3389/fonc.2024.1359635] [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: 12/21/2023] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
Background Epithelial ovarian cancer (EOC) is a significant cause of mortality among gynecological cancers. While Olaparib, a PARP inhibitor, has demonstrated efficacy in EOC maintenance therapy, individual responses vary. This study aims to assess the prognostic significance of body composition and systemic inflammation markers in EOC patients undergoing initial Olaparib treatment. Methods A retrospective analysis was conducted on 133 EOC patients initiating Olaparib therapy. Progression-free survival (PFS) was assessed through Kaplan-Meier analysis and Cox proportional hazards regression. Pre-treatment computed tomography images were utilized to evaluate body composition parameters including subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), skeletal muscle area index (SMI), and body mineral density (BMD). Inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), serum albumin, and hemoglobin levels, were also measured. Results The median follow-up duration was 16 months (range: 5-49 months). Survival analysis indicated that high SATI, high VATI, high SMI, high BMD, low NLR, and low PLR were associated with decreased risk of disease progression (all p < 0.05). Multivariate analysis identified several factors independently associated with poor PFS, including second or further lines of therapy (HR = 2.16; 95% CI = 1.09-4.27, p = 0.027), low VATI (HR = 3.79; 95% CI = 1.48-9.70, p = 0.005), low SMI (HR = 2.52; 95% CI = 1.11-5.72, p = 0.027), low BMD (HR = 2.36; 95% CI = 1.22-4.54, p = 0.010), and high NLR (HR = 0.31; 95% CI = 0.14-0.69, p = 0.004). Subgroup analysis in serous adenocarcinoma patients revealed distinct prognostic capabilities of SATI, VATI, SMI, PLR, and NLR. Conclusion Body composition and inflammation variables hold promise as predictors of therapeutic response to Olaparib in EOC patients. Understanding their prognostic significance could facilitate tailored treatment strategies, potentially improving patient outcomes.
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Affiliation(s)
- Xingzi Guo
- Department of Gynecologic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jie Tang
- Department of Gynecologic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Haifeng He
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lian Jian
- Department of Radiology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ouyang Qiang
- Department of Gynecologic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yongzhi Xie
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
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Harborg S, Kjærgaard KA, Thomsen RW, Borgquist S, Cronin-Fenton D, Hjorth CF. New Horizons: Epidemiology of Obesity, Diabetes Mellitus, and Cancer Prognosis. J Clin Endocrinol Metab 2024; 109:924-935. [PMID: 37552777 DOI: 10.1210/clinem/dgad450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/30/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
The global prevalence of obesity and diabetes mellitus has increased in parallel with increasing cancer incidence, due to environmental and lifestyle factors and population aging. Metabolic diseases are associated with increased cancer risk, so a growing number of patients with cancer have coexistent obesity and/or diabetes mellitus. In this narrative review, we highlight recent evidence on the clinical impact of obesity and diabetes mellitus on the prognosis of prostate, breast, and colorectal cancer, and provide an overview of the underlying mechanisms. There is evidence that obesity is associated with increased risk of recurrence, and all-cause and cancer-specific mortality among adults with prostate, breast, and colorectal cancer. Diabetes mellitus is associated with increased all-cause and cancer-specific mortality for these 3 cancers, beyond any impact of obesity. Evidence also suggests increased risk of colorectal cancer recurrence in patients with diabetes mellitus. The underlying mechanisms are multifactorial and likely include hormonal imbalances and chronic inflammation that promote cancer cell growth. Obesity and diabetes mellitus are associated with increased risk of complications and side effects of cancer treatment. Associated comorbidities such as impaired kidney function, cardiovascular disease, and neuropathies may preclude the use of guideline cancer treatment and are competing causes of death. Cancer patients with metabolic diseases require a designated clinical program and a multidisciplinary approach involving oncologists, endocrinologists, surgeons, nutritionists, and physiotherapists, to ensure coordinated and optimized patient care.
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Affiliation(s)
- Sixten Harborg
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark
| | - Kasper A Kjærgaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark
| | - Signe Borgquist
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark
| | - Cathrine F Hjorth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark
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Zhang T, Li S, Chang J, Qin Y, Li C. Impact of BMI on the survival outcomes of non-small cell lung cancer patients treated with immune checkpoint inhibitors: a meta-analysis. BMC Cancer 2023; 23:1023. [PMID: 37872469 PMCID: PMC10594865 DOI: 10.1186/s12885-023-11512-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES ICIs have become the standard treatment for advanced NSCLC patients. Currently, PD-L1 is the most widely useful biomarker to predict ICI efficacy, but the sensitivity and specificity are limited. Therefore, the useful predictive biomarkers of ICI efficacy is urgently needed. BMI is an internationally used measure of body health. Obesity may affect ICI efficacy by changing T cell functions. This meta-analysis aimed to clarify the relationship between BMI and survival outcomes of NSCLC patients treated with ICIs. METHODS A systematic review was conducted to identify studies that assessed the association between BMI and survival outcomes in patients treated with ICIs. OS was the primary endpoint, and PFS was the secondary endpoint. Random-effect models or fixed-effect models were utilized to combine study effects according to the Cochran Q and I2 tests. RESULTS Nine studies, including 4602 NSCLC patients treated with ICIs, that met the inclusion criteria were selected for this meta-analysis. There was no significant difference in PFS (HR 0.885; 95% CI 0.777-1.009, p = 0.068) or OS (HR 0.947; 95% CI 0.789-1.137, p = 0.560) between the low BMI group and the high BMI group. However, in the subgroup analysis, compared with normal-weight patients, overweight and obese patients achieved prolonged PFS (HR 0.862; 95% CI 0.760-0.978, p = 0.021) and OS (HR 0.818; 95% CI 0.741-0.902, p<0.0001). CONCLUSION Overweight and obese NSCLC patients tend to achieve prolonged survival time with ICI regimens. Further prospective studies are needed to strengthen the association between ICI outcomes and BMI levels.
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Affiliation(s)
- Tongtong Zhang
- Department of Medical Oncology, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Guangdong, Shenzhen, 518116, China
| | - Shuluan Li
- Department of Nutrition, Shenzhen Hospital, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Guangdong, Shenzhen, 518116, China
| | - Jianhua Chang
- Department of Medical Oncology, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Guangdong, Shenzhen, 518116, China
| | - Yan Qin
- Department of Medical Oncology, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Guangdong, Shenzhen, 518116, China.
| | - Chao Li
- Department of Pharmacy, Shenzhen Hospital, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Guangdong, Shenzhen, 518116, China.
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Conroy MA, O'Connor AL, Qureshi AP, Wood SG. Impact of Morbid Obesity on Post-esophagectomy Leak Rate: a NSQIP Analysis. J Gastrointest Surg 2023; 27:1539-1544. [PMID: 37081219 DOI: 10.1007/s11605-023-05669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/03/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Morbid obesity is becoming more prevalent and is a known risk factor for esophageal cancer. Esophagectomy in this population is technically more challenging than the non-obese, thus increasing the risks of surgery. This study hypothesizes that higher body mass index (BMI) is associated with higher anastomotic leak rates after esophagectomy. METHODS This study is a retrospective review of patients undergoing esophagectomy in the National Surgical Quality Improvement Program (NSQIP) Targeted Esophagectomy database from 2016 to 2019. Patients were stratified by BMI < 35 versus BMI > 35, with the primary outcome being leak post-esophagectomy. Univariate analyses were performed for demographics and post-operative outcomes, and multivariate analyses were performed specifically for the primary outcome of anastomotic leak (all diagnoses and malignancy/dysplasia subgroup). This study was approved by the Institutional Review Board. RESULTS Of 4165 patients, 439 (10.5%) had a BMI > 35. Patients with BMI > 35 were often younger (mean age 60 vs 64 years, p < 0.001), White (p < 0.001), female (p < 0.001), non-smoker (p < 0.001), diabetic (p < 0.001), with hypertension (p < 0.001), and ASA ≥ 3 (p < 0.001). There were no differences between BMI groups with regard to indication for esophagectomy (malignancy/dysphasia vs other), conversion to open, mortality, or length of stay. The BMI > 35 cohort reported higher operative times (p < 0.001), open operative approach (p = 0.04), superficial surgical site infection (p < 0.001), return to operating room (p = 0.01), and leak (13.5% vs 10.1%, p = 0.01). BMI > 35 was not an independent predictor of leak for all diagnoses; however, the subgroup analysis of esophagectomy for malignancy/dysplasia demonstrated that BMI > 35 was predictive of leak (OR 1.42, 95% CI 1.05-1.91), as well as operative time and hypertension. CONCLUSION Patients with a BMI > 35 and who undergo esophagectomy have a higher rate of anastomotic leak. BMI > 35 was also an independent predictor of leak when esophagectomy was performed for malignancy/dysplasia, but not for all diagnoses. The risk of anastomotic leak should be considered in morbidly obese patients undergoing esophagectomy, particularly for malignancy.
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Affiliation(s)
- Molly A Conroy
- Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L223A, Portland, OR, 97239, USA
| | - Amber L O'Connor
- Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L223A, Portland, OR, 97239, USA
| | - Alia P Qureshi
- Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L223A, Portland, OR, 97239, USA
| | - Stephanie G Wood
- Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L223A, Portland, OR, 97239, USA.
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Trinkner P, Günther S, Monsef I, Kerschbaum E, von Bergwelt-Baildon M, Cordas Dos Santos DM, Theurich S. Survival and immunotoxicities in association with sex-specific body composition patterns of cancer patients undergoing immune-checkpoint inhibitor therapy - A systematic review and meta-analysis. Eur J Cancer 2023; 184:151-171. [PMID: 36931074 DOI: 10.1016/j.ejca.2023.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Imbalanced body composition is mechanistically connected to dysregulated immune activities. Whether overweight/obesity or sarcopenia has an impact on treatment results in cancer patients undergoing immune checkpoint inhibitor (ICI) therapy is currently under debate. We aimed to answer if survival rates and occurrence of immune-related adverse events (irAEs) were different in obese or sarcopenic patients. METHODS A systematic search was conducted in PubMed, Embase and CENTRAL for all records published until July 2022 using specific search terms for body composition in combination with terms for ICI regimens. Two authors screened independently. All studies that reported on body mass index or sarcopenia measures were selected for further analysis. RESULTS 48 studies reporting on overweight/obesity comprising of 19,767 patients, and 32 studies reporting on sarcopenia comprising of 3193 patients fulfilled the inclusion criteria. In the entire cohort, overweight/obesity was significantly associated with better progression-free survival (PFS; p = 0.009) and overall survival (OS; p <0.00001). Subgroup analyses stratified by sex revealed that overweight/obese males had the strongest survival benefit (PFS: p = 0.05; OS: p = 0.0005), and overweight/obese female patients did not show any. However, overweight/obese patients of both sexes had a higher risk to develop irAEs grade ≥3 (p = 0.0009). Sarcopenic patients showed significantly shorter PFS (p <0.0001) and OS (p <0.0001). The frequency of irAEs did not differ between sarcopenic and non-sarcopenic patients. CONCLUSION This meta-analysis suggests that body composition is associated in a sex-specific manner with survival and irAEs in cancer patients undergoing ICI treatment.
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Affiliation(s)
- Paul Trinkner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Cancer- and Immunometabolism Research Group, Gene Center, LMU Munich, Munich, Germany
| | - Sophie Günther
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Cancer- and Immunometabolism Research Group, Gene Center, LMU Munich, Munich, Germany
| | - Ina Monsef
- Evidence-based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Eva Kerschbaum
- Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich (CCCM), Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David M Cordas Dos Santos
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Cancer- and Immunometabolism Research Group, Gene Center, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Theurich
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Cancer- and Immunometabolism Research Group, Gene Center, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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6
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Effects of the exercise-inducible myokine irisin on proliferation and malignant properties of ovarian cancer cells through the HIF-1 α signaling pathway. Sci Rep 2023; 13:170. [PMID: 36599894 DOI: 10.1038/s41598-022-26700-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Exercise has been shown to be associated with reduced risk and improving outcomes of several types of cancers. Irisin -a novel exercise-related myokine- has been proposed to exert beneficial effects in metabolic disorders including cancer. No previous studies have investigated whether irisin may regulate malignant characteristics of ovarian cancer cell lines. In the present study, we aimed to explore the effect of irisin on viability and proliferation of ovarian cancer cells which was examined by MTT assay. Then, we evaluated the migratory and invasive abilities of the cells via transwell assays. Moreover, the percentage of apoptosis induction was determined by flow cytometry. Furthermore, the mRNA expression level of genes related to the aerobic respiration (HIF-1α, c-Myc, LDHA, PDK1 and VEGF) was detected by real-time PCR. Our data revealed that irisin treatment significantly attenuated the proliferation, migration and invasion of ovarian cancer cells. Additionally, irisin induced apoptosis in ovarian cancer cells. We also observed that irisin regulated the expression of genes involved in aerobic respiration of ovarian cancer cells. Our results indicated that irisin may play a crucial role in inhibition of cell growth and malignant characteristics of ovarian cancer. These findings may open up avenues for future studies to identify the further therapeutic use of irisin in ovarian cancer management.
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7
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Deng Y, Zhao L, Huang X, Zeng Y, Xiong Z, Zuo M. Contribution of skeletal muscle to cancer immunotherapy: A focus on muscle function, inflammation, and microbiota. Nutrition 2023; 105:111829. [PMID: 36265324 DOI: 10.1016/j.nut.2022.111829] [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: 02/25/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
Sarcopenia, characterized by degenerative and systemic loss of skeletal muscle mass and function, is a multifactorial syndrome commonly observed in individuals with cancer. Additionally, it represents a poor nutritional status and indicates possible presence of cancer cachexia. Recently, with the extensive application of cancer immunotherapy, the effects of sarcopenia/cachexia on cancer immunotherapy, have gained attention. The aim of this review was to summarize the influence of low muscle mass (sarcopenia/cachexia) on the response and immune-related adverse events to immunotherapy from the latest literature. It was revealed that low muscle mass (sarcopenia/cachexia) has detrimental effects on cancer immunotherapy in most cases, although there were results that were not consistent with this finding. This review also discussed potential causes of the paradox, such as different measure methods, research types, muscle indicators, time point, and cancer type. Mechanically, chronic inflammation, immune cells, and microbiota may be critically involved in regulating the efficacy of immunotherapy under the condition of low muscle mass (sarcopenia/cachexia). Thus, nutritional interventions will likely be promising ways for individuals with cancer to increase the efficacy of immunotherapy in the future, for low muscle mass (sarcopenia/cachexia) is an important prognostic factor for cancer immunotherapy.
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Affiliation(s)
- Yuanle Deng
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Ling Zhao
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Xuemei Huang
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Yu Zeng
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Zhujuan Xiong
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China.
| | - Ming Zuo
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
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Roth G, Teyssier Y, Benhamou M, Abousalihac M, Caruso S, Sengel C, Seror O, Ghelfi J, Seigneurin A, Ganne-Carrie N, Gigante E, Blaise L, Sutter O, Decaens T, Nault JC. Impact of sarcopenia on tumor response and survival outcomes in patients with hepatocellular carcinoma treated by trans-arterial (chemo)-embolization. World J Gastroenterol 2022; 28:5324-5337. [PMID: 36185630 PMCID: PMC9521519 DOI: 10.3748/wjg.v28.i36.5324] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/22/2022] [Accepted: 08/30/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND At the diagnosis of hepatocellular carcinoma (HCC), more than 90% of HCC patients present cirrhosis, a clinical condition often associated to malnutrition. Sarcopenia is an indirect marker of malnutrition assessable on computed tomography (CT).
AIM To evaluate the prognostic value of sarcopenia in patients with HCC treated by trans-arterial (chemo)-embolization.
METHODS Patients with HCC treated by a first session of trans-arterial (chemo)embolization and an available CT scan before treatment were included. Sarcopenia was assessed using skeletal muscle index at baseline and at the first radiological assessment. Radiological response was recorded after the first session of treatment using mRECIST.
RESULTS Of 225 patients treated by trans-arterial bland embolization (n = 71) or trans-arterial chemoembolization (n = 154) for HCC between 2007 and 2013, Barcelona Clinic of Liver Cancer stage was A, B, and C in 27.5%, 55%, and 16.8% of cases, respectively. Sarcopenia was present in 57.7% of the patients. Patients with sarcopenia presented a higher rate of progressive disease (19% vs 8%, P = 0.0236), a shorter progression-free survival (8.3 vs 13.2 mo, P = 0.0035), and a shorter median overall survival (19.4 mo vs 35.5 mo, P = 0.0149) compared with non-sarcopenic patients. Finally, patients whose sarcopenia appeared after first transarterial treatment had the worst prognosis (P = 0.0004).
CONCLUSION Sarcopenia is associated with tumor progression and poor survival outcomes after trans-arterial (chemo)-embolization for HCC.
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Affiliation(s)
- Gael Roth
- Univ. Grenoble-Alpes, Grenoble 38058, France
- Department of Hepatology, Gastroenterology and Digestive Oncology, CHU Grenoble Alpes, Grenoble 38043, France
- Institute for Advanced Biosciences, INSERM U1209/CNRS UMR 5309, Grenoble 38043, France
| | - Yann Teyssier
- Univ. Grenoble-Alpes, Grenoble 38058, France
- Department of Radiology, CHU Grenoble Alpes, Grenoble 38043, France
| | - Maxime Benhamou
- Department of Radiology, CHU Avicenne-APHP, Bobigny 93000, France
| | - Mélodie Abousalihac
- Department of Hepatology, Gastroenterology and Digestive Oncology, CHU Grenoble Alpes, Grenoble 38043, France
| | - Stefano Caruso
- Functional Genomics of Solid Tumors Laboratory, Centre de Recherche des Cordeliers-INSERM UMR 1138, Inserm, Université Paris, Paris 75006, France
| | - Christian Sengel
- Department of Radiology, CHU Grenoble Alpes, Grenoble 38043, France
| | - Olivier Seror
- Department of Radiology, CHU Avicenne-APHP, Bobigny 93000, France
- Functional Genomics of Solid Tumors Laboratory, Centre de Recherche des Cordeliers-INSERM UMR 1138, Inserm, Université Paris, Paris 75006, France
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris 93430, France
| | - Julien Ghelfi
- Univ. Grenoble-Alpes, Grenoble 38058, France
- Institute for Advanced Biosciences, INSERM U1209/CNRS UMR 5309, Grenoble 38043, France
- Department of Radiology, CHU Grenoble Alpes, Grenoble 38043, France
| | - Arnaud Seigneurin
- Univ. Grenoble-Alpes, Grenoble 38058, France
- Service d'Epidémiologie et Evaluation Médicale, CHU Grenoble Alpes, Grenoble 38043, France
| | - Nathalie Ganne-Carrie
- Functional Genomics of Solid Tumors Laboratory, Centre de Recherche des Cordeliers-INSERM UMR 1138, Inserm, Université Paris, Paris 75006, France
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris 93430, France
- Department of Hepatology, CHU Avicenne-APHP, Bobigny 93000, France
| | - Elia Gigante
- Department of Hepatology, CHU Avicenne-APHP, Bobigny 93000, France
| | - Lorraine Blaise
- Department of Hepatology, CHU Avicenne-APHP, Bobigny 93000, France
| | - Olivier Sutter
- Department of Radiology, CHU Avicenne-APHP, Bobigny 93000, France
| | - Thomas Decaens
- Univ. Grenoble-Alpes, Grenoble 38058, France
- Department of Hepatology, Gastroenterology and Digestive Oncology, CHU Grenoble Alpes, Grenoble 38043, France
- Institute for Advanced Biosciences, INSERM U1209/CNRS UMR 5309, Grenoble 38043, France
| | - Jean-Charles Nault
- Functional Genomics of Solid Tumors Laboratory, Centre de Recherche des Cordeliers-INSERM UMR 1138, Inserm, Université Paris, Paris 75006, France
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris 93430, France
- Department of Hepatology, CHU Avicenne-APHP, Bobigny 93000, France
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Excess weight and anti-PD-1 immune checkpoint inhibitor’s outcomes in non-small cell lung cancer. Clin Transl Oncol 2022; 24:2241-2249. [DOI: 10.1007/s12094-022-02887-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/05/2022] [Indexed: 10/16/2022]
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10
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Mojibi Y, Seif F, Mojibi N, Aghamajidi A, Mohsenzadegan M, Torang HA. Efficacy of immunotherapy in obese patients with cancer. Immunopharmacol Immunotoxicol 2022; 44:471-483. [PMID: 35369842 DOI: 10.1080/08923973.2022.2061989] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obesity is a condition of excessive fat tissue and high body mass index (BMI ≥30), which is increasing worldwide. Excess body weight is associated with poorer results in cancer treatments; however, recent studies emphasized that elevated BMI was associated with improved outcomes in cases treated by immune checkpoint inhibitor (ICI) therapies, which is called the obesity paradox. In this review, we discuss the correlation between obesity and cancer immunotherapy, especially ICIs, the underlying mechanisms, and the outcomes in different types of cancers. In addition, we describe the occurrence of immune-related adverse events (irAE) and the effect of gender in obese patients during immunotherapy using all relevant studies with available full texts.
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Affiliation(s)
- Yasaman Mojibi
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Seif
- Department of Immunology and Allergy, Academic Center for Education, Culture, and Research (ACECR), Tehran, Iran.,Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nastaran Mojibi
- Department of Clinical Biochemistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Azin Aghamajidi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Monireh Mohsenzadegan
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hamzeh-Ali Torang
- Rheumatology Department, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Lee JH, Yoon YC, Kim HS, Cha MJ, Kim JH, Kim K, Kim HS. Obesity is associated with improved postoperative overall survival, independent of skeletal muscle mass in lung adenocarcinoma. J Cachexia Sarcopenia Muscle 2022; 13:1076-1086. [PMID: 35212195 PMCID: PMC8978026 DOI: 10.1002/jcsm.12956] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/03/2022] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although the obesity paradox is a topic of immense interest for oncologists and epidemiologists, the mechanism underlying this unexpected benefit of obesity is poorly understood. We explored the prognostic value of obesity and its association with skeletal muscle mass. METHODS This retrospective study evaluated the data of patients who underwent surgical excision for lung adenocarcinoma between January 2011 and December 2015. Body mass index was categorized according to the criteria of the Asia-Pacific classification. Cross-sectional areas of the skeletal muscle, subcutaneous fat, and visceral fat were measured. Skeletal muscle mass status was defined based on the cut-offs of skeletal muscle index (cm2 /m2 ), calculated as the area of skeletal muscle divided by height squared. Overall survival was estimated using the Kaplan-Meier method, and differences in survival probabilities were compared using the log-rank test. Cox proportional hazards regression analysis was conducted to determine the association with overall survival. RESULTS A total of 636 patients with a median age of 61 years (interquartile range, 54.0-68.5 years; 321 men and 315 women) were included. Obese patients (body mass index ≥ 25 kg/m2 ) had longer overall survival than non-obese patients (mean, 110.2 months vs. 98.7 months; log-rank P = 0.015). Under multivariable Cox proportional hazard regression analysis, obesity was associated with longer overall survival after adjusting for covariates (hazard ratio, 0.59; 95% confidence interval, 0.40-0.86; P = 0.007). The prognostic value of obesity remained and predicted favourable overall survival after additional adjusting for skeletal muscle mass status (hazard ratio, 0.57; 95% confidence interval, 0.36-0.89; P = 0.014), skeletal muscle index (hazard ratio, 0.53; 95% confidence interval, 0.33-0.84; P = 0.008), or skeletal muscle area (hazard ratio, 0.61; 95% confidence interval, 0.38-0.98; P = 0.041). No association was observed between skeletal muscle mass status and the impact of body mass index on overall survival (P for interaction = 0.512). CONCLUSIONS Obesity was associated with favourable overall survival, independent of skeletal muscle mass, after surgical excision of lung adenocarcinoma.
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Affiliation(s)
- Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hye Seung Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
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12
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Zhang J, Bellocco R, Ye W, Johansson J, Nilsson M, Lindblad M. OUP accepted manuscript. BJS Open 2022; 6:6594074. [PMID: 35639945 PMCID: PMC9154327 DOI: 10.1093/bjsopen/zrac035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/27/2021] [Accepted: 02/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background Accumulating evidence suggests a survival benefit after curative oesophageal cancer surgery in women compared with men. The aim of this study was to explore sex disparities in survival after surgery with curative intent in patients with oesophageal cancer. Methods This was a population-based cohort study, including all patients with oesophageal or gastric cancer who underwent surgery with a curative intent between 2006 and 2017 in Sweden. Female versus male mortality rate ratio (MRR) and excess mortality rate ratio (EMRR) were used as measures of survival. Two different parametric models were designed to account for potential confounders. Patients with gastric cancer were used as a comparison group as no differences in survival between sexes were expected among these patients. Results A total of 1301 patients underwent resection for oesophageal adenocarcinoma and 305 patients for oesophageal squamous cell carcinoma. Women had a lower EMRR (0.76, 95 per cent c.i. 0.58 to 1.01, P = 0.056; 0.52, 95 per cent c.i. 0.32 to 0.84, P = 0.007 respectively) in both histological subtypes. The effect was more profound in early clinical stages, in patients receiving neoadjuvant treatment, and without postoperative complications. No sex-related difference was observed in survival of patients with gastric cancer. Conclusions Women undergoing resection for oesophageal carcinoma have better survival compared with men.
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Affiliation(s)
- Ji Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Correspondence to: Ji Zhang, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE171 77, Stockholm, Sweden (e-mail: )
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jan Johansson
- Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
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13
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Adequacy of nutritional support using computed tomography (CT) in patients with head and neck cancer (HNC) during chemo-radiotherapy (CRT). Eur J Clin Nutr 2021; 75:1515-1519. [PMID: 33568807 DOI: 10.1038/s41430-021-00863-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 01/30/2023]
Abstract
We assessed forty HNC patients receiving treatment with curative intent. Specific quantitative muscle and fat changes were evaluated using CT. Nutrition support was provided according to ESPEN guidelines, with adjusted body weight (ABW) in overweight/obese patients used to define their nutritional targets. Linear regression models were used to evaluate clinical predictors of tissue loss. Mean overall losses were body weight (-10.5%), and CT-defined muscle (-8.4%) and fat mass (-24.8%), p < 0.001. A subset of 20 patients had high muscle loss (-14.7%) with concurrent negative energy balance as reflected by considerable fat loss (-29.7%); those tended to have higher baseline body mass index (26.2 vs. 23.3 kg/m2, p = 0.063). In multivariate regression, only ABW independently predicted muscle loss (p < 0.001) and fat loss (p = 0.002). Nutrition support according to guidelines was appropriate for a subset of patients. ABW use to set nutrition targets in overweight/obese patients would appear to be insufficient, based on large tissue losses.
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14
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Gómez de Segura I, Ahechu P, Gómez-Ambrosi J, Rodríguez A, Ramírez B, Becerril S, Unamuno X, Mentxaka A, Baixauli J, Valentí V, Moncada R, Silva C, Frühbeck G, Catalán V. Decreased Levels of Microfibril-Associated Glycoprotein (MAGP)-1 in Patients with Colon Cancer and Obesity Are Associated with Changes in Extracellular Matrix Remodelling. Int J Mol Sci 2021; 22:ijms22168485. [PMID: 34445187 PMCID: PMC8395192 DOI: 10.3390/ijms22168485] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The protein microfibril-associated glycoprotein (MAGP)-1 constitutes a crucial extracellular matrix protein. We aimed to determine its impact on visceral adipose tissue (VAT) remodelling during obesity-associated colon cancer (CC). METHODS Samples obtained from 79 subjects (29 normoponderal (NP) (17 with CC) and 50 patients with obesity (OB) (19 with CC)) were used in the study. Circulating concentrations of MAGP-1 and its gene expression levels (MFAP2) in VAT were analysed. The impact of inflammation-related factors and adipocyte-conditioned media (ACM) on MFAP2 mRNA levels in colon adenocarcinoma HT-29 cells were further analysed. The effects of MAGP-1 in the expression of genes involved in the extracellular matrix (ECM) remodelling and tumorigenesis in HT-29 cells was also explored. RESULTS Obesity (p < 0.01) and CC (p < 0.001) significantly decreased MFAP2 gene expression levels in VAT whereas an opposite trend in TGFB1 mRNA levels was observed. Increased mRNA levels of MFAP2 after the stimulation of HT-29 cells with lipopolysaccharide (LPS) (p < 0.01) and interleukin (IL)-4 (p < 0.01) together with a downregulation (p < 0.05) after hypoxia mimicked by CoCl2 treatment was observed. MAGP-1 treatment significantly enhanced the mRNA levels of the ECM-remodelling genes collagen type 6 α3 chain (COL6A3) (p < 0.05), decorin (DCN) (p < 0.01), osteopontin (SPP1) (p < 0.05) and TGFB1 (p < 0.05). Furthermore, MAGP-1 significantly reduced (p < 0.05) the gene expression levels of prostaglandin-endoperoxide synthase 2 (COX2/PTGS2), a key gene controlling cell proliferation, growth and adhesion in CC. Interestingly, a significant decrease (p < 0.01) in the mRNA levels of MFAP2 in HT-29 cells preincubated with ACM from volunteers with obesity compared with control media was observed. Conclusion: The decreased levels of MAGP-1 in patients with obesity and CC together with its capacity to modulate key genes involved in ECM remodelling and tumorigenesis suggest MAGP-1 as a link between AT excess and obesity-associated CC development.
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Affiliation(s)
- Iranzu Gómez de Segura
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (I.G.d.S.); (J.G.-A.); (A.R.); (B.R.); (S.B.); (X.U.); (A.M.)
| | - Patricia Ahechu
- Department of Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (P.A.); (J.B.); (V.V.)
| | - Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (I.G.d.S.); (J.G.-A.); (A.R.); (B.R.); (S.B.); (X.U.); (A.M.)
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
- Obesity and Adipobiology Group, IdiSNA, 31008 Pamplona, Spain
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (I.G.d.S.); (J.G.-A.); (A.R.); (B.R.); (S.B.); (X.U.); (A.M.)
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
- Obesity and Adipobiology Group, IdiSNA, 31008 Pamplona, Spain
| | - Beatriz Ramírez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (I.G.d.S.); (J.G.-A.); (A.R.); (B.R.); (S.B.); (X.U.); (A.M.)
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
- Obesity and Adipobiology Group, IdiSNA, 31008 Pamplona, Spain
| | - Sara Becerril
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (I.G.d.S.); (J.G.-A.); (A.R.); (B.R.); (S.B.); (X.U.); (A.M.)
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
- Obesity and Adipobiology Group, IdiSNA, 31008 Pamplona, Spain
| | - Xabier Unamuno
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (I.G.d.S.); (J.G.-A.); (A.R.); (B.R.); (S.B.); (X.U.); (A.M.)
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
| | - Amaia Mentxaka
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (I.G.d.S.); (J.G.-A.); (A.R.); (B.R.); (S.B.); (X.U.); (A.M.)
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
| | - Jorge Baixauli
- Department of Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (P.A.); (J.B.); (V.V.)
| | - Víctor Valentí
- Department of Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (P.A.); (J.B.); (V.V.)
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
- Obesity and Adipobiology Group, IdiSNA, 31008 Pamplona, Spain
| | - Rafael Moncada
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
- Department of Anesthesia, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Camilo Silva
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
- Obesity and Adipobiology Group, IdiSNA, 31008 Pamplona, Spain
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (I.G.d.S.); (J.G.-A.); (A.R.); (B.R.); (S.B.); (X.U.); (A.M.)
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
- Obesity and Adipobiology Group, IdiSNA, 31008 Pamplona, Spain
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- Correspondence: (G.F.); (V.C.); Tel.: +34-9-4825-5400 (ext. 4484) (G.F.); +34-9-4825-5400 (ext. 5133) (V.C.)
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (I.G.d.S.); (J.G.-A.); (A.R.); (B.R.); (S.B.); (X.U.); (A.M.)
- CIBEROBN, Instituto de Salud Carlos III, 31008 Pamplona, Spain; (R.M.); (C.S.)
- Obesity and Adipobiology Group, IdiSNA, 31008 Pamplona, Spain
- Correspondence: (G.F.); (V.C.); Tel.: +34-9-4825-5400 (ext. 4484) (G.F.); +34-9-4825-5400 (ext. 5133) (V.C.)
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15
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Baldessari C, Guaitoli G, Valoriani F, Bonacini R, Marcheselli R, Reverberi L, Pecchi A, Menozzi R, Torricelli P, Bertolini F, Barbieri F, Dominici M. Impact of body composition, nutritional and inflammatory status on outcome of non-small cell lung cancer patients treated with immunotherapy. Clin Nutr ESPEN 2021; 43:64-75. [PMID: 34024567 DOI: 10.1016/j.clnesp.2021.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Body composition and balance of nutritional and inflammatory status are important for the immune system. Alterations of these aspects may impact on response, outcome and toxicities of immunotherapy. In this review we try to clarify some definitions and tools used for the assessment of the different aspects of nutritional disorders, body composition and inflammatory status with a focus on lung cancer. METHODS We primary investigate the definitions of malnutrition, cachexia, sarcopenia and overweight. Secondary, tools used to measure body composition, nutritional and inflammatory status, mainly in lung cancer are reviewed. RESULTS All these features, in the time of precision medicine may improve assessment and selection of patients, incorporating also early palliative care in standard therapy. CONCLUSIONS A multimodal approach based on nutrition assessment and physical exercise should be evaluated to improve aspects of the immune response against cancer and to propose the best treatment to every patient.
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Affiliation(s)
- Cinzia Baldessari
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy.
| | - Giorgia Guaitoli
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Filippo Valoriani
- Unit of Metabolic Disorder and Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Riccardo Bonacini
- Department of Radiology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Raffaella Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Linda Reverberi
- Unit of Metabolic Disorder and Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Annarita Pecchi
- Department of Radiology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Renata Menozzi
- Unit of Metabolic Disorder and Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Pietro Torricelli
- Department of Radiology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Fausto Barbieri
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Massimo Dominici
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
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16
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Nigro E, Orlandella FM, Polito R, Mariniello RM, Monaco ML, Mallardo M, De Stefano AE, Iervolino PLC, Salvatore G, Daniele A. Adiponectin and leptin exert antagonizing effects on proliferation and motility of papillary thyroid cancer cell lines. J Physiol Biochem 2021; 77:237-248. [PMID: 33587254 PMCID: PMC8121733 DOI: 10.1007/s13105-021-00789-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/13/2021] [Indexed: 12/20/2022]
Abstract
Adiponectin (Acrp30) and leptin, adipokines produced and secreted mainly by the adipose tissue, are involved in human carcinogenesis. Thyroid carcinomas are frequent endocrine cancers, and several evidences suggest that they are correlated with obesity. In this study, we first analyzed the expression levels and prognostic values of Acrp30, leptin, and their receptors in thyroid cancer cells. Then, we investigated the role of Acrp30 and leptin in proliferation, migration, and invasion. We found that Acrp30 treatment alone inhibits cell proliferation and cell viability in a time and dose-dependent manner; leptin alone does not influence thyroid cancer cells (BCPAP and K1) proliferation, but the combined treatment reverts Acrp30-induced effects on cell proliferation. Additionally, through wound healing and Matrigel Matrix invasion assays, we unveiled that Acrp30 inhibits thyroid cancer cell motility, while leptin induces the opposite effect. Importantly, in the combined treatment, Acrp30 and leptin exert antagonizing effects on papillary thyroid cancer cells’ migration and invasion in both BCPAP and K1 cell lines. Highlights of these studies suggest that Acrp30 and leptin could represent therapeutic targets and biomarkers for the management of thyroid cancer.
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Affiliation(s)
- Ersilia Nigro
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania, "Luigi Vanvitelli,", Via G. Vivaldi 42, 81100, Caserta, Italy.,CEINGE - Biotecnologie Avanzate S.c.a.r.l., Via Gaetano Salvatore 486, 80145, Napoli, Italy
| | | | - Rita Polito
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania, "Luigi Vanvitelli,", Via G. Vivaldi 42, 81100, Caserta, Italy.,CEINGE - Biotecnologie Avanzate S.c.a.r.l., Via Gaetano Salvatore 486, 80145, Napoli, Italy
| | - Raffaela Mariarosaria Mariniello
- CEINGE - Biotecnologie Avanzate S.c.a.r.l., Via Gaetano Salvatore 486, 80145, Napoli, Italy.,Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli "Parthenope,", Via Medina 40, 80133, Napoli, Italy
| | - Maria Ludovica Monaco
- CEINGE - Biotecnologie Avanzate S.c.a.r.l., Via Gaetano Salvatore 486, 80145, Napoli, Italy
| | - Marta Mallardo
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania, "Luigi Vanvitelli,", Via G. Vivaldi 42, 81100, Caserta, Italy
| | - Anna Elisa De Stefano
- CEINGE - Biotecnologie Avanzate S.c.a.r.l., Via Gaetano Salvatore 486, 80145, Napoli, Italy.,Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli "Parthenope,", Via Medina 40, 80133, Napoli, Italy
| | - Paola Lucia Chiara Iervolino
- CEINGE - Biotecnologie Avanzate S.c.a.r.l., Via Gaetano Salvatore 486, 80145, Napoli, Italy.,Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II,", Via Pansini 5, 80131, Napoli, Italy
| | - Giuliana Salvatore
- CEINGE - Biotecnologie Avanzate S.c.a.r.l., Via Gaetano Salvatore 486, 80145, Napoli, Italy. .,IRCCS SDN, Via Emanuele Gianturco 113, 80143, Napoli, Italy. .,Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli "Parthenope,", Via Medina 40, 80133, Napoli, Italy.
| | - Aurora Daniele
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania, "Luigi Vanvitelli,", Via G. Vivaldi 42, 81100, Caserta, Italy. .,CEINGE - Biotecnologie Avanzate S.c.a.r.l., Via Gaetano Salvatore 486, 80145, Napoli, Italy.
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17
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Kuehm LM, Khojandi N, Piening A, Klevorn LE, Geraud SC, McLaughlin NR, Griffett K, Burris TP, Pyles KD, Nelson AM, Preuss ML, Bockerstett KA, Donlin MJ, McCommis KS, DiPaolo RJ, Teague RM. Fructose Promotes Cytoprotection in Melanoma Tumors and Resistance to Immunotherapy. Cancer Immunol Res 2021; 9:227-238. [PMID: 33023966 PMCID: PMC7864871 DOI: 10.1158/2326-6066.cir-20-0396] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/03/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022]
Abstract
Checkpoint blockade immunotherapy relies on the empowerment of the immune system to fight cancer. Why some patients fail to achieve durable clinical responses is not well understood, but unique individual factors such as diet, obesity, and related metabolic syndrome could play a role. The link between obesity and patient outcomes remains controversial and has been mired by conflicting reports and limited mechanistic insight. We addressed this in a C57BL/6 mouse model of diet-induced obesity using a Western diet high in both fats and sugars. Obese mice bearing B16 melanoma or MC38 carcinoma tumors had impaired immune responses to immunotherapy and a reduced capacity to control tumor progression. Unexpectedly, these compromised therapeutic outcomes were independent of body mass and, instead, were directly attributed to dietary fructose. Melanoma tumors in mice on the high-fructose diet were resistant to immunotherapy and showed increased expression of the cytoprotective enzyme heme oxygenase-1 (HO-1). This increase in HO-1 protein was recapitulated in human A375 melanoma cells exposed to fructose in culture. Induced expression of HO-1 shielded tumor cells from immune-mediated killing and was critical for resistance to checkpoint blockade immunotherapy, which could be overcome in vivo using a small-molecule inhibitor of HO-1. This study reveals dietary fructose as a driver of tumor immune evasion, identifying HO-1 expression as a mechanism of resistance and a promising molecular target for combination cancer immunotherapy.See article by Khojandi et al., p. 214.
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Affiliation(s)
- Lindsey M Kuehm
- Saint Louis University School of Medicine, Molecular Microbiology and Immunology, St. Louis, Missouri
| | - Niloufar Khojandi
- Saint Louis University School of Medicine, Molecular Microbiology and Immunology, St. Louis, Missouri
| | - Alexander Piening
- Saint Louis University School of Medicine, Molecular Microbiology and Immunology, St. Louis, Missouri
| | - Lauryn E Klevorn
- Saint Louis University School of Medicine, Molecular Microbiology and Immunology, St. Louis, Missouri
| | - Simone C Geraud
- Saint Louis University School of Medicine, Molecular Microbiology and Immunology, St. Louis, Missouri
| | - Nicole R McLaughlin
- Saint Louis University School of Medicine, Molecular Microbiology and Immunology, St. Louis, Missouri
| | - Kristine Griffett
- Saint Louis University School of Medicine, Pharmacological and Physiological Sciences, St. Louis, Missouri
| | - Thomas P Burris
- Saint Louis University School of Medicine, Pharmacological and Physiological Sciences, St. Louis, Missouri
| | - Kelly D Pyles
- Saint Louis University School of Medicine, Biochemistry and Molecular Biology, St. Louis, Missouri
| | - Afton M Nelson
- Webster University, Department of Biological Sciences, St. Louis, Missouri
| | - Mary L Preuss
- Webster University, Department of Biological Sciences, St. Louis, Missouri
| | - Kevin A Bockerstett
- Saint Louis University School of Medicine, Molecular Microbiology and Immunology, St. Louis, Missouri
| | - Maureen J Donlin
- Saint Louis University School of Medicine, Biochemistry and Molecular Biology, St. Louis, Missouri
| | - Kyle S McCommis
- Saint Louis University School of Medicine, Biochemistry and Molecular Biology, St. Louis, Missouri
| | - Richard J DiPaolo
- Saint Louis University School of Medicine, Molecular Microbiology and Immunology, St. Louis, Missouri
- Alvin J. Siteman NCI Comprehensive Cancer Center, St. Louis, Missouri
| | - Ryan M Teague
- Saint Louis University School of Medicine, Molecular Microbiology and Immunology, St. Louis, Missouri.
- Alvin J. Siteman NCI Comprehensive Cancer Center, St. Louis, Missouri
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Deshpande RP, Sharma S, Watabe K. The Confounders of Cancer Immunotherapy: Roles of Lifestyle, Metabolic Disorders and Sociological Factors. Cancers (Basel) 2020; 12:E2983. [PMID: 33076303 PMCID: PMC7602474 DOI: 10.3390/cancers12102983] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
Checkpoint blockade immunotherapy (CPI) is an effective treatment option for many types of cancers. Irrespective of its wide clinical implications, the overall efficacy remains unpredictable and even poor in certain pathologies such as breast cancer. Thus, it is imperative to understand the role of factors affecting its responsiveness. In this review, we provide an overview on the involvement of sociological factors, lifestyles and metabolic disorders in modulating the CPI response in patients from multiple malignancies. Lifestyle habits including exercise, and diet promoted therapeutic responsiveness while alcohol consumption mitigated the CPI effect by decreasing mutational burden and hampering antigen presentation by dendritic cells. Metabolic disorder such as obesity was recognized to enhance the PD-1 expression while diabetes and hypertension were consequences of CPI therapy rather than causes. Among the sociologic factors, sex and race positively influenced the CPI effectiveness on account of increased effector T cell activity and increased PD-1 expression while ageing impaired CPI responsiveness by decreasing functional T cell and increased toxicity. The combined effect of these factors was observed for obesity and gender, in which obese males had the most significant effect of CPI. Therefore these variables should be carefully considered before treating patients with CPI for optimal treatment outcome.
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Affiliation(s)
| | | | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA; (R.P.D.); (S.S.)
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19
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Dieterich LC, Bikfalvi A. The tumor organismal environment: Role in tumor development and cancer immunotherapy. Semin Cancer Biol 2020; 65:197-206. [DOI: 10.1016/j.semcancer.2019.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/03/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023]
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Vigneri R, Sciacca L, Vigneri P. Rethinking the Relationship between Insulin and Cancer. Trends Endocrinol Metab 2020; 31:551-560. [PMID: 32600959 DOI: 10.1016/j.tem.2020.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/20/2020] [Accepted: 05/13/2020] [Indexed: 12/14/2022]
Abstract
In addition to being a major metabolic hormone, insulin is also a growth factor with a mitogenic effect on all cells, more marked in malignant cells that often overexpress the insulin receptor. In patients with metabolic diseases characterized by hyperinsulinemia (obesity, type 2 diabetes, and metabolic syndrome), the incidence of several types of cancer is increased, as is cancer-related mortality. Because of the worldwide growing prevalence of metabolic diseases and the diffuse use of insulin and its analogs for treating diabetes, the relationship between insulin and cancer has become a clinically relevant issue. Clinical studies have not clarified the degree to which hyperinsulinemia can influence cancer occurrence and prognosis. To better understand this issue, an improved scientific approach is required, with more careful consideration of the mechanisms related to hyperinsulinemia and carcinogenesis.
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Affiliation(s)
- R Vigneri
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy.
| | - L Sciacca
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - P Vigneri
- Center of Experimental Oncology and Hematology, Department of Clinical and Experimental Medicine, University of Catania, A.O.U. Policlinico Vittorio-Emanuele, Catania, Italy
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Testing the Multiple Pathways of Residential Greenness to Pregnancy Outcomes Model in a Sample of Pregnant Women in the Metropolitan Area of Donostia-San Sebastián. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124520. [PMID: 32586011 PMCID: PMC7345127 DOI: 10.3390/ijerph17124520] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/16/2022]
Abstract
Residential greenness may positively impact diverse human health indicators through the reduction of air pollution, the improvement of psychological health, and the promotion of physical activity. Previous studies indicate a weak but positive association with pregnancy outcomes. Our aim was to test the multiple pathways from residential greenness to pregnancy outcomes model, using residential NO2 concentrations, psychological health, and moderate-to-vigorous physical activity (MVPA) during the first trimester of pregnancy, in a sample of 440 pregnant women residing in Donostia, Spain. Three metrics of residential greenness were calculated around each participant’s home address: normalized difference vegetation index (NDVI) within 300 m, and green space (>5000 m2) availability within 300 and 500 m. Residential NO2 concentrations, psychological health, and MVPA were explored as mediators of the associations between these metrics and the following pregnancy outcomes: birth weight (BW), low birth weight (LBW), prematurity, small for gestational age (SGA), and large for gestational age (LGA). Educational attainment, parity, and body mass index (BMI) were treated as covariates. Counterfactual mediation analyses showed very low to null statistical support for an association between any of the greenspace metrics and pregnancy outcomes in the full sample. Green space availability (300 m) was associated with lower BW and showed a marginal protective effect against LGA.
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22
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Rogado J, Romero-Laorden N, Sanchez-Torres JM, Ramos-Levi AM, Pacheco-Barcia V, Ballesteros AI, Arranz R, Lorenzo A, Gullon P, Garrido A, Serra López-Matencio JM, Donnay O, Adrados M, Costas P, Aspa J, Alfranca A, Mondejar R, Colomer R. Effect of excess weight and immune-related adverse events on the efficacy of cancer immunotherapy with anti-PD-1 antibodies. Oncoimmunology 2020; 9:1751548. [PMID: 32363123 PMCID: PMC7185216 DOI: 10.1080/2162402x.2020.1751548] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/02/2020] [Accepted: 02/29/2020] [Indexed: 12/20/2022] Open
Abstract
Immunotherapy is an effective treatment in advanced cancer, although predictors of response are limited. We studied whether excess weight influences the efficacy outcomes of immunotherapy. We have also evaluated the combined prognostic effect of excess weight and immune-related adverse events (irAEs). Efficacy of anti-PD-1 treatment was evaluated with both objective radiological response (ORR) rate and progression-free survival (PFS), and toxicity with irAEs. We studied the association between excess weight and ORR, PFS or irAEs. 132 patients diagnosed with advanced cancer were included. Median body mass index (BMI) was 24.9 kg/m2. 64 patients had normal weight (BMI<25 kg/m2), and 64 patients had excess weight (BMI≥25 kg/m2). Four patients had underweight and were excluded from further analysis. ORR was achieved in 50 patients (38.0%), median PFS was 6 months. 44 patients developed irAEs (33.3%). ORR was higher in excess weight patients than in patients with normal weight (51.6% vs 25.0%; OR 3.45, p = .0009). PFS was improved in patients with excess weight (7.25 months vs 4 months, HR 1.72, p = .01). The incidence of IrAEs was not different in patients with excess weight (54.5% vs 43.2%, p = .21). When high BMI and irAEs were combined, we observed a marked prognostic trend in ORR rate (87.5% vs 6.2%; OR 161.0, p < .00001), and in PFS (14 months vs 3 months; HR 5.89, p < .0001). Excess weight patients with advanced cancer that receive single-agent anti-PD-1 antibody therapy exhibit a significantly improved clinical outcome compared with normal BMI patients. This association was especially marked when BMI and irAEs were considered combined.
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Affiliation(s)
- Jacobo Rogado
- Medical Oncology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain.,Medical Oncology Department, HU Infanta Leonor, Madrid, Spain
| | - Nuria Romero-Laorden
- Medical Oncology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain
| | - José Miguel Sanchez-Torres
- Medical Oncology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain
| | - Ana María Ramos-Levi
- Endocrinology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain
| | - Vilma Pacheco-Barcia
- Medical Oncology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain
| | - Ana Isabel Ballesteros
- Medical Oncology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain
| | - Reyes Arranz
- Hematology Department, HU La Princesa, Madrid, Spain
| | - Alicia Lorenzo
- Hematology Department, Complejo Asistencial De Segovia, Segovia, Castilla Y León, Spain
| | - Pedro Gullon
- Social and Cardiovascular Epidemiology Research Group, Alcalá University, Madrid, Spain
| | - Ana Garrido
- Medical Oncology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain
| | | | - Olga Donnay
- Medical Oncology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain
| | - Magdalena Adrados
- Pathology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain
| | - Pablo Costas
- Medical Oncology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain
| | - Javier Aspa
- Neumology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain
| | - Arantzazu Alfranca
- Immunology Department, Instituto De Investigación Sanitaria La Princesa, Madrid, Spain
| | - Rebeca Mondejar
- Medical Oncology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain.,Department of Medicine, Universidad Autónoma De Madrid, Madrid, Spain
| | - Ramon Colomer
- Medical Oncology Department, Instituto De Investigación Sanitaria La Princesa, HU La Princesa, Madrid, Spain.,Department of Medicine, Universidad Autónoma De Madrid, Madrid, Spain
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Chen ZX, Jian ZW, Wu XW, Wang JC, Peng JY, Huang CY, Lao XM. Impact of overweightness and critical weight loss on overall survival in patients with hepatocellular carcinoma initially treated with chemoembolization. Gastroenterol Rep (Oxf) 2020; 8:125-133. [PMID: 32280472 PMCID: PMC7136712 DOI: 10.1093/gastro/goz040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/15/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The effects of overweightness and weight loss on the development and prognosis of hepatocellular carcinoma (HCC) remain unclear. In this study, we aimed to evaluate the impact of overweightness and weight loss on the survival of patients with intermediate/advanced HCC receiving chemoembolization as initial treatment. METHODS We examined 1,170 patients who underwent chemoembolization as initial treatment for Barcelona-Clínic Liver Cancer stages B and C HCC at Sun Yat-sen University Cancer Center (Guangzhou, China) between December 2009 and May 2015. A baseline body mass index (BMI) of ≥23 kg/m2 was defined as overweight, and body-weight loss of ≥5.0% from baseline was defined as critical weight loss (CWL). Cox regression analysis was used to determine the association between overweightness or CWL and overall survival (OS). RESULTS The median survival time was 16.8 (95% confidence interval, 13.9-19.7) months and 11.1 (95% confidence interval, 10.0-12.2) months in the overweight and non-overweight groups (log-rank test, P < 0.001), respectively. Cox multivariate analysis identified overweightness as an independent protective prognostic factor for OS (P < 0.001). Subgroup stratification analysis revealed a significant association between overweightness and survival among patients receiving further treatment (P = 0.005), but not in those not receiving further treatment (P = 0.683). Multivariate analysis showed that both overweightness and CWL were independent prognostic factors for OS among patients receiving further treatment. CONCLUSION Among patients with intermediate- or advanced-stage HCC initially treated with chemoembolization, overweightness was associated with longer OS. Furthermore, CWL was an independent adverse prognostic factor for OS in patients receiving additional treatment.
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Affiliation(s)
- Zhen-Xin Chen
- Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P. R. China
| | - Zhi-Wei Jian
- Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P. R. China
| | - Xi-Wen Wu
- Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P. R. China
| | - Jun-Cheng Wang
- Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P. R. China
| | - Jing-Yuan Peng
- Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P. R. China
| | - Chun-Yu Huang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P. R. China
| | - Xiang-Ming Lao
- Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P. R. China
- Corresponding author. Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong 510060, P. R. China. Tel: +86-20-87343828; Fax: +86-20-87343585;
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Pestine E, Stokes A, Trinquart L. Representation of obese participants in obesity-related cancer randomized trials. Ann Oncol 2019; 29:1582-1587. [PMID: 29897392 DOI: 10.1093/annonc/mdy138] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Obesity is a risk factor for numerous cancer types, and may influence cancer treatment outcomes. Underrepresentation of obese patients in obesity-related cancer randomized controlled trials (RCTs) may affect generalizability of results. We aimed to assess the reporting of information about eligibility and enrollment of obese participants in obesity-related cancer RCTs. Methods We conducted a systematic review of RCTs of 10 obesity-related cancer types (esophagus, colon/rectum, liver, gallbladder, pancreas, postmenopausal breast, endometrium, ovary, kidney, and thyroid cancer). We selected RCTs published between 2013 and 2016 in five major journals. For each trial, we examined the article, the protocol, and the registration record. We assessed if eligibility criteria limiting the enrollment of obese participants were reported, the proportion of obese participants that were enrolled, and if a subgroup analysis according to obesity status was reported. We systematically contacted corresponding authors and asked for information about eligibility of obese participants and the proportion of obese participants. Results We included 76 RCTs. Colon/rectum (n = 20), postmenopausal breast (n = 11), and kidney (n = 11) cancers were the most frequent types. Based on publicly available sources, information on the eligibility of obese participants was available in 5 (7%) trials. The proportion of obese participants could be estimated in 9 (12%) trials only. We found a subgroup analysis in only one RCT. When considering unpublished information, the eligibility of obese participants was explicitly stated in 31 (41%) trials but it was unclear if the remaining 59% trials considered obese participants as eligible and what proportion of obese participants was included. Across 22 trials, the median proportion of obese participants included was 18% (Q1-Q3 11-23). Conclusion Information on the eligibility and enrollment of obese participants in cancer RCTs is dramatically underreported. More transparency is needed to understand the applicability of obesity-related cancer RCT results to obese patients with cancer.
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Affiliation(s)
- E Pestine
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - A Stokes
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - L Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, USA.
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Overweight or Obesity is an Unfavorable Long-Term Prognostic Factor for Patients who Underwent Gastrectomy for Stage II/III Gastric Cancer. World J Surg 2019; 43:1766-1776. [PMID: 30820737 DOI: 10.1007/s00268-019-04969-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Obesity has been reported to be a prognostic factor for many diseases in epidemiological studies; however, the results of studies examining the relationship between obesity and gastric cancer (GC) prognosis are inconsistent. METHODS A total of 460 patients with Stage II and III GC who underwent open R0 gastrectomy were included. Age, sex, body mass index (BMI classified into < 18.5, 18.5-25, and ≥ 25 kg/m2), stage, and postoperative adjuvant chemotherapy were analyzed to investigate the correlation with relapse-free survival (RFS). RESULTS Five-year RFS was 51% for the study patients. Five-year RFS values were 47.6%, 54.3%, and 40.1% for patients with BMI < 18.5, 18.5-25, and ≥ 25 kg/m2, respectively. The forest plot for relapse risk according to BMI showed a U shape. Multivariate analysis for RFS showed significant differences in stage and BMI; the hazard ratio for recurrence in patients with BMI ≥ 25 kg/m2 was 1.42 (95% confidence interval: 1.01-2.02, p = 0.0423) with reference to patients with BMI < 25 kg/m2. BMI ≥ 25.0 was associated with longer operation times, more blood loss, fewer lymph nodes dissected, more frequent postoperative surgical site infection, and intra-abdominal abscesses. CONCLUSIONS BMI ≥ 25 kg/m2 is an unfavorable prognostic factor for patients who underwent gastrectomy for Stage II and III GC.
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Chen Z, Jian Z, Wu X, Wang J, Peng J, Lao X. Clinical conditions and treatment requirements for long-term survival among hepatitis B-related hepatocellular carcinoma initially treated with chemoembolization. Cancer Med 2019; 8:5097-5107. [PMID: 31313476 PMCID: PMC6718579 DOI: 10.1002/cam4.2380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Transarterial chemoembolization (TACE) is recommended to treat intermediate/advanced stage of hepatocellular carcinoma (HCC). However, the overall survival among initially TACE-treated patients varies significantly. The clinical characterization of long-term survival following TACE remains uncertain. We sought to identify clinical parameters and treatment requirements for long-term survival among patients with hepatitis B-related HCC who were initially treated with TACE. MATERIALS AND METHODS The included patients with HCC were admitted to our cancer center between December 2009 and May 2015. Patients who survived for >3 years were compared with those who died within 3 years. The clinical and laboratory findings that were associated with the survival were also analyzed. RESULTS One in six (17.9%) patients with HCC in this cohort survived for > 3 years after TACE. Body mass index (BMI) ≥ 23kg/m2 , aspartate aminotransferase levels ≤ 40 U/L, an activated partial thromboplastin time ≤ 34 seconds, α-fetoprotein (AFP) levels ≤ 25 ng/mL, antiviral therapy, tumor size ≤ 8 cm, solitary nodule, and the absence of vascular invasion were independently favorably associated with a 3-year survival. An absence of vascular invasion was the only independent factor associated with 3-year survival in patients who received resection and/or ablation after TACE. CONCLUSION In this cohort, a 3-year survival was associated with BMI, antivirus treatment, tumor status, hepatic function, and AFP level. Distant metastasis did not negatively impact the long-term survival among patients with hepatitis B-related HCC initially treated with TACE. Vascular invasion was the single impediment to long-term survival in patients who received add-on resection and/or ablation after TACE.
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Affiliation(s)
- Zhen‐Xin Chen
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
| | - Zhi‐Wei Jian
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
| | - Xi‐Wen Wu
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
| | - Jun‐Cheng Wang
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
| | - Jing‐Yuan Peng
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
| | - Xiang‐Ming Lao
- Department of Hepatobiliary and Pancreatic SurgerySun Yat‐sen University Cancer CenterGuangzhouP. R. China
- State Key Laboratory of Southern ChinaGuangzhouP. R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP. R. China
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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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Martin L, Gioulbasanis I, Senesse P, Baracos VE. Cancer-Associated Malnutrition and CT-Defined Sarcopenia and Myosteatosis Are Endemic in Overweight and Obese Patients. JPEN J Parenter Enteral Nutr 2019; 44:227-238. [PMID: 31012128 DOI: 10.1002/jpen.1597] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/27/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Overweight/obese patients' large fat mass can mask the loss of skeletal muscle, which is associated with mortality in the oncology setting. We investigated the prevalence of computed tomography (CT)-defined sarcopenia and myosteatosis across different levels of nutrition risk assessed by the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF). We also evaluated whether the PG-SGA SF, sarcopenia, and myosteatosis were prognostic of overall survival. METHODS This was a prospective, observational study. Consecutive patients with body mass index ≥25.0 kg/m2 with newly diagnosed head and neck cancer (any stage) or lung and gastrointestinal tract cancer (locally recurrent or metastatic) were screened at presentation to oncology clinics. Nutrition risk was assigned based on PG-SGA SF triage recommendations. Based on CT, patients were classified with sarcopenia and/or myosteatosis using published cutoffs. Survival analyses were conducted. RESULTS Patients (n=1157) were 63.6 ± 11.4 years, 64% male, and 61% had stage IV disease. Sarcopenia and myosteatosis were prevalent across PG-SGA SF nutrition risk categories (scores 0-1 [no risk; 36% sarcopenic; 44% myosteatotic], scores 2-3 [37%; 37%], scores 4-8 [40%; 41%], and scores ≥9 [high risk; 50%; 49%]). In multivariable survival analysis, PG-SGA SF scores ≥9 (hazard ratio [HR] 2.08, 95% confidence interval [CI] 1.66-2.60, P<0.001), sarcopenia (HR 1.25, 95% CI 1.06-1.46, P=0.006), and myosteatosis (HR 1.25, 95% CI 1.07-1.46, P<0.001) independently predicted reduced survival. CONCLUSION CT-defined sarcopenia and myosteatosis are prevalent across different levels of nutrition risk in overweight/obese patients with cancer. Assessment of skeletal muscle using CT adds prognostic value to the PG-SGA SF.
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Affiliation(s)
- Lisa Martin
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Ioannis Gioulbasanis
- Department of Chemotherapy, Larissa General Clinic "E Patsidis", Larissa, Thessaly, Greece
| | - Pierre Senesse
- Clinical Nutrition and Gastroenterology Unit, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Vickie E Baracos
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Obesity is associated with both increased cancer incidence and progression in multiple tumour types, and is estimated to contribute to up to 20% of cancer-related deaths. These associations are driven, in part, by metabolic and inflammatory changes in adipose tissue that disrupt physiological homeostasis both within local tissues and systemically. However, the mechanisms underlying the obesity-cancer relationship are poorly understood. In this Review, we describe how the adipose tissue microenvironment (ATME) evolves during body-weight gain, and how these changes might influence tumour initiation and progression. We focus on multiple facets of ATME physiology, including inflammation, vascularity and fibrosis, and discuss therapeutic interventions that have the potential to normalize the ATME, which might be translationally relevant for cancer prevention and therapy. Given that the prevalence of obesity is increasing on an international scale, translational research initiatives are urgently needed to provide mechanistic explanations for the obesity-cancer relationship, and how to best identify high-risk individuals without relying on crude measures, such as BMI.
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Affiliation(s)
- Daniela F Quail
- Goodman Cancer Research Centre, Department of Physiology, McGill University, Montreal, Quebec, Canada.
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30
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Wang Z, Aguilar EG, Luna JI, Dunai C, Khuat LT, Le CT, Mirsoian A, Minnar CM, Stoffel KM, Sturgill IR, Grossenbacher SK, Withers SS, Rebhun RB, Hartigan-O'Connor DJ, Méndez-Lagares G, Tarantal AF, Isseroff RR, Griffith TS, Schalper KA, Merleev A, Saha A, Maverakis E, Kelly K, Aljumaily R, Ibrahimi S, Mukherjee S, Machiorlatti M, Vesely SK, Longo DL, Blazar BR, Canter RJ, Murphy WJ, Monjazeb AM. Paradoxical effects of obesity on T cell function during tumor progression and PD-1 checkpoint blockade. Nat Med 2019; 25:141-151. [PMID: 30420753 PMCID: PMC6324991 DOI: 10.1038/s41591-018-0221-5] [Citation(s) in RCA: 511] [Impact Index Per Article: 102.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/12/2018] [Indexed: 12/23/2022]
Abstract
The recent successes of immunotherapy have shifted the paradigm in cancer treatment, but because only a percentage of patients are responsive to immunotherapy, it is imperative to identify factors impacting outcome. Obesity is reaching pandemic proportions and is a major risk factor for certain malignancies, but the impact of obesity on immune responses, in general and in cancer immunotherapy, is poorly understood. Here, we demonstrate, across multiple species and tumor models, that obesity results in increased immune aging, tumor progression and PD-1-mediated T cell dysfunction which is driven, at least in part, by leptin. However, obesity is also associated with increased efficacy of PD-1/PD-L1 blockade in both tumor-bearing mice and clinical cancer patients. These findings advance our understanding of obesity-induced immune dysfunction and its consequences in cancer and highlight obesity as a biomarker for some cancer immunotherapies. These data indicate a paradoxical impact of obesity on cancer. There is heightened immune dysfunction and tumor progression but also greater anti-tumor efficacy and survival after checkpoint blockade which directly targets some of the pathways activated in obesity.
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Affiliation(s)
- Ziming Wang
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ethan G Aguilar
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Jesus I Luna
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Cordelia Dunai
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Lam T Khuat
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Catherine T Le
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Annie Mirsoian
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Christine M Minnar
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kevin M Stoffel
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ian R Sturgill
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Steven K Grossenbacher
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Sita S Withers
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Robert B Rebhun
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Dennis J Hartigan-O'Connor
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, USA
- California National Primate Research Center, University of California Davis, Davis, CA, USA
| | - Gema Méndez-Lagares
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, USA
- California National Primate Research Center, University of California Davis, Davis, CA, USA
| | - Alice F Tarantal
- California National Primate Research Center, University of California Davis, Davis, CA, USA
- Department of Pediatrics, University of California Davis School of Medicine, Davis, CA, USA
- Department of Cell Biology and Human Anatomy, University of California Davis, Davis, CA, USA
| | - R Rivkah Isseroff
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
- Dermatology Service, Sacramento VA Medical Center, Mather, CA, USA
| | - Thomas S Griffith
- Department of Urology, Center for Immunology, Masonic Cancer Center, Microbiology, Immunology, and Cancer Biology Graduate Program, University of Minnesota, Minneapolis, MN, USA
| | - Kurt A Schalper
- Department of Pathology & Translational Immuno-oncology Laboratory, Yale University School of Medicine, New Haven, CT, USA
| | - Alexander Merleev
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
- Immune Monitoring Core, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Asim Saha
- Masonic Cancer Center and Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
- Immune Monitoring Core, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Karen Kelly
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis Schoolof Medicine, Sacramento, CA, USA
| | - Raid Aljumaily
- Department of Internal Medicine, Section of Hematology and Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sami Ibrahimi
- Department of Internal Medicine, Section of Hematology and Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sarbajit Mukherjee
- Department of Internal Medicine, Section of Hematology and Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael Machiorlatti
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dan L Longo
- Laboratory of Genetics and Genomics, National Institute on Aging, NIH, Baltimore, MD, USA
| | - Bruce R Blazar
- Masonic Cancer Center and Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Robert J Canter
- Division of Surgical Oncology, Department of Surgery, University of California Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA, USA
| | - William J Murphy
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA.
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis Schoolof Medicine, Sacramento, CA, USA.
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Universityof California School of Medicine, Sacramento, CA, USA
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Lee VR, Barr KJ, Kelly JJ, Johnston D, Brown CFC, Robb KP, Sayedyahossein S, Huang K, Gros R, Flynn LE, Penuela S. Pannexin 1 regulates adipose stromal cell differentiation and fat accumulation. Sci Rep 2018; 8:16166. [PMID: 30385873 PMCID: PMC6212408 DOI: 10.1038/s41598-018-34234-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022] Open
Abstract
Pannexin 1 (Panx1) is a channel-forming glycoprotein important in paracrine signaling and cellular development. In this study, we discovered that mice globally lacking Panx1 (KO) have significantly greater total fat mass and reduced lean mass compared to wild type (WT) mice under a normal diet. Despite having higher fat content, Panx1 KO mice on a high fat diet exhibited no differences in weight gain and blood markers of obesity as compared to WT controls, except for an increase in glucose and insulin levels. However, metabolic cage data revealed that these Panx1 KO mice display significantly increased activity levels, higher ambulatory activity, and reduced sleep duration relative to their WT littermates on a high-fat diet. To uncover the cellular mechanism responsible for the increased fat content in the KO, we isolated primary cultures of adipose-derived stromal cells (ASCs) from WT and KO fat pads. In WT ASCs we observed that Panx1 protein levels increase upon induction into an adipogenic lineage. ASCs isolated from Panx1 KO mice proliferate less but demonstrate enhanced adipogenic differentiation with increased intracellular lipid accumulation, glycerol-3-phosphate dehydrogenase (GPDH) enzyme activity, and adipokine secretion, as compared to WT ASCs. This was consistent with the increased adipocyte size and decreased adipocyte numbers observed in subcutaneous fat of the Panx1 KO mice compared to WT. We concluded that Panx1 plays a key role in adipose stromal cells during the early stages of adipogenic proliferation and differentiation, regulating fat accumulation in vivo.
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Affiliation(s)
- Vanessa R Lee
- Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6A5C1, Canada
| | - Kevin J Barr
- Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6A5C1, Canada
| | - John J Kelly
- Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6A5C1, Canada
| | - Danielle Johnston
- Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6A5C1, Canada
| | - Cody F C Brown
- Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6A5C1, Canada
| | - Kevin P Robb
- Biomedical Engineering Graduate Program, University of Western Ontario, London, Ontario, Canada
| | - Samar Sayedyahossein
- Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6A5C1, Canada
| | - Kenneth Huang
- Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6A5C1, Canada
| | - Robert Gros
- Departments of Physiology and Pharmacology, and of Medicine, University of Western Ontario, London, Ontario, Canada
- Molecular Medicine Research Group Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Lauren E Flynn
- Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6A5C1, Canada
- Department of Chemical and Biochemical Engineering, University of Western Ontario, London, Ontario, Canada
| | - Silvia Penuela
- Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6A5C1, Canada.
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Cespedes Feliciano EM, Avrutin E, Caan BJ, Boroian A, Mourtzakis M. Screening for low muscularity in colorectal cancer patients: a valid, clinic-friendly approach that predicts mortality. J Cachexia Sarcopenia Muscle 2018; 9:898-908. [PMID: 30066490 PMCID: PMC6204585 DOI: 10.1002/jcsm.12317] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Low skeletal muscle quantified using computed tomography (CT) scans is associated with morbidity and mortality among cancer patients. However, existing methods to assess skeletal muscle from CT are time-consuming, expensive, and require training. Clinic-friendly tools to screen for low skeletal muscle in cancer patients are urgently needed. METHODS We included 807 scans from non-metastatic colorectal cancer patients. With the digital ruler available in most radiological software, we implemented an abbreviated method to assess skeletal muscle area at the third lumbar vertebra (L3), which consisted of assessing the height and width of the psoas and paraspinal muscles and computing their combined 'linear area' in centimetres squared (cm2 ). A subset of CT scans was assessed twice by two analysts to compute intra-rater and inter-rater reliability. We derived cut-points for 'low' linear area using optimal stratification and then calculated the sensitivity and specificity of these cut-points relative to standard methods (total L3 cross-sectional area assessed with Slice-O-Matic research software). We further evaluated the association of low linear area with death from any cause after colorectal cancer diagnosis in Cox proportional hazards models adjusting for demographics, smoking, body mass index category, and tumour characteristics. RESULTS The linear area was highly correlated with total cross-sectional area assessed using standard methods [r = 0.92; 95% confidence interval (CI): 0.91, 0.93] overall and within subgroups defined by age, sex, and body mass index group. Intra-rater and inter-rater reliability were equally high (both intra-class correlations = 0.98). Cut-points for low linear area were sensitive (0.75; 95% CI: 0.70, 0.80) and specific (0.77; 95% CI: 0.73, 0.80) for identifying low skeletal muscle relative to the standard of total L3 cross-sectional area. The hazard ratio and 95% CI for death associated with a low linear area were hazard ratio = 1.66; 95% CI: 1.22, 2.25. CONCLUSIONS Clinic-friendly methods that assess linear area from CT scans are an accurate screening tool to identify low skeletal muscle among non-metastatic colorectal cancer patients. These linear measures are associated with mortality after colorectal cancer, suggesting they could be clinically useful both to improve prognostication and to provide a practical screening tool to identify cancer patients who require nutrition or exercise intervention.
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Affiliation(s)
| | - Egor Avrutin
- Department of KinesiologyUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
| | - Bette J. Caan
- Division of ResearchKaiser Permanente Northern California200 Broadway, 5th FloorOaklandCAUSA
| | - Adam Boroian
- Division of ResearchKaiser Permanente Northern California200 Broadway, 5th FloorOaklandCAUSA
| | - Marina Mourtzakis
- Department of KinesiologyUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
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Robado de Lope L, Alcíbar OL, Amor López A, Hergueta-Redondo M, Peinado H. Tumour-adipose tissue crosstalk: fuelling tumour metastasis by extracellular vesicles. Philos Trans R Soc Lond B Biol Sci 2018; 373:rstb.2016.0485. [PMID: 29158314 DOI: 10.1098/rstb.2016.0485] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 12/12/2022] Open
Abstract
During metastasis, tumour cells must communicate with their microenvironment by secreted soluble factors and extracellular vesicles. Different stromal cell types (e.g. bone marrow-derived cells, endothelial cells and fibroblasts) influence the growth and progression of tumours. In recent years, interest has extended to other cell types in the tumour microenvironment such as adipocytes and adipose tissue-derived mesenchymal stem cells. Indeed, obesity is becoming pandemic in some developing countries and it is now considered to be a risk factor for cancer progression. However, the true impact of obesity on the metastatic behaviour of tumours is still not yet fully understood. In this 'Perspective' article, we will discuss the potential influence of obesity on tumour metastasis, mainly in melanoma, breast and ovarian cancer. We summarize the main mechanisms involved with special attention to the role of extracellular vesicles in this process. We envisage that besides having a direct impact on tumour cells, obesity systemically preconditions the tumour microenvironment for future metastasis by favouring the formation of pro-inflammatory niches.This article is part of the discussion meeting issue 'Extracellular vesicles and the tumour microenvironment'.
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Affiliation(s)
- Lucía Robado de Lope
- Microenvironment and Metastasis Group, Department of Molecular Oncology, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain
| | - Olwen Leaman Alcíbar
- Microenvironment and Metastasis Group, Department of Molecular Oncology, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain
| | - Ana Amor López
- Microenvironment and Metastasis Group, Department of Molecular Oncology, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain
| | - Marta Hergueta-Redondo
- Microenvironment and Metastasis Group, Department of Molecular Oncology, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain
| | - Héctor Peinado
- Microenvironment and Metastasis Group, Department of Molecular Oncology, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain .,Children's Cancer and Blood Foundation Laboratories. Department of Pediatrics, Drukier Institute for Children's Health and Meyer Cancer Center, Belfer Research Building, Weill Cornell Medicine, New York, NY 10021, USA
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Aguilar EG, Murphy WJ. Obesity induced T cell dysfunction and implications for cancer immunotherapy. Curr Opin Immunol 2018; 51:181-186. [PMID: 29655021 DOI: 10.1016/j.coi.2018.03.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/09/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
Abstract
Obesity has been shown to increase risk for a number of different disorders, including cancer. In addition, obesity is also associated with immune dysfunction, which could contribute to its strong association with other comorbidities. Recently, the immune system has been found to be heavily regulated by changes in metabolism. In particular, T cells are able to respond to intrinsic metabolic regulatory mechanisms, as well as extrinsic factors such as the changes in metabolite availability. The dysfunctional metabolic environment created by obesity could therefore have a direct impact on T cell responses. In this review, we highlight recent findings in the fields of T cell biology and obesity, with a focus on mechanisms driving T cell dysfunction and potential implications for immunotherapeutic treatment of cancer.
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Affiliation(s)
- Ethan G Aguilar
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA 95816, USA
| | - William J Murphy
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA 95816, USA; Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA.
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Tao W, Konings P, Hull MA, Adami HO, Mattsson F, Lagergren J. Colorectal Cancer Prognosis Following Obesity Surgery in a Population-Based Cohort Study. Obes Surg 2017; 27:1233-1239. [PMID: 27822767 PMCID: PMC5403840 DOI: 10.1007/s11695-016-2431-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Obesity surgery involves mechanical and physiological changes of the gastrointestinal tract that might promote colorectal cancer progression. Thus, we hypothesised that obesity surgery is associated with poorer prognosis in patients with colorectal cancer. Methods This nationwide population-based cohort study included all patients with an obesity diagnosis who subsequently developed colorectal cancer in Sweden from 1980 to 2012. The exposure was obesity surgery, and the main and secondary outcomes were disease-specific mortality and all-cause mortality, respectively. Cox proportional hazard survival models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for sex, age, calendar year and education level. Results The exposed and unexposed cohort included 131 obesity surgery and 1332 non-obesity surgery patients with colorectal cancer. There was a statistically significant increased rate of colorectal cancer deaths following obesity surgery (disease-specific HR 1.50, 95% CI 1.00–2.19). When analysed separately, the mortality rate was more than threefold increased in rectal cancer patients with prior obesity surgery (disease-specific HR 3.70, 95% CI 2.00–6.90), while no increased mortality rate was found in colon cancer patients (disease-specific HR 1.10, 85% CI 0.67–1.70). Conclusion This population-based study among obese individuals found a poorer prognosis in colorectal cancer following obesity surgery, which was primarily driven by the higher mortality rate in rectal cancer.
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Affiliation(s)
- Wenjing Tao
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 171 76, Stockholm, Sweden.
| | - Peter Konings
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 171 76, Stockholm, Sweden
| | - Mark A Hull
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, UK
| | - Hans-Olov Adami
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.,Department of Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 171 76, Stockholm, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 171 76, Stockholm, Sweden.,Division of Cancer Studies, King's College London, London, UK
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Flori N, Lecornu H, Arnac S, Clavie B, Fallières A, Francioni L, Vaille A, Georges G, Lacroix C, Senesse P. Cancer chez le sujet obèse : impact sur la survie et sur la prise en charge oncologique. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zhang X, Liu Y, Shao H, Zheng X. Obesity Paradox in Lung Cancer Prognosis: Evolving Biological Insights and Clinical Implications. J Thorac Oncol 2017; 12:1478-1488. [PMID: 28757418 DOI: 10.1016/j.jtho.2017.07.022] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/18/2017] [Accepted: 07/22/2017] [Indexed: 01/16/2023]
Abstract
The survival rate of lung cancer remains low despite the progress of surgery and chemotherapy. With the increasing comorbidity of obesity in patients with lung cancer, new challenges are emerging in the management of this patient population. A key issue of interest is the prognostic effect of obesity on surgical and chemotherapeutic outcomes in patients with lung cancer, which is fueled by the growing observation of survival benefits in overweight or obese patients. This unexpected inverse relationship between obesity and lung cancer mortality, called the obesity paradox, remains poorly understood. The evolving insights into the heterogeneity of obesity phenotypes and associated biological connections with lung cancer progression in recent years may help explain some of the seemingly paradoxical relationship, and well-designed clinical studies looking at the causal role of obesity-associated molecules are expected. Here, we examine potential biological mechanisms behind the protective effects of obesity in lung cancer. We highlight the need to clarify the clinical implications of this relationship toward an updated intervention strategy in the clinical care of patients with lung cancer and obesity.
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Affiliation(s)
- Xueli Zhang
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Yamin Liu
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Hua Shao
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Xiao Zheng
- School of Pharmacy, China Pharmaceutical University, Nanjing, People's Republic of China.
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Ichter ZA, Parthasarathy M, Morton JM. Multi-modality surgical treatment for an increasingly common patient with morbid obesity and papillary thyroid carcinoma. J Surg Case Rep 2017; 2017:rjw200. [PMID: 28603603 PMCID: PMC5460003 DOI: 10.1093/jscr/rjw200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 06/01/2017] [Indexed: 12/30/2022] Open
Abstract
The link between obesity and health disorders such as hypertension, diabetes and coronary artery disease is well known. When a morbidly obese patient presents with a new diagnosis of any cancer, it adds to the many challenges both the patient and treating physicians face. Not only is surgical resection of the malignancy more technically challenging, but also postoperative care such as therapeutic radiation and follow-up imaging is limited by the weight and size restrictions of the machines. With time to treatment being a key factor in limiting the progression of disease, standard weight loss techniques such as diet and exercise in the majority of cases take too long or fail to lead to adequate results. We present a case of a 48-year-old female with newly diagnosed papillary thyroid cancer who underwent gastric bypass surgery in order to lose enough weight to undergo radiation therapy to treat her metastatic disease.
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Affiliation(s)
- Zachary A Ichter
- Department of Minimally Invasive and Bariatric Surgery, Stanford University Hospitals and Clinics, Stanford, CA, USA
| | - Madhumithaa Parthasarathy
- Department of Minimally Invasive and Bariatric Surgery, Stanford University Hospitals and Clinics, Stanford, CA, USA
| | - John M Morton
- Department of Minimally Invasive and Bariatric Surgery, Stanford University Hospitals and Clinics, Stanford, CA, USA
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Body Mass Index and Clinical Outcomes from Endoscopic Submucosal Dissection of Gastric Neoplasia. Dig Dis Sci 2017; 62:1657-1665. [PMID: 28391415 DOI: 10.1007/s10620-017-4560-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/28/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM Association between obesity and endoscopic resection outcomes has not been investigated. We sought to determine the clinical impact of obesity in patients who underwent endoscopic submucosal dissection (ESD) for gastric neoplasia. METHODS A total of 1571 consecutive patients with gastric neoplasia who underwent ESD between December 2010 and March 2016 were enrolled in this study. We retrospectively analyzed 1181 cases that were divided into three groups based upon body mass index (BMI, kg/m2) according to the criteria for Asia-Pacific populations: normal (<23, n = 411), overweight (≥23 and <25, n = 312), and obese (≥25, n = 458). Demographics, endoscopic findings, pathologic results, and clinical outcomes were analyzed. RESULTS No significant differences were observed between the three BMI groups in the following measures: the en-bloc resection rate, the complete resection rate, lymphovascular involvement or submucosal invasion of tumor cells, and adverse events. However, when comparing the obese and overweight groups with the normal group, mean procedure time was longer (P = 0.001) and the percentage of cases requiring more than 30 min, which was the overall mean procedure time, was greater (60.7, 53.2, and 50.1%, respectively; P = 0.006). The significantly associated factors with procedure durations longer than 30 min were obesity, longitudinal and circumferential location, large resection size (≥4 cm), cancer pathology, and submucosal layer invasion. In multivariate analyses, obesity was an independent predictor of long procedure time for gastric ESD. CONCLUSION Being obese or overweight did not directly affect clinical outcomes in gastric ESD. However, obesity was significantly associated with long procedure time. Our results suggest that gastric ESD can be performed safely and effectively in obese patients.
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40
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Jackson SE, Heinrich M, Beeken RJ, Wardle J. Weight Loss and Mortality in Overweight and Obese Cancer Survivors: A Systematic Review. PLoS One 2017; 12:e0169173. [PMID: 28060948 PMCID: PMC5218508 DOI: 10.1371/journal.pone.0169173] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/13/2016] [Indexed: 12/17/2022] Open
Abstract
Background Excess adiposity is a risk factor for poorer cancer survival, but there is uncertainty over whether losing weight reduces the risk. We conducted a critical review of the literature examining weight loss and mortality in overweight or obese cancer survivors. Methods We systematically searched PubMed and EMBASE for articles reporting associations between weight loss and mortality (cancer-specific or all-cause) in overweight/obese patients with obesity-related cancers. Where available, data from the same studies on non-overweight patients were compared. Results Five articles describing observational studies in breast cancer survivors were included. Four studies reported a positive association between weight loss and mortality in overweight/obese survivors, and the remaining study observed no significant association. Results were similar for non-overweight survivors. Quality assessment indicated high risk of bias across studies. Conclusions There is currently a lack of observational evidence that weight loss improves survival for overweight and obese cancer survivors. However, the potential for bias in these studies is considerable and the results likely reflect the consequences of disease-related rather than intentional weight loss. There is a need for stronger study designs, incorporating measures of intentionality of weight loss, and extended to other cancers.
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Affiliation(s)
- Sarah E. Jackson
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
- * E-mail:
| | - Malgorzata Heinrich
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Rebecca J. Beeken
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
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Lindsey S, Astroth K, Kumar P. Improving Awareness, Identification, and Management of Sarcopenic Obesity in Cancer Survivors: An Evidence-Based Toolbox. Clin J Oncol Nurs 2016; 20:E132-8. [PMID: 27668384 DOI: 10.1188/16.cjon.e132-e138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sarcopenic obesity, the dual condition of decreased muscle mass with increased fat mass, can affect morbidity, mortality, and quality of life in adult cancer survivors. OBJECTIVES The purpose of this project was to determine the effects of the use of an educational toolbox on advanced practice nurses' (APNs') confidence in identifying and managing adult cancer survivors at risk for sarcopenic obesity. METHODS APNs in an outpatient practice who care for adult cancer survivors received an educational toolbox with strategies to identify and manage adult cancer survivors at risk for sarcopenic obesity. FINDINGS APNs reported being more confident in their ability to identify adult patients with cancer at risk for sarcopenic obesity and in their ability to manage these patients compared to prior to the intervention. Educational resources provided an effective tool for identifying and managing patients at risk for sarcopenic obesity.
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Wu SE, Charles HW, Park JS, Goldenberg AS, Deipolyi AR. Obesity conveys poor outcome in patients with hepatocellular carcinoma treated by transarterial chemoembolization. Diagn Interv Imaging 2016; 98:37-42. [PMID: 27372418 DOI: 10.1016/j.diii.2016.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of this retrospective study was to evaluate the impact of obesity on radiologic outcomes in patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE). MATERIALS AND METHODS A total of 100 TACE procedures performed in 57 patients (42 men, 15 women) with a mean age of 62 years±8.4 (SD) (range: 39-83 years) were retrospectively reviewed. The 1-2-month follow-up computed tomography or magnetic resonance imaging examinations was assessed for new or residual disease and radiologic response using mRECIST criteria. Patients were categorized into two groups according to body mass index (BMI). Patients with BMI<25kg/m2 were further referred as to low BMI patients and those with BMI≥25kg/m2 as high BMI patients. Outcomes were compared between the two groups. RESULTS Low and high BMI patients were similar in regard to age, gender, HCC etiology and stage, and pre-procedure disease burden. TACE for high BMI, compared to low BMI, patients resulted in lower complete response (39% vs. 66%) and higher progressive disease (21% vs. 5%) rates (P=0.04), and higher rates of residual disease (63% vs. 39%, P=0.02) and new lesions in untreated liver (39% vs. 18%, P=0.04) on 1-2-month follow-up imaging. CONCLUSIONS High BMI is associated with significantly more residual disease, new lesions, and progressive disease in patients with HCC treated by TACE.
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Affiliation(s)
- S E Wu
- Vascular and Interventional Radiology, NYU Langone Medical Center, 560 1st Avenue, 2nd Floor, New York, NY 10016, USA
| | - H W Charles
- Vascular and Interventional Radiology, NYU Langone Medical Center, 560 1st Avenue, 2nd Floor, New York, NY 10016, USA
| | - J S Park
- Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, 550 1st avenue, New York, NY 10016, USA
| | - A S Goldenberg
- Hematology, Department of Medicine, NYU Langone Medical Center, 157 East 32nd Street, 2nd Floor, New York, NY 10016, USA
| | - A R Deipolyi
- Vascular and Interventional Radiology, NYU Langone Medical Center, 560 1st Avenue, 2nd Floor, New York, NY 10016, USA.
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Comparison of Survival Rates, Tumor Stages, and Localization in between Obese and Nonobese Patients with Gastric Cancer. Gastroenterol Res Pract 2016; 2016:9382750. [PMID: 27418926 PMCID: PMC4932154 DOI: 10.1155/2016/9382750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/27/2016] [Accepted: 05/25/2016] [Indexed: 12/17/2022] Open
Abstract
Purpose. In this study we tried to determine the association between body-mass index (BMI), survival rate, and the stage of tumor at the time of diagnosis in patients with gastric cancer. Methods. A total of 270 gastric cancer patients' hospital records were retrospectively evaluated. Patients were grouped according to their BMI at the time of tumor diagnosis. Tumor stages at admission were compared according to their BMI values. Results. There were no differences in OS among BMI subgroups (p = 0.230). The percent of patients with stage III tumor was significantly higher in nonobese while the percent of stage IV tumor was surprisingly higher in obese patients (p was 0.011 and 0.004, resp.). Percent of patients who did not have any surgical intervention was significantly lower in overweight and obese patients than normal and/or underweight patients. Conclusions. At the time of diagnosis, obese patients had significantly higher percent of stage IV tumor than nonobese patients. Despite of that, there were no differences in survival rates among BMI subgroups. Our study results are consistent with "obesity paradox" in gastric cancer patients. We also did not find any relationship between BMI and localization of gastric tumor.
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Anandavadivelan P, Brismar TB, Nilsson M, Johar AM, Martin L. Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. Clin Nutr 2016; 35:724-30. [DOI: 10.1016/j.clnu.2015.05.011] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 04/23/2015] [Accepted: 05/15/2015] [Indexed: 01/06/2023]
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Sarcopenia Impacts on Short- and Long-term Results of Hepatectomy for Hepatocellular Carcinoma. Ann Surg 2016; 261:1173-83. [PMID: 24950264 DOI: 10.1097/sla.0000000000000743] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the prevalence of sarcopenia among European patients with resectable hepatocellular carcinoma (HCC) and to assess its prognostic impact on overall and disease-free survival. BACKGROUND Identification of preoperative prognostic factors in liver surgery for HCC is required to better select patients and improve survival. Recent studies have shown that preoperative discrimination of patients with low skeletal muscle mass (sarcopenic patients) using computed tomography was associated with morbidity and mortality after liver and colorectal surgery. Assessment of sarcopenia could be used to evaluate patients before hepatectomy for HCC. METHODS All consecutive patients who underwent hepatectomy for HCC in our institution, between February 2006 and September 2012, were included. Univariate and multivariate analyses evaluating prognostic factors of postoperative mortality and cancer recurrence were performed, including preoperative, surgical, and histopathological factors. RESULTS Among 198 patients who underwent hepatectomy for HCC, 109 patients had an available computed tomographic scan and represent the study cohort. After a median follow-up of 21.23 months, 27 patients (24.8%) died. There were 20 deaths among the 59 patients who had sarcopenia and only 7 deaths in the nonsarcopenic group. Sarcopenic patients had significantly shorter median overall survival than nonsarcopenic patients (52.3 months vs 70.3 months; P = 0.015). On multivariate analysis, sarcopenia was found to be an independent predictor of poor overall survival (hazard ratio = 3.19; P = 0.013) and disease-free survival (hazard ratio = 2.60; P = 0.001). CONCLUSIONS Sarcopenia was found to be a strong and independent prognostic factor for mortality after hepatectomy for HCC in European patients and could be used to evaluate eligibility of patients with HCC before surgery.
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Chen HN, Chen XZ, Zhang WH, Yang K, Chen XL, Zhang B, Chen ZX, Chen JP, Zhou ZG, Hu JK. The Impact of Body Mass Index on the Surgical Outcomes of Patients With Gastric Cancer: A 10-Year, Single-Institution Cohort Study. Medicine (Baltimore) 2015; 94:e1769. [PMID: 26496304 PMCID: PMC4620840 DOI: 10.1097/md.0000000000001769] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study aimed to investigate the impact of body mass index (BMI) on the short-term and long-term results of a large cohort of gastric cancer (GC) patients undergoing gastrectomy.Recently, the "obesity paradox" has been proposed, referring to the paradoxically "better" outcomes of overweight and obese patients compared with nonoverweight patients. The associations between BMI and surgical outcomes among patients with GC remain controversial.A single-institution cohort of 1249 GC patients undergoing gastrectomy between 2000 and 2010 were categorized to low-BMI (<18.49 kg/m), normal-BMI (18.50-24.99 kg/m), and high-BMI (≥25.00 kg/m) groups. The postoperative complications were classified according to the Clavien-Dindo system, and their severity was assessed by using the Comprehensive Complication Index (CCI). The impact of BMI on the postoperative complications and overall survival was analyzed.There were 908, 158, and 182 patients in the normal-BMI, low-BMI, and high-BMI groups, respectively. The overall morbidity in the high-BMI group (24.7%) was higher than that in either the low-BMI or the normal-BMI group (20.9% and 15.5%, respectively; P = 0.006), but the mean CCI in the low-BMI group was significantly higher (8.32 ± 19.97) than the mean CCI in the normal-BMI and high-BMI groups (3.76 ± 11.98 and 5.58 ± 13.07, respectively; P < 0.001). The Kaplan-Meier curve and the log-rank test demonstrated that the low-BMI group exhibited the worst survival outcomes compared with the normal-BMI group, whereas the high-BMI group exhibited the best survival outcomes (P < 0.001). In multivariate analysis, BMI was identified as an independent prognostic factor. In the stage-specific subgroup analysis, a low BMI was associated with poorer survival in the cases of stage III-IV diseases.Low BMI was associated with more severe postoperative complications and poorer prognosis. Despite a higher risk of mild postoperative complications, the high-BMI patients exhibited paradoxically "superior" survival outcomes compared with the normal-BMI patients. These findings confirm the "obesity paradox" in GC patients undergoing gastrectomy.
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Affiliation(s)
- Hai-Ning Chen
- From the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China (H-NC, X-ZC, W-HZ, KY, X-LC, BZ, Z-XC, J-PC, Z-GZ, J-KH); and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China (X-ZC, W-HZ, KY, X-LC, J-KH)
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Maret-Ouda J, Tao W, Mattsson F, Brusselaers N, El-Serag HB, Lagergren J. Esophageal adenocarcinoma after obesity surgery in a population-based cohort study. Surg Obes Relat Dis 2015; 13:28-34. [PMID: 26723560 DOI: 10.1016/j.soard.2015.09.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/22/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obesity is strongly associated with esophageal adenocarcinoma (EAC), yet it is unclear whether weight loss reduces the risk of EAC. OBJECTIVES To test the hypothesis that the risk of EAC decreases after weight reduction achieved by obesity surgery. SETTING Nationwide register-based cohort study. METHODS This study included a majority of individuals who underwent obesity surgery in Sweden in 1980 to 2012. The incidence of EAC after obesity surgery was compared with the incidence in the corresponding background population of Sweden by means of calculation of standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). The risk of EAC after obesity surgery also was compared with the risk in obese individuals who did not undergo obesity surgery by means of multivariable Cox regression, providing hazard ratios with 95% CIs, adjusted for potential confounders. RESULTS Among 34,437 study participants undergoing obesity surgery and 239,775 person-years of follow-up, 8 cases of EAC occurred (SIR 1.6; 95% CI .7-3.2). No clear trend of decreased SIRs was observed in relation to increased follow-up time after surgery. The SIR of EACs (n = 53) among 123,695 obese individuals who did not undergo obesity surgery (673,238 person-years) was increased to a similar extent as in the obesity surgery cohort (SIR = 1.9, 95% CI 1.4-2.5). Cox regression demonstrated no difference in risk of EAC between participants who underwent obesity surgery and those who did not (adjusted hazard ratio = .9, 95% CI .4-1.9). CONCLUSION The risk of EAC might not decrease after obesity surgery, but larger studies with longer follow-up are needed to establish this association.
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Affiliation(s)
- John Maret-Ouda
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Wenjing Tao
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Nele Brusselaers
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College, London, UK
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Wu Q, Tang SG, Yuan ZM. Gremlin 2 inhibits adipocyte differentiation through activation of Wnt/β-catenin signaling. Mol Med Rep 2015; 12:5891-6. [PMID: 26239165 DOI: 10.3892/mmr.2015.4117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 10/31/2014] [Indexed: 11/06/2022] Open
Abstract
The primary function of white adipose tissues is to store excess energy. The current study aimed to investigate the roles of Gremlin 2 (Grem2), a glycoprotein in adipogenesis. Using polymerase chain reaction‑based microarrays, it was determined that Grem2 was markedly downregulated in adipose tissues from obese animals and humans. In addition, 3T3‑L1 cells were used to investigate the details of the mechanisms underlying the anti‑adipogenic effects of Grem2. Grem2 expression was markedly decreased upon the induction of adipocyte differentiation, as demonstrated by reverse transcription‑quantitative polymerase chain reaction and western blot analysis. Notably, Grem2 overexpression inhibited adipogenesis, while knockdown of Grem2 led to an increase in adipogenesis. At the molecular level, Grem2 promotes nuclear translocation of β‑catenin, an integral Wnt signaling component. Consistently, inhibition of Wnt/β‑catenin signaling using a retrovirus targeting the β‑catenin coding region attenuated the anti‑adipogenic effects of Grem2. Therefore, to the best of our knowledge, the current study shows for the first time that Grem2 may be an important regulator of adipocyte differentiation.
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Affiliation(s)
- Qing Wu
- Department of Geriatrics Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
| | - Shi-Guo Tang
- Department of Endocrinology, Chongqing Ninth People's Hospital, Chongqing 400010, P.R. China
| | - Zhong-Ming Yuan
- Department of Geriatrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
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Chang YT, Tien YW, Jeng YM, Yang CY, Liang PC, Wong JM, Chang MC. Overweight increases the risk of malignancy in patients with pancreatic mucinous cystic neoplasms. Medicine (Baltimore) 2015; 94:e797. [PMID: 25997051 PMCID: PMC4602873 DOI: 10.1097/md.0000000000000797] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Distinguishing between benign and malignant pancreatic cysts remains a clinical challenge. The aim of this study was to investigate the influence of body mass index (BMI) and preoperative clinical and cyst features, as described by the International Consensus Guidelines, on malignancy in patients with pancreatic mucinous cystic neoplasms (PMCNs).A retrospective cohort study was performed on patients with PMCNs who underwent surgical resection between January 1994 and June 2014. Preoperative BMI, clinical demographic data, cystic features, tumor markers, and surgical pathology results were analyzed. Predictors of malignancy were determined by univariate and multivariate analysis using logistic regression.One hundred sixty-four cases of PMCNs, including 106 intraductal papillary mucinous neoplasms (IPMNs) and 58 mucinous cystic neoplasms (MCNs), were analyzed. On univariate analysis, older age (P = 0.008), male sex (P = 0.007), high-risk stigmata (P = 0.007), diabetes mellitus (DM; P = 0.008), and BMI >25 (P < 0.001) were associated with malignancy. Multivariate analysis found that BMI >25 (odds ratio, 3.99; 95% confidence interval: 1.60-10) was an independent predictor of malignancy. In subgroup analysis, BMI >25 was an independent predictor of malignancy in IPMNs but not in MCNs.Overweight patients with IPMNs have a higher risk of malignancy and should be followed closely or undergo resection. The operative strategy for PMCNs should consider cyst-related and patient-related risk factors.
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Affiliation(s)
- Yu-Ting Chang
- From the Departments of Internal Medicine (YTC, JMW, M-CC), Surgery (YWT, C-YY), Pathology (YMJ) and Medical Image (P-CL), National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Sarkozy C, Camus V, Tilly H, Salles G, Jardin F. Body mass index and other anthropometric parameters in patients with diffuse large B-cell lymphoma: physiopathological significance and predictive value in the immunochemotherapy era. Leuk Lymphoma 2015; 56:1959-68. [PMID: 25363401 DOI: 10.3109/10428194.2014.979412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common form of aggressive non-Hodgkin lymphoma, accounting for 30-40% of newly diagnosed cases. Obesity is a well-defined risk factor for DLBCL. However, the impact of body mass index (BMI) on DLBCL prognosis is controversial. Recent studies suggest that skeletal muscle wasting (sarcopenia) or loss of fat mass can be detected by computed tomography (CT) images and is useful for predicting the clinical outcome in several types of cancer including DLBCL. Several hypotheses have been proposed to explain the differences in DLBCL outcome according to BMI or weight that include tolerance to treatment, inflammatory background and chemotherapy or rituximab metabolism. In this review, we summarize the available literature, addressing the impact and physiopathological relevance of simple anthropometric tools including BMI and tissue distribution measurements. We also discuss their relationship with other nutritional parameters and their potential role in the management of patients with DLBCL.
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Affiliation(s)
- Clémentine Sarkozy
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Université Claude Bernard , Pierre Bénite , France
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