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Davis EW, Attwood K, Prunier J, Paragh G, Joseph JM, Klein A, Roche C, Barone N, Etter JL, Ray AD, Trabert B, Schabath MB, Peres LC, Cannioto R. The association of body composition phenotypes before chemotherapy with epithelial ovarian cancer mortality. J Natl Cancer Inst 2024; 116:1513-1524. [PMID: 38802116 DOI: 10.1093/jnci/djae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/17/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The association of body composition with epithelial ovarian carcinoma (EOC) mortality is poorly understood. To date, evidence suggests that high adiposity is associated with decreased mortality (an obesity paradox), but the impact of muscle on this association has not been investigated. Herein, we define associations of muscle and adiposity joint-exposure body composition phenotypes with EOC mortality. METHODS Body composition from 500 women in the Body Composition and Epithelial Ovarian Cancer Survival Study was dichotomized as normal or low skeletal muscle index (SMI), a proxy for sarcopenia, and high or low adiposity. Four phenotypes were classified as fit (normal SMI and low adiposity; reference; 16.2%), overweight or obese (normal SMI and high adiposity; 51.2%), sarcopenia and overweight or obese (low SMI and high adiposity; 15.6%), and sarcopenia or cachexia (low SMI and low adiposity; 17%). We used multivariable Cox models to estimate associations of each phenotype with mortality for EOC overall and high-grade serous ovarian carcinoma (HGSOC). RESULTS Overweight or obesity was associated with up to 51% and 104% increased mortality in EOC and HGSOC [Hazard Ratio (HR)] = 1.51, 95% CI = 1.05 to 2.19 and HR = 2.04, 95% CI = 1.29 to 3.21). Sarcopenia and overweight or obesity was associated with up to 66% and 67% increased mortality in EOC and HGSOC (HR = 1.66, 95% CI = 1.13 to 2.45 and HR = 1.67, 95% CI = 1.05 to 2.68). Sarcopenia or cachexia was associated with up to 73% and 109% increased mortality in EOC and HGSOC (HR = 1.73, 95% CI = 1.14 to 2.63 and HR = 2.09, 95% CI = 1.25 to 3.50). CONCLUSIONS Overweight or obesity, sarcopenia and overweight or obesity, and sarcopenia or cachexia phenotypes were each associated with increased mortality in EOC and HGSOC. Exercise and dietary interventions could be leveraged as ancillary treatment strategies for improving outcomes in the most fatal gynecological malignancy with no previously established modifiable prognostic factors.
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Affiliation(s)
- Evan W Davis
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Joseph Prunier
- Lake Erie College of Osteopathic Medicine, Elmira, NY, USA
| | - Gyorgy Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Janine M Joseph
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - André Klein
- Department of Research Information Technology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Charles Roche
- Department of Diagnostic Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Nancy Barone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - John Lewis Etter
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Andrew D Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Rehabilitation, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Britton Trabert
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute at the University of Utah, Cancer Control and Population Sciences, Salt Lake City, UT, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Rikki Cannioto
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Borsati A, Giannarelli D, Belluomini L, Ciurnelli C, Colonna A, D’Amico I, Daniele A, Del Bianco N, Toniolo L, Trestini I, Tregnago D, Insolda J, Sposito M, Lanza M, Milella M, Schena F, Pilotto S, Avancini A. Exploring the Association between Health-Related Physical Fitness and Quality of Life in Patients with Cancer: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1643. [PMID: 39201201 PMCID: PMC11353676 DOI: 10.3390/healthcare12161643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Whereas an exercise intervention effectively improves patients' quality of life, little information is available about the contribution of each physical fitness component. This study aims to explore the association between physical fitness components and the quality-of-life domain in patients with cancer. Between September 2021 and August 2023, 160 patients with mixed cancer types visiting the Oncology Unit were selected on a consecutive basis according to selection criteria. They underwent a comprehensive baseline assessment including the six-minute walking test, the handgrip strength test, the isometric leg press test, the back scratch, sit and reach tests, their waist-hip ratio, and their body mass index. The European Organization for Research and Treatment of Cancer Quality of Life and Core Questionnaire was used to measure the quality of life. The sample size was based on the use of regression models to study associations between clinical characteristics and fitness outcomes. All of the analyses were performed using the SPSS v.25 statistical package. Patients had a mean age of 58 years, 68% were female, 42% were affected by breast cancer, and all were receiving anticancer treatments. Higher functional capacity was associated with better global health status (p < 0.0001) and physical (p < 0.0001), role (p < 0.0001), emotional (p = 0.026), and social function (p = 0.016) and inversely linked with fatigue (p = 0.001). Lower-limb flexibility was significantly associated with all of the domains except for role and social functions. The waist-hip ratio was inversely associated with physical function (p < 0.0001) and positively related to fatigue (p = 0.037). Exercise programs aiming to improve the quality of life in cancer should be addressed to optimize these fitness components.
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Affiliation(s)
- Anita Borsati
- Department of Medicine, University of Verona, 37129 Verona, Italy;
| | - Diana Giannarelli
- A. Gemelli University Hospital Foundation, IRCCS-Epidemiology&Biostatistic, 00168 Rome, Italy;
| | - Lorenzo Belluomini
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Christian Ciurnelli
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Alessio Colonna
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Irene D’Amico
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Arianna Daniele
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Nicole Del Bianco
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Linda Toniolo
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Ilaria Trestini
- Dietetics Service, Medical Direction, University Hospital of Verona, 37126 Verona, Italy;
| | - Daniela Tregnago
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Jessica Insolda
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Marco Sposito
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Massimo Lanza
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Michele Milella
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Federico Schena
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Sara Pilotto
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Alice Avancini
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
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Morena F, Cabrera AR, Greene NP. Exploring heterogeneity: a dive into preclinical models of cancer cachexia. Am J Physiol Cell Physiol 2024; 327:C310-C328. [PMID: 38853648 DOI: 10.1152/ajpcell.00317.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 06/11/2024]
Abstract
Cancer cachexia (CC) is a multifactorial and complex syndrome experienced by up to 80% of patients with cancer and implicated in ∼40% of cancer-related deaths. Given its significant impact on patients' quality of life and prognosis, there has been a growing emphasis on elucidating the underlying mechanisms of CC using preclinical models. However, the mechanisms of cachexia appear to differ across several variables including tumor type and model and biologic variables such as sex. These differences may be exacerbated by variance in experimental approaches and data reporting. This review examines literature spanning from 2011 to March 2024, focusing on common preclinical models of CC, including Lewis Lung Carcinoma, pancreatic KPC, and colorectal colon-26 and Apcmin/+ models. Our analysis reveals considerable heterogeneity in phenotypic outcomes, and investigated mechanisms within each model, with particular attention to sex differences that may be exacerbated through methodological differences. Although searching for unified mechanisms is critical, we posit that effective treatment approaches are likely to leverage the heterogeneity presented by the tumor and pertinent biological variables to direct specific interventions. In exploring this heterogeneity, it becomes critical to consider methodological and data reporting approaches to best inform further research.
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Affiliation(s)
- Francielly Morena
- Cachexia Research Laboratory, Exercise Science Research Center, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, United States
| | - Ana Regina Cabrera
- Cachexia Research Laboratory, Exercise Science Research Center, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, United States
| | - Nicholas P Greene
- Cachexia Research Laboratory, Exercise Science Research Center, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, United States
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4
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Beaudry AG, Law ML, Gilley-Connor KR, Buley H, Dungan CM, Nascimento CMC, Vichaya EG, Wiggs MP. Diet-induced obesity does not exacerbate cachexia in male mice bearing Lewis-lung carcinoma tumors. Am J Physiol Regul Integr Comp Physiol 2024; 326:R254-R265. [PMID: 38252513 DOI: 10.1152/ajpregu.00208.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Cachexia is a muscle-wasting syndrome commonly observed in patients with cancer, which can significantly worsen clinical outcomes. Because of a global rise in obesity, the coexistence of cachexia in obese individuals poses unique challenges, with the impact of excessive adiposity on cachexia severity and underlying pathophysiology not well defined. Understanding the interplay between cachexia and obesity is crucial for improving diagnosis and treatment strategies for these patients; therefore, the present study examined differences in cachexia between lean and obese mice bearing Lewis lung carcinoma (LLC) tumors. Nine-week-old, male C57Bl6J mice were placed on either a chow or a high-fat diet (HFD) for 9 wk. After the diet intervention, mice were inoculated with LLC or vehicle. Markers of cachexia, such as body and muscle loss, were noted in both chow and HFD groups with tumors. Tumor weight of HFD animals was greater than that of chow. LLC tumors reduced gastrocnemius, plantaris, and soleus mass, regardless of diet. The tibialis anterior and plantaris mass and cross-sectional area of type IIb/x fibers in the gastrocnemius were not different between HFD-chow, HFD-tumor, and chow-tumor. Using RNA sequencing (RNA-seq) of the plantaris muscle from chow-tumor and HFD-tumor groups, we identified ∼400 differentially expressed genes. Bioinformatic analysis identified changes in lipid metabolism, mitochondria, bioenergetics, and proteasome degradation. Atrophy was not greater despite larger tumor burden in animals fed an HFD, and RNA-seq data suggests that partial protection is mediated through differences in mitochondrial function and protein degradation, which may serve as future mechanistic targets.NEW & NOTEWORTHY This study provides timely information on the interaction between obesity and cancer cachexia. Lean and obese animals show signs of cachexia with reduced body weight, adipose tissue, and gastrocnemius muscle mass. There was not significant wasting in the tibialis anterior, plantaris, or fast twitch fibers in the gastrocnemius muscle of obese animals with tumors. RNA-seq analysis reveals that obese tumor bearing animals had differential expression of mitochondria- and degradation-related genes, which may direct future studies in mechanistic research.
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Affiliation(s)
- Anna G Beaudry
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, United States
| | - Michelle L Law
- Department of Human Sciences and Design, Baylor University, Waco, Texas, United States
| | - Kayla R Gilley-Connor
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, United States
| | - Hailey Buley
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, United States
| | - Cory M Dungan
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, United States
| | | | - Elisabeth G Vichaya
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, United States
| | - Michael P Wiggs
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, United States
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5
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Bradshaw PT. Body composition and cancer survival: a narrative review. Br J Cancer 2024; 130:176-183. [PMID: 37891197 PMCID: PMC10803330 DOI: 10.1038/s41416-023-02470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Interest in understanding the relationship between body composition and cancer survival has remained strong for decades, with a number of recent systematic reviews on the topic. However, the current state of evidence is based on heterogeneous exposure definitions based on anthropometry, yielding inconsistent findings with regard to this association. Recently the field has taken an exciting direction with the application of radiological assessments to measure specific aspects of body composition, yet reconciliation of findings from these modern assessment tools with those from the historic use of anthropometric data proves challenging. In this paper, I briefly review the biological basis for a link between body composition and cancer survival and summarize the epidemiological evidence with consideration to specific exposure measures. As enthusiasm is building around novel assessments, I conclude with a discussion of issues that researchers should be aware of when interpreting results from these new modalities.
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Affiliation(s)
- Patrick T Bradshaw
- School of Public Health, Division of Epidemiology, University of California Berkeley, Berkeley, CA, USA.
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6
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Ge YZ, Liu T, Deng L, Zhang Q, Liu CA, Ruan GT, Xie HL, Song MM, Lin SQ, Yao QH, Shen X, Shi HP. The age-related obesity paradigm: results from two large prospective cohort studies. J Cachexia Sarcopenia Muscle 2024; 15:442-452. [PMID: 38146198 PMCID: PMC10834317 DOI: 10.1002/jcsm.13415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 10/12/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND The obesity paradigm has been a health concern globally for many years, its meaning is controversial. In this study, we assess the characteristics and causes of obesity paradigm and detail the mediation of obesity and inflammation on survival. METHODS The original cohort included participants from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, a prospective cohort of a nationally representative sample of adult participants; the oncology validation cohort included patients from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) from 2013 to 2021, a prospective cohort of Chinese patients with cancer. Survival analysis was performed using weighted (NHANES) or unweighted (INSCOC) Cox survival analyses. The normal BMI group was used as a reference for all comparisons. Systemic inflammation was defined as neutrophil-to-lymphocyte ratio (NLR) > 3. Model-based causal mediation analysis was used to identify the mediators. RESULTS A total of 52 270 (weighted population: 528506229) participants of the NHANES [mean follow-up times: 10.2 years; mean age (SD): 47 (19.16) years] were included in the original cohort; and a total of 17 418 patients with cancer of INSCOC [mean follow-up times: 2.9 years; mean age (SD): 57.37 (11.66) years] were included in the validation cohort. In the subgroups of all the participants, the obesity paradigm was more apparent in older participants and participants with disease [HR (95% CI): age ≥ 65 years, 0.84 (0.76, 0.93); with cancer, 0.84 (0.71, 0.99); with CVD, 0.74 (0.65, 0.85)]. As aged, the protective effect of a high BMI on survival gradually increased and a high BMI showed the effect of a protective factor on older participants [for obese II, HR (95% CI): young adults, 1.91 (1.40, 2.62); middle age, 1.56 (1.28, 1.91); old adults, 0.85 (0.76, 0.96]). The aged-related obesity paradigm in patients with cancer from the NHANES was verified in the INSCOC cohorts [for obese, HR (95%CI): 0.65 (0.52, 0.81)]. The NLR is an important mediator of the effect of BMI on survival (proportion of mediation = 15.4%). CONCLUSIONS The obesity paradigm has a strong correlation with age. Relative to normal weight, obese in young people was association with higher all-cause mortality, and obese in elderly people was not association with higher mortality. The protection of obesity is association with systemic inflammation.
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Affiliation(s)
- Yi-Zhong Ge
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Tong Liu
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Li Deng
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Qi Zhang
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Department of Colorectal Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Chen-An Liu
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Guo-Tian Ruan
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Hai-Lun Xie
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Meng-Meng Song
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Shi-Qi Lin
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Qin-Hua Yao
- Department of Integrated Chinese and Western Medicine, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Integrated Traditional Chinese and Western Medicine Oncology Laboratory, Key Laboratory of Traditional Chinese Medicine of Zhejiang Province, Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Xian Shen
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
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Lee JH, Kang D, Ahn JS, Guallar E, Cho J, Lee HY. Obesity paradox in patients with non-small cell lung cancer undergoing immune checkpoint inhibitor therapy. J Cachexia Sarcopenia Muscle 2023; 14:2898-2907. [PMID: 37964713 PMCID: PMC10751411 DOI: 10.1002/jcsm.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/30/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The obesity paradox in patients with advanced non-small cell lung cancer receiving immune checkpoint inhibitor therapy has been observed, but its underlying mechanism is not fully understood. We aimed to investigate whether body composition affects the prognostic impact of obesity, as determined by body mass index (BMI), on survival. METHODS This retrospective study evaluated the data collected from Asian patients who were treated with immune checkpoint inhibitors for advanced non-small cell lung cancer between October 2015 and October 2021. We used abdominal cross-sectional imaging to calculate the skeletal muscle and visceral fat indices (cm2 /m2 ) by dividing the cross-sectional areas of the skeletal muscle and visceral fat by the height squared. Cox proportional-hazards regression was performed to determine the correlation between BMI according to the Asia-Pacific classification, body composition metrics and overall survival. RESULTS We analysed the data of 820 patients (630 men and 190 women, with a mean age of 64.3 years [standard deviation: 10.4 years]) and observed 572 (69.8%) deaths with the 1-year mortality rate of 0.58 (95% confidence interval, 0.55-0.62). Obese BMI was associated with longer overall survival, independent of clinical covariates (hazard ratio, 0.64; 95% confidence interval: 0.52-0.80). The prognostic value of obese BMI remained after additional adjustments for skeletal muscle index (hazard ratio, 0.68; 95% confidence interval, 0.53-0.87) or visceral fat index (hazard ratio, 0.54; 95% confidence interval: 0.41-0.70). No association was observed between sex and the impact of BMI on overall survival (P-value for interaction >0.05). CONCLUSIONS In Asian patients with advanced non-small cell lung cancer who received immune checkpoint inhibitors, obese BMI was associated with favourable overall survival independent of skeletal muscle or visceral fat mass.
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Affiliation(s)
- Ji Hyun Lee
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST)Sungkyunkwan UniversitySeoulRepublic of Korea
| | - Jin Seok Ahn
- Department of Medicine, Division of Hematology‐Oncology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Eliseo Guallar
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreMDUSA
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST)Sungkyunkwan UniversitySeoulRepublic of Korea
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreMDUSA
- Center for Clinical Epidemiology, Samsung Medical CenterSungkyunkwan UniversitySeoulRepublic of Korea
| | - Ho Yun Lee
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
- Department of Health Sciences and Technology, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST)Sungkyunkwan UniversitySeoulRepublic of Korea
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McManus HD, Zhang D, Schwartz FR, Wu Y, Infield J, Ho E, Armstrong AJ, George DJ, Kruse D, Gupta RT, Harrison MR. Relationship Between Pretreatment Body Composition and Clinical Outcomes in Patients With Metastatic Renal Cell Carcinoma Receiving First-Line Ipilimumab Plus Nivolumab. Clin Genitourin Cancer 2023; 21:e429-e437.e2. [PMID: 37271698 DOI: 10.1016/j.clgc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Biomarkers are needed to identify patients with metastatic renal cell carcinoma (mRCC) most likely to benefit from immune checkpoint inhibitors. We examined associations between radiographically assessed body composition (BC) variables and body mass index (BMI) with clinical outcomes for patients with mRCC receiving first-line ipilimumab + nivolumab (ipi/nivo). PATIENTS AND METHODS We retrospectively reviewed all patients with mRCC treated with first-line ipi/nivo at one institution before June 1, 2021 with an analyzable baseline computed tomography (CT) scan. BC variables (skeletal muscle index [SMI], subcutaneous adipose tissue index [SATI], and visceral adipose tissue index [VATI]) were measured using baseline CT scans. Relationships between BC variables and clinical outcomes were examined using Cox proportional hazard regression models. RESULTS Ninety-nine patients were analyzed (74% male, 64% overweight/obese, 75% low SMI). Controlling for age, IMDC risk, and sex (for BMI analyses), high vs. low SMI (HR=2.433, CI: 1.397-4.238, P=.0017), high vs. low SATI (HR=1.641, CI: 1.023-2.632, P=.0398), and obese BMI (≥ 30 kg/m2) vs. normal/overweight BMI (<30 kg/m2) (HR=1.859, CI: 1.156-2.989, P=.0105) were significantly associated with progression-free survival (PFS). Median overall survival (OS) for low SMI patients was higher (42.74 months, CI: 26.84, NR) than median OS for high SMI patients (27.01 months, CI: 15.28, NR) (adjusted HR=1.728, CI: 0.909-3.285, P=.0952). No BC variables were significantly associated with OS or objective response rate. CONCLUSIONS Low SMI and low SATI were associated with significantly better PFS for patients with mRCC receiving first-line ipi/nivo. Radiographic BC variables may be useful prognostic biomarkers in this setting.
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Affiliation(s)
- Hannah D McManus
- Department of Medicine, Duke University Medical Center, Durham, NC.
| | - Dylan Zhang
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Fides R Schwartz
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Yuan Wu
- Department of Biostatics and Bioinformatics, Duke University, Durham, NC
| | - Jordan Infield
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Ethan Ho
- Department of Biomedical Engineering, Duke University, Durham, NC
| | - Andrew J Armstrong
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC; Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Daniel J George
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC; Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Danielle Kruse
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Surgery, Division of Urology, Duke Cancer Institute, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
| | - Michael R Harrison
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC; Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
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Miao X, Ding L, Lu J, Zhu H, Zhao K, Xu X, Zhu S, Chen L, Hu J, Xu Q. Preoperative low handgrip strength (HGS) with HGS asymmetry is associated with adverse outcomes among older adults with gastric cancer. J Geriatr Oncol 2023; 14:101583. [PMID: 37429105 DOI: 10.1016/j.jgo.2023.101583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION This study aimed to explore the associations of low hand grip strength (HGS), HGS asymmetry, their combinations, and frailty on hospital readmissions, total complications, and prolonged length of stay (PLOS) among older adults with gastric cancer. MATERIALS AND METHODS This study included 342 patients with gastric cancer aged ≥60 years who were scheduled to undergo radical surgery. The Tilburg Frailty Indicator (TFI) was used to collect information on frailty. HGS was measured twice for each hand using an electronic handgrip dynamometer. The highest HGS readings on each hand were used for calculating the HGS asymmetry ratio: non-dominant HGS (kg)/dominant HGS (kg). The Fine and Gray proportional subdistribution hazard model and the logistic regression model were used for the analyses, with covariates adjusted. RESULTS Low HGS (subdistribution hazard ratios [SHR] = 2.10, 95% confidence interval [CI] = 1.05-3.93, P = 0.036) and low HGS with HGS asymmetry (SHR = 3.95, 95% CI = 1.50-10.36, P = 0.005) were significantly associated with hospital readmissions. Frailty was associated with total complications (odds ratio [OR] = 2.87, 95% CI = 1.61-5.13, P < 0.001) and PLOS (OR = 1.98, 95% CI = 1.19-3.29, P < 0.001). Low HGS, HGS asymmetry, and their combinations were not significantly associated with total complications and PLOS. DISCUSSION Preoperative low HGS and low HGS with HGS asymmetry were associated with hospital readmissions, while frailty was associated with total complications and PLOS among older adults with gastric cancer. In the future, more rigorously designed studies are needed to verify our results further to improve preoperative clinical assessment and frailty evaluation among older adults with gastric cancer.
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Affiliation(s)
- Xueyi Miao
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Lingyu Ding
- Department of Colorectal Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Jinling Lu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Xinyi Xu
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Li Chen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Jieman Hu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China.
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Olsson LT, Eberle CE, Petruzella S, Robinson WR, Furberg H. A comparison of analytic approaches for investigating the obesity paradox in kidney cancer. Cancer Causes Control 2023; 34:361-370. [PMID: 36786871 PMCID: PMC10448500 DOI: 10.1007/s10552-023-01670-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 01/16/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Body mass index (BMI) and kidney cancer mortality are inconsistently associated in the scientific literature. To understand how study design affects results, we contrasted associations between pre-diagnosis BMI and mortality under different analytic scenarios in a large, population-based prospective cohort study. METHODS Using data from the NIH-AARP Diet and Health Study (1995-2011), we constructed two cohorts: a "full at-risk" cohort with no kidney cancer history at baseline (n = 252,845) and an "incident cancer" subset who developed kidney cancer during follow-up (n = 1,652). Cox Proportional Hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) between pre-diagnosis BMI and mortality for different outcomes (all-cause and cancer-specific mortality), in the different cohorts (full at-risk vs. incident cancer cohort), and with different covariates (minimally vs. fully adjusted). For the incident cancer cohort, we also examined time to mortality using different timescales: from enrollment or diagnosis. RESULTS In the full at-risk study population, higher pre-diagnosis BMI was associated with greater cancer-specific mortality in fully adjusted multivariable models, particularly for obese participants [HR, (95% CI): 1.76, (1.38-2.25)]. This association was less pronounced in the incident cancer cohort [1.50, (1.09-2.07)]. BMI was not strongly associated with all-cause mortality in either cohort in fully adjusted models [full cohort: 1.03, (1.01, 1.06); incident cancer cohort: 1.20, (0.97, 1.48)]. CONCLUSIONS Populations characterized by high adult BMI will likely experience greater population burdens of mortality from kidney cancer, partially because of higher rates of kidney cancer diagnosis. Questions regarding overall mortality burden and post-diagnosis cancer survivorship are distinct and require different study designs.
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Affiliation(s)
- Linnea T Olsson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carolyn E Eberle
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stacey Petruzella
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Whitney R Robinson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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11
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Seo D, Kim HS, Ahn JB, Park YR. Investigation of the Trajectory of Muscle and Body Mass as a Prognostic Factor in Patients With Colorectal Cancer: Longitudinal Cohort Study. JMIR Public Health Surveill 2023; 9:e43409. [PMID: 36947110 PMCID: PMC10131753 DOI: 10.2196/43409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Skeletal muscle and BMI are essential prognostic factors for survival in colorectal cancer (CRC). However, there is a lack of understanding due to scarce studies on the continuous aspects of these variables. OBJECTIVE This study aimed to evaluate the prognostic impact of the initial status and trajectories of muscle and BMI on overall survival (OS) and assess whether these 4 profiles within 1 year can represent the profiles 6 years later. METHODS We analyzed 4056 newly diagnosed patients with CRC between 2010 to 2020. The volume of the muscle with 5-mm thickness at the third lumbar spine level was measured using a pretrained deep learning algorithm. The skeletal muscle volume index (SMVI) was defined as the muscle volume divided by the square of the height. The correlation between BMI status at the first, third, and sixth years of diagnosis was analyzed and assessed similarly for muscle profiles. Prognostic significances of baseline BMI and SMVI and their 1-year trajectories for OS were evaluated by restricted cubic spline analysis and survival analysis. Patients were categorized based on these 4 dimensions, and prognostic risks were predicted and demonstrated using heat maps. RESULTS Trajectories of SMVI were categorized as decreased (812/4056, 20%), steady (2014/4056, 49.7%), or increased (1230/4056, 30.3%). Similarly, BMI trajectories were categorized as decreased (792/4056, 19.5%), steady (2253/4056, 55.5%), or increased (1011/4056, 24.9%). BMI and SMVI values in the first year after diagnosis showed a statistically significant correlation with those in the third and sixth years (P<.001). Restricted cubic spline analysis showed a nonlinear relationship between baseline BMI and SMVI change ratio and OS; BMI, in particular, showed a U-shaped correlation. According to survival analysis, increased BMI (hazard ratio [HR] 0.83; P=.02), high baseline SMVI (HR 0.82; P=.04), and obesity stage 1 (HR 0.80; P=.02) showed a favorable impact, whereas decreased SMVI trajectory (HR 1.31; P=.001), decreased BMI (HR 1.23; P=.02), and initial underweight (HR 1.38; P=.02) or obesity stages 2-3 (HR 1.79; P=.01) were negative prognostic factors for OS. Considered simultaneously, BMI >30 kg/m2 with a low SMVI at the time of diagnosis resulted in the highest mortality risk. We observed improved survival in patients with increased muscle mass without BMI loss compared to those with steady muscle mass and BMI. CONCLUSIONS Profiles within 1 year of both BMI and muscle were surrogate indicators for predicting the later profiles. Continuous trajectories of body and muscle mass are independent prognostic factors of patients with CRC. An automatic algorithm provides a unique opportunity to conduct longitudinal evaluations of body compositions. Further studies to understand the complicated natural courses of muscularity and adiposity are necessary for clinical application.
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Affiliation(s)
- Dongjin Seo
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Han Sang Kim
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 FOUR Project, Graduate School of Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Severance Hospital, Seoul, Republic of Korea
| | - Joong Bae Ahn
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu Rang Park
- Brain Korea 21 FOUR Project, Graduate School of Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Severance Hospital, Seoul, Republic of Korea
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
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12
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Abstract
Rather than serving as a mere onlooker, adipose tissue is a complex endocrine organ and active participant in disease initiation and progression. Disruptions of biological processes operating within adipose can disturb healthy systemic physiology, the sequelae of which include metabolic disorders such as obesity and type 2 diabetes. A burgeoning interest in the field of adipose research has allowed for the elucidation of regulatory networks underlying both adipose tissue function and dysfunction. Despite this progress, few diseases are treated by targeting maladaptation in the adipose, an oft-overlooked organ. In this review, we elaborate on the distinct subtypes of adipocytes, their developmental origins and secretory roles, and the dynamic interplay at work within the tissue itself. Central to this discussion is the relationship between adipose and disease states, including obesity, cachexia, and infectious diseases, as we aim to leverage our wealth of knowledge for the development of novel and targeted therapeutics.
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Affiliation(s)
- Christopher Auger
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA;
| | - Shingo Kajimura
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; .,Howard Hughes Medical Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA;
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13
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Wan B, Ma N, Lu W. Mendelian randomization investigation identified the causal relationship between body fat indexes and the risk of bladder cancer. PeerJ 2023; 11:e14739. [PMID: 36700002 PMCID: PMC9869775 DOI: 10.7717/peerj.14739] [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: 09/06/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023] Open
Abstract
Background Observational studies have suggested that obesity is associated with the risk of bladder cancer (BCa). However, their causal relationship remains unclear. This study aimed to prove the causal relationship between obesity and the risk of BCa by using Mendelian randomization. Methods Single-nucleotide polymorphisms (SNPs) correlated with body fat indexes were screened from several genome-wide association studies (GWAS) with more than 300,000 individuals. Summary-level genetic data of BCa-related GWAS were obtained from a European cohort with a sample size of 218,792. An inverse-variance-weighted (IVW) method was used as the major MR analysis. The MR-Egger regression, IVW regression, leave-one-out test, and MR-Pleiotropy Residual Sum and Outlier methods were used to test the reliability and stability of MR results. Results Genetically predicted per 1-SD increase in body fat indexes (whole body fat mass, and the right leg, left leg, right arm, left arm, and trunk fat mass) were associated with increased BCa risk with values of 51.8%, 77.9%, 75.1%, 67.2%, 59.7%, and 36.6%, respectively. Sensitivity analyses suggested that the genetically determined risk effect of obesity on BCa was stable and reliable. Conclusions Our study provided powerful evidence to support the causal hypothesis that the genetically predicted high body fat mass was associated with a risk increase for BCa. The finding is a new idea for drawing up prevention strategies for BCa.
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Affiliation(s)
- Bangbei Wan
- Reproductive Medical Center, Hainan Women and Children’s Medical Center, Haikou, Hainan, China,Department of Urology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, Hainan, China
| | - Ning Ma
- Reproductive Medical Center, Hainan Women and Children’s Medical Center, Haikou, Hainan, China
| | - Weiying Lu
- Reproductive Medical Center, Hainan Women and Children’s Medical Center, Haikou, Hainan, China
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14
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Jiménez-Cortegana C, Hontecillas-Prieto L, García-Domínguez DJ, Zapata F, Palazón-Carrión N, Sánchez-León ML, Tami M, Pérez-Pérez A, Sánchez-Jiménez F, Vilariño-García T, de la Cruz-Merino L, Sánchez-Margalet V. Obesity and Risk for Lymphoma: Possible Role of Leptin. Int J Mol Sci 2022; 23:ijms232415530. [PMID: 36555171 PMCID: PMC9779026 DOI: 10.3390/ijms232415530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Obesity, which is considered a pandemic due to its high prevalence, is a risk factor for many types of cancers, including lymphoma, through a variety of mechanisms by promoting an inflammatory state. Specifically, over the last few decades, obesity has been suggested not only to increase the risk of lymphoma but also to be associated with poor clinical outcomes and worse responses to different treatments for those diseases. Within the extensive range of proinflammatory mediators that adipose tissue releases, leptin has been demonstrated to be a key adipokine due to its pleotropic effects in many physiological systems and diseases. In this sense, different studies have analyzed leptin levels and leptin/leptin receptor expressions as a probable bridge between obesity and lymphomas. Since both obesity and lymphomas are prevalent pathophysiological conditions worldwide and their incidences have increased over the last few years, here we review the possible role of leptin as a promising proinflammatory mediator promoting lymphomas.
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Affiliation(s)
- Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY 10065, USA
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Lourdes Hontecillas-Prieto
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Daniel J. García-Domínguez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Fernando Zapata
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Natalia Palazón-Carrión
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - María L. Sánchez-León
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Malika Tami
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Antonio Pérez-Pérez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Flora Sánchez-Jiménez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Teresa Vilariño-García
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
| | - Luis de la Cruz-Merino
- Oncology Service, Department of Medicines, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Correspondence: (L.d.l.C.-M.); (V.S.-M.)
| | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain
- Correspondence: (L.d.l.C.-M.); (V.S.-M.)
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15
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Arafat Y, Loft M, Cao K, Reid F, Kosmider S, Lee M, Gibbs P, Faragher IG, Yeung JM. Current colorectal cancer chemotherapy dosing limitations and novel assessments to personalize treatments. ANZ J Surg 2022; 92:2784-2785. [PMID: 36398349 PMCID: PMC9827998 DOI: 10.1111/ans.18046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Yasser Arafat
- Department of Colorectal SurgeryWestern HealthMelbourneVictoriaAustralia,Western PrecinctThe University of MelbourneMelbourneVictoriaAustralia
| | - Matthew Loft
- Western PrecinctThe University of MelbourneMelbourneVictoriaAustralia,Department of OncologyWestern HealthMelbourneVictoriaAustralia
| | - Ke Cao
- Western PrecinctThe University of MelbourneMelbourneVictoriaAustralia
| | - Fiona Reid
- Department of Colorectal SurgeryWestern HealthMelbourneVictoriaAustralia,Western PrecinctThe University of MelbourneMelbourneVictoriaAustralia
| | | | - Margret Lee
- Department of OncologyWestern HealthMelbourneVictoriaAustralia,Personalised Oncology DivisionWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia,Consultant Department of Medical OncologyEastern HealthMelbourneVictoriaAustralia
| | - Peter Gibbs
- Western PrecinctThe University of MelbourneMelbourneVictoriaAustralia,Department of OncologyWestern HealthMelbourneVictoriaAustralia,Personalised Oncology DivisionWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
| | - Ian G. Faragher
- Department of Colorectal SurgeryWestern HealthMelbourneVictoriaAustralia,Western PrecinctThe University of MelbourneMelbourneVictoriaAustralia
| | - Justin M Yeung
- Department of Colorectal SurgeryWestern HealthMelbourneVictoriaAustralia,Western PrecinctThe University of MelbourneMelbourneVictoriaAustralia
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The Association of Waist Circumference with the Prevalence and Survival of Digestive Tract Cancer in US Adults: A Population Study Based on Machine Learning Methods. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2492488. [PMID: 36245841 PMCID: PMC9562134 DOI: 10.1155/2022/2492488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022]
Abstract
Aims This paper aims to investigate the relationship of waist circumference (WC) with digestive tract cancer morbidity and mortality. Methods Based on the data from a nationally representative US population survey, we summarized the prevalence of digestive tract cancer and all-cause mortality of cancer patients across WC quartiles. Adjusted logistic regression and restricted spline curve were used to analyze WC and the prevalence of digestive tract cancer. Moreover, Cox regression and the Kaplan-Meier curve were applied to investigate the association of WC with all-cause mortality. We also attempted to make a model to predict cancer happening. Results This paper included a total of 34,041 participants, with digestive tract cancer observed in 265 (0.7%) individuals. WC was positively associated with digestive tract cancer morbidity after full adjustment of covariates (OR: 1.72 and 95% CI: 1.41-2.10). Also, individuals in the highest WC group had a higher risk of digestive tract cancer (Q4, OR: 2.71 and 95% CI: 1.48-5.00). Moreover, no significant association was observed in upper digestive cancer, and WC was associated with a longer survival time once diagnosed (hazard ratio (HR): 0.50 and 95% CI: 0.28-0.92). Finally, the model we made proved to be effective. Conclusion High WC is a risk factor for digestive tract cancer with or without adjusting for body mass index, especially those located in the lower digestive tract. However, once digestive tract cancer has been diagnosed, patients with higher WC showed better survival outcomes. Moreover, machine learning methods can be used to predict digestive tract cancer risk in the future.
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17
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Lee D. Comment on: Obesity is Associated with Improved Postoperative Overall Survival, Independent of Skeletal Muscle Mass in Lung Adenocarcinoma by Lee et al. J Cachexia Sarcopenia Muscle 2022; 13:2576-2578. [PMID: 35965371 PMCID: PMC9530545 DOI: 10.1002/jcsm.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Duk‐Hee Lee
- Department of Preventive Medicine, School of MedicineKyungpook National UniversityDaeguSouth Korea
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18
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Demirel E, Dilek O. A new finding for the obesity paradox? Evaluation of the relationship between muscle and adipose tissue in nuclear grade prediction in patients with clear cell renal cell carcinoma. Acta Radiol 2022; 64:1659-1667. [PMID: 37023029 DOI: 10.1177/02841851221126358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Obesity is associated with an increased risk of developing clear cell renal cell carcinoma (ccRCC), but paradoxically there is a positive association between obesity and surveillance. Purpose To investigate the relationship between nucleus grade classification and body composition in patients with matched co-morbid conditions with non-metastatic ccRCC. Materials and Methods A total of 253 patients with non-metastatic ccRCC were included in the study. Body composition was assessed with abdominal computed tomography (CT) using an automated artificial intelligence software. Both adipose and muscle tissue parameters of the patients were calculated. In order to investigate the net effect of body composition, propensity score matching (PSM) procedure was applied over age, sex, and T stage parameters. In this way, selection bias and imbalance between groups were minimized. Univariate and multivariate logistic regression analyses were performed to identify the association between body composition and WHO/ISUP grade (I–IV). Result When the body composition of the patients was examined without matching the conditions, it was found that the subcutaneous adipose tissue (SAT) values were higher in patients with low grades ( P = 0.001). Normal attenuation muscle area (NAMA) was higher in high-grade patients than low-grade patients ( P < 0.05). In the post-matching evaluation, only SAT/NAMA was found to be associated with high-grade ccRCC (univariate analysis: odds ratio [OR]=0.899, 95% confidence interval [CI]=0.817−0.988, P = 0.028; multivariate analysis: OR=0.922, 95% CI=0.901−0.974, P = 0.042). Conclusion CT-based body composition parameters can be used as a prognostic marker in predicting nuclear grade when age, sex, and T stage match conditions. This finding offers a new perspective on the obesity paradox.
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Affiliation(s)
- Emin Demirel
- Department of Radiology, Emirdag City of Hospital, Afyonkarahisar, Turkey
| | - Okan Dilek
- Department of Radiology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
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Preoperative Body Composition Combined with Tumor Metabolism Analysis by PET/CT Is Associated with Disease-Free Survival in Patients with NSCLC. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7429319. [PMID: 35935304 PMCID: PMC9300276 DOI: 10.1155/2022/7429319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Objective. To evaluate the relationship between preoperative primary tumor metabolism and body composition in patients with NSCLC and analyze their effects on DFS. Method. A retrospective study was conducted on 154 patients with NSCLC. All patients were scanned by baseline 18F-FDG PET/CT. SUVmax (maximum standard uptake value) of primary tumor, liver SUVmean (mean standard uptake value), and spleen SUVmean were measured by AW workstation. The skeletal muscle area (SMA), skeletal muscle mass index (SMI), skeletal muscle radiation density (SMD), visceral fat area (VFA), visceral adipose tissue index (VATI), and skeletal muscle visceral fat ratio (SVR) were measured by ImageJ software. Kaplan–Meier survival analysis was used to evaluate the impact of the above parameters on DFS. Results. Compared with the low SUVmax group of primary tumors, the mean values of SMA, VFA, and VATI in the high SUVmax group were significantly higher. In addition, there were obvious differences in histopathological type, pathological differentiation, AJCC stage, and T stage between the two groups. Univariate analysis of DFS showed that VFA, VATI, pathological differentiation, tumor SUVmax, AJCC stage, tumor T stage, and N stage all affected the DFS of patients except for the parameters reflecting skeletal muscle content. Multivariate regression analysis showed that only VFA and SUVmax were associated with DFS. Kaplan–Meier survival analysis showed that high SUVmax, low VFA, high T stage, and high N stage were related to the decrease of DFS. Conclusion:Preoperative 18F-FDG PET/CT could comprehensively evaluate the primary tumor SUVmax, skeletal muscle, and visceral fat in patients with NSCLC. The combination of primary tumor SUVmax and visceral fat area can well evaluate the prognosis of patients with NSCLC.
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Jung JH, Yoon SJ, Lee OJ, Shin SH, Han IW, Heo JS. Surgical outcomes and prognostic factors of distal common bile duct adenocarcinoma: chronological analysis in a single high-volume institutional experience. BMC Surg 2022; 22:258. [PMID: 35787702 PMCID: PMC9254901 DOI: 10.1186/s12893-022-01649-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Distal common bile duct (dCBD) cancer is typical indication for pancreaticoduodenectomy (PD). We aimed to retrospectively evaluate surgical outcomes and investigate prognostic factors of dCBD adenocarcinoma for which PD was performed at a single institution. Methods We searched consecutive cases of dCBD adenocarcinoma undergone PD at Samsung Medical Center from 1995 to 2018. Cases with distant metastasis or palliative intent were excluded. The year in which the survival rate was dramatically improved was identified and entire years were divided into two periods for comparison. To balance between the two periods, we conducted propensity score matching (PSM) analysis using age, sex, body mass index (BMI), and American Society of Anesthesiologist score. Results Total of 804 cases were enrolled in this study. The entire period was divided into early period of 18 years and recent period of 6 years. The early and late period included 466 and 338 patients, respectively. As a result of PSM, balanced 316 patients were selected from each of the two periods. Significant improvements in surgical outcomes were identified, including shorter operation time, fewer blood loss, shorter hospitalization, and favorable overall survival. As results of multivariable analysis of independent risk factors for overall survival, older age and advanced N stage were identified, as expected. It was distinct that aggressive surgery and advanced tumor state in the early period and a lower BMI in the late period negatively affected the survival, respectively. Conclusions Surgical outcomes of dCBD cancer underwent PD was improved. There were few modifiable factors to improve survival and continuous further study is needed to detect dCBD cancer in the early stages.
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Affiliation(s)
- Ji Hye Jung
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul, South Korea
| | - So Jeong Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul, South Korea
| | - Ok Joo Lee
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul, South Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul, South Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul, South Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul, South Korea.
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Chen K, Zhang J, Beeraka NM, Tang C, Babayeva YV, Sinelnikov MY, Zhang X, Zhang J, Liu J, Reshetov IV, Sukocheva OA, Lu P, Fan R. Advances in the Prevention and Treatment of Obesity-Driven Effects in Breast Cancers. Front Oncol 2022; 12:820968. [PMID: 35814391 PMCID: PMC9258420 DOI: 10.3389/fonc.2022.820968] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/16/2022] [Indexed: 12/11/2022] Open
Abstract
Obesity and associated chronic inflammation were shown to facilitate breast cancer (BC) growth and metastasis. Leptin, adiponectin, estrogen, and several pro-inflammatory cytokines are involved in the development of obesity-driven BC through the activation of multiple oncogenic and pro-inflammatory pathways. The aim of this study was to assess the reported mechanisms of obesity-induced breast carcinogenesis and effectiveness of conventional and complementary BC therapies. We screened published original articles, reviews, and meta-analyses that addressed the involvement of obesity-related signaling mechanisms in BC development, BC treatment/prevention approaches, and posttreatment complications. PubMed, Medline, eMedicine, National Library of Medicine (NLM), and ReleMed databases were used to retrieve relevant studies using a set of keywords, including "obesity," "oncogenic signaling pathways," "inflammation," "surgery," "radiotherapy," "conventional therapies," and "diet." Multiple studies indicated that effective BC treatment requires the involvement of diet- and exercise-based approaches in obese postmenopausal women. Furthermore, active lifestyle and diet-related interventions improved the patients' overall quality of life and minimized adverse side effects after traditional BC treatment, including postsurgical lymphedema, post-chemo nausea, vomiting, and fatigue. Further investigation of beneficial effects of diet and physical activity may help improve obesity-linked cancer therapies.
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Affiliation(s)
- Kuo Chen
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Zhang
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Narasimha M. Beeraka
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Academy of Higher Education and Research (JSS AHER), JSS Medical College, Mysuru, India
| | - Chengyun Tang
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Yulia V. Babayeva
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Mikhail Y. Sinelnikov
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Xinliang Zhang
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Jiacheng Zhang
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junqi Liu
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Igor V. Reshetov
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Olga A. Sukocheva
- Discipline of Health Sciences, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Pengwei Lu
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruitai Fan
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Ji W, Liu X, Zhang Y, Zhao Y, He Y, Cui J, Li W. Development of Formulas for Calculating L3 Skeletal Muscle Mass Index and Visceral Fat Area Based on Anthropometric Parameters. Front Nutr 2022; 9:910771. [PMID: 35782936 PMCID: PMC9249379 DOI: 10.3389/fnut.2022.910771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background The anthropometric index is not accurate but shows a great advantage in accessibility. Simple body composition formulas should be investigated before proceeding with the universal nutrition screening. Materials and Methods Clinical data of patients with a malignant tumor of the digestive system were collected. SliceOmatic 5.0 software (TOMOVISION, Canada) was used to analyze abdominal CT images and taken as references. A linear regression analysis was adopted to establish the formula for calculating skeletal muscle index (SMI) and visceral fat area (VFA). In addition, the relweights function was adopted to measure the contribution of each variable. Results In total, 344 patients were divided into the training set and 134 patients into the validation set. The selected formulas were SMI.pre = 0.540 × weight (kg) – 0.559 × height (cm) – 13.877 × sex (male = 1, female = 2) + 123.583, and VFA.pre = 5.146 × weight (kg) – 2.666 × height (cm) + 1.436 × age (year) + 134.096, of which the adjusted R2 were 0.597 and 0.581, respectively. The “weight” explained more than 80% of R2 in the prediction of VFA. In addition, “sex” occupied approximately 40% of R2 in the prediction of SMI. The paired t-test showed no significant difference between the real measured indices and the predicting ones (p = 0.123 for SMI and p = 0.299 for VFA). The logistic regression analysis exhibited similar diagnostic efficacy of the real measured parameters and formulas. Conclusion The SMI and VFA formulas were developed through basic indices, such as weight, height, sex, and age. According to the contribution of each variable, weight should always be focused on preserving appropriate muscle and adipose tissue.
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Xu XY, Jiang XM, Xu Q, Xu H, Luo JH, Yao C, Ding LY, Zhu SQ. Skeletal Muscle Change During Neoadjuvant Therapy and Its Impact on Prognosis in Patients With Gastrointestinal Cancers: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:892935. [PMID: 35692760 PMCID: PMC9186070 DOI: 10.3389/fonc.2022.892935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundGastrointestinal cancers are the most common malignant tumors worldwide. As the improvement of survival by surgical resection alone for cancers is close to the bottleneck, recent neoadjuvant therapy has been emphasized and applied in the treatment. Despite the advantage on improving the prognosis, some studies have reported neoadjuvant therapy could reduce skeletal muscle and therefore affect postoperative outcomes. However, the conclusions are still controversial.MethodsPubMed, CINAHL, Embase, and Cochrane Library were searched from inception to September 2, 2021. The inclusion criteria were observational studies, published in English, of individuals aged ≥18 years who underwent neoadjuvant therapy with gastrointestinal cancers and were assessed skeletal muscle mass before and after neoadjuvant therapy, with sufficient data on skeletal muscle change or the association with clinical outcomes. Meta-analysis was conducted by using the STATA 12.0 package when more than two studies reported the same outcome.ResultsA total of 268 articles were identified, and 19 studies (1,954 patients) were included in the review. The fixed effects model showed that the risk of sarcopenia increased 22% after receiving neoadjuvant therapy (HR=1.22, 95% CI 1.14, 1.31, Z=4.286, P<0.001). In the random effects model, neoadjuvant therapy was associated with skeletal muscle loss, with a standardized mean difference of -0.20 (95% CI -0.31, -0.09, Z=3.49, P<0.001) and a significant heterogeneity (I2 =62.2%, P<0.001). Multiple meta regression indicated that population, neoadjuvant therapy type, and measuring tool were the potential sources of heterogeneity. The funnel plot revealed that there was no high publication bias in these studies (Begg’s test, P=0.544) and the sensitivity analysis showed stable results when separately excluding studies. For the postoperative outcomes, the results revealed that muscle loss during neoadjuvant therapy was significantly related to overall survival (HR=2,08, 95% CI =1.47, 2.95, Z=4.12, P<0.001, I2 = 0.0%), but not related to disease-free survival and other short-term outcomes.ConclusionsThis systematic review and meta-analysis revealed that skeletal muscle decreased significantly during neoadjuvant therapy in patients with gastrointestinal cancers and skeletal muscle loss was strongly associated with worse overall survival. More high-quality studies are needed to update and valid these conclusions in a more specific or stratified way.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier PROSPERO (CRD42021292118)
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Affiliation(s)
- Xin-Yi Xu
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Xiao-Man Jiang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
- *Correspondence: Qin Xu,
| | - Hao Xu
- Department of Gastric Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Hua Luo
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cui Yao
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ling-Yu Ding
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shu-Qin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, China
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Association between weight change and breast cancer prognosis. Breast Cancer Res Treat 2022; 193:677-684. [PMID: 35435529 DOI: 10.1007/s10549-022-06592-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/30/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Results of the associations between weight change after breast cancer diagnosis and prognosis were inconsistent. The modification effects of menopausal status and endocrine therapy on the associations remain poorly understood. METHODS A total of 2016 breast cancer patients were recruited between October 2008 and January 2018 and followed up until December 31, 2019 in Guangzhou. Multivariate Cox models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for progression-free survival (PFS) in association with weight change after diagnosis. RESULTS Weight loss at 2 years (HR = 1.34, 95% CI 0.87-2.06) or more than 2 years (HR = 1.95, 95% CI 1.22-3.10) after diagnosis increased risk of breast cancer progression. The adverse effect of weight loss was significantly more pronounced in post-menopausal than pre-menopausal women, particularly for weight loss at 2 years after diagnosis, with the HRs and 95% CIs of 2.41 (1.25-4.63) and 0.90 (0.49-1.64), respectively. Weight gain tended to reduce the risk of disease progression among patients with endocrine therapy but not for those with non-endocrine therapy; the significant interaction between weight gain at 2 years after diagnosis and endocrine therapy was observed (Pinteraction = 0.042). CONCLUSION Our finding suggested that weight loss was detrimental to breast cancer prognosis, particularly for post-menopausal women, while weight gain may be a potential beneficial indicator for the patients with endocrine therapy but not for those with non-endocrine therapy.
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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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Assumpção JAF, Pasquarelli-do-Nascimento G, Duarte MSV, Bonamino MH, Magalhães KG. The ambiguous role of obesity in oncology by promoting cancer but boosting antitumor immunotherapy. J Biomed Sci 2022; 29:12. [PMID: 35164764 PMCID: PMC8842976 DOI: 10.1186/s12929-022-00796-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/07/2022] [Indexed: 12/13/2022] Open
Abstract
Obesity is nowadays considered a pandemic which prevalence's has been steadily increasingly in western countries. It is a dynamic, complex, and multifactorial disease which propitiates the development of several metabolic and cardiovascular diseases, as well as cancer. Excessive adipose tissue has been causally related to cancer progression and is a preventable risk factor for overall and cancer-specific survival, associated with poor prognosis in cancer patients. The onset of obesity features a state of chronic low-grade inflammation and secretion of a diversity of adipocyte-derived molecules (adipokines, cytokines, hormones), responsible for altering the metabolic, inflammatory, and immune landscape. The crosstalk between adipocytes and tumor cells fuels the tumor microenvironment with pro-inflammatory factors, promoting tissue injury, mutagenesis, invasion, and metastasis. Although classically established as a risk factor for cancer and treatment toxicity, recent evidence suggests mild obesity is related to better outcomes, with obese cancer patients showing better responses to treatment when compared to lean cancer patients. This phenomenon is termed obesity paradox and has been reported in different types and stages of cancer. The mechanisms underlying this paradoxical relationship between obesity and cancer are still not fully described but point to systemic alterations in metabolic fitness and modulation of the tumor microenvironment by obesity-associated molecules. Obesity impacts the response to cancer treatments, such as chemotherapy and immunotherapy, and has been reported as having a positive association with immune checkpoint therapy. In this review, we discuss obesity's association to inflammation and cancer, also highlighting potential physiological and biological mechanisms underlying this association, hoping to clarify the existence and impact of obesity paradox in cancer development and treatment.
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Affiliation(s)
| | | | - Mariana Saldanha Viegas Duarte
- Immunology and Tumor Biology Program - Research Coordination, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Martín Hernan Bonamino
- Immunology and Tumor Biology Program - Research Coordination, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Vice - Presidency of Research and Biological Collections (VPPCB), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Kelly Grace Magalhães
- Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia, Brasília, DF, Brazil.
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Thresholds of visceral fat area and percent of body fat to define sarcopenic obesity and its clinical consequences in Chinese cancer patients. Clin Nutr 2022; 41:737-745. [DOI: 10.1016/j.clnu.2022.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/08/2022] [Accepted: 01/29/2022] [Indexed: 11/19/2022]
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Brown JC, Heymsfield SB, Caan BJ. Scaling of computed tomography body composition to height: relevance of height-normalized indices in patients with colorectal cancer. J Cachexia Sarcopenia Muscle 2022; 13:203-209. [PMID: 34741439 PMCID: PMC8818649 DOI: 10.1002/jcsm.12847] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/13/2021] [Accepted: 10/01/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Body weight scales to height with a power of ≈2 (weight/height2 ), forming the basis of body mass index (BMI). The corresponding scaling of body composition measured by abdominal computed tomography (CT) to height has not been established. The objective of this analysis was to quantify the scaling of body composition measured by a single-slice axial abdominal CT image (skeletal muscle, and visceral, subcutaneous, and total adipose tissue) to height in patients with colorectal cancer (CRC). METHODS This cross-sectional study included non-Hispanic white males and females, aged 18-80 years, who were diagnosed with stage I-III CRC at an integrated health care system in North America between January 2006 and December 2011. Body composition was measured by a single-slice axial CT image of the third lumbar vertebra and analysed with a semi-automated threshold segmentation procedure. Allometric regression models were used to quantify height scaling powers (β ± standard error) for each body composition measure, adjusted for age, for males and females. An interaction test was used to determine if height scaling powers were statistically significantly different between males and females. RESULTS Among 2036 subjects, the mean (standard deviation) age was 64 ± 11 years, 1008 (49.5%) were female, and the mean (standard deviation) BMI was 27.9 ± 5.4 kg/m2 . Powers for skeletal muscle area were 1.06 ± 0.12 for males and 0.80 ± 0.12 for females (P = 0.049). Powers for visceral adipose tissue area were 1.81 ± 0.64 for males and 0.57 ± 0.79 for females (P = 0.16). Powers for subcutaneous adipose tissue area were 2.04 ± 0.42 for males and 0.81 ± 0.45 for females (P = 0.056). Powers for total abdominal adipose tissue area were 1.80 ± 0.46 for males and 0.76 ± 0.50 for females (P = 0.20). CONCLUSIONS Body composition measured by single-slice axial abdominal CT, particularly muscle area, scales to height with age-adjusted powers that are different than 2 and are distinct between males and females. These observations may have implications for the development of height-adjusted body composition indices in patients with cancer.
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Affiliation(s)
- Justin C Brown
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA, USA.,Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Bette J Caan
- Kaiser Permanente Northern California, Oakland, CA, USA
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Umlauff L, Weber M, Freitag N, Fairman CM, Heidenreich A, Bloch W, Schumann M. Dietary interventions to improve body composition in men treated with androgen deprivation therapy for prostate cancer: a solution for the growing problem? Prostate Cancer Prostatic Dis 2022; 25:149-158. [PMID: 34193946 PMCID: PMC9184277 DOI: 10.1038/s41391-021-00411-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) has adverse effects on body composition, including muscle wasting and body fat accumulation, which may be attenuated by nutrition therapy. This systematic review summarises available evidence on the effects of dietary interventions on lean mass, fat mass and body mass index (BMI) in men treated with ADT for prostate cancer. METHODS MEDLINE, Embase, Web of Science and ClinicalTrials.org were searched from inception through December 2020. We included all controlled trials evaluating effects of supplementation or dietary interventions on body composition in men with prostate cancer receiving continuous ADT. Methodological quality of the studies was assessed using the Cochrane Collaboration's risk of bias tool. Meta-analysis was performed using a random effects model to calculate standardised mean differences between intervention and comparator groups. (PROSPERO; CRD42020185777). RESULTS Eleven studies (n = 536 participants) were included. Seven studies investigated the effects of dietary advice interventions, e.g. individual or group counselling, and four studies included a nutritional supplement. Eight studies combined the dietary intervention with exercise. Nine studies reported sufficient data for inclusion in the meta-analysis. Dietary advice and supplementation interventions combined were not associated with significant changes in lean mass (0.05 kg; 95% CI: -0.17, 0.26; p = 0.674; n = 355), fat mass (-0.22 kg; 95% CI: -0.45, 0.01; p = 0.064; n = 336) or BMI (-0.16 kg*m-2; 95% CI: -0.37, 0.04; p = 0.121; n = 399). Dietary advice interventions alone were associated with a significant fat mass reduction (-0.29 kg; 95% CI: -0.54, -0.03; p = 0.028; n = 266). CONCLUSIONS Most studies were dietary advice interventions targeting caloric restriction, which showed the potential to reduce fat mass but did not increase lean mass in men treated with ADT. Future interventions should investigate whether a combination of dietary advice and protein supplementation with concomitant resistance exercise could counteract ADT-induced muscle wasting.
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Affiliation(s)
- Lisa Umlauff
- Department for Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Manuel Weber
- Department for Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Nils Freitag
- Department for Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
- Olympic Training Centre Berlin, Berlin, Germany
| | - Ciaran M Fairman
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Wilhelm Bloch
- Department for Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Moritz Schumann
- Department for Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany.
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Obesity and Pancreatic Cancer: Insight into Mechanisms. Cancers (Basel) 2021; 13:cancers13205067. [PMID: 34680216 PMCID: PMC8534007 DOI: 10.3390/cancers13205067] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Obesity is recognized as a chronic progressive disease and risk factor for many human diseases. The high and increasing number of obese people may underlie the expected increase in pancreatic cancer cases in the United States. There are several pathways discussed that link obesity with pancreatic cancer. Adipose tissue and adipose tissue-released factors may thereby play an important role. This review discusses selected mechanisms that may accelerate pancreatic cancer development in obesity. Abstract The prevalence of obesity in adults and children has dramatically increased over the past decades. Obesity has been declared a chronic progressive disease and is a risk factor for a number of metabolic, inflammatory, and neoplastic diseases. There is clear epidemiologic and preclinical evidence that obesity is a risk factor for pancreatic cancer. Among various potential mechanisms linking obesity with pancreatic cancer, the adipose tissue and obesity-associated adipose tissue inflammation play a central role. The current review discusses selected topics and mechanisms that attracted recent interest and that may underlie the promoting effects of obesity in pancreatic cancer. These topics include the impact of obesity on KRAS activity, the role of visceral adipose tissue, intrapancreatic fat, adipose tissue inflammation, and adipokines on pancreatic cancer development. Current research on lipocalin-2, fibroblast growth factor 21, and Wnt5a is discussed. Furthermore, the significance of obesity-associated insulin resistance with hyperinsulinemia and obesity-induced gut dysbiosis with metabolic endotoxemia is reviewed. Given the central role that is occupied by the adipose tissue in obesity-promoted pancreatic cancer development, preventive and interceptive strategies should be aimed at attenuating obesity-associated adipose tissue inflammation and/or at targeting specific molecules that mechanistically link adipose tissue with pancreatic cancer in obese patients.
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Fasting and Exercise in Oncology: Potential Synergism of Combined Interventions. Nutrients 2021; 13:nu13103421. [PMID: 34684421 PMCID: PMC8537603 DOI: 10.3390/nu13103421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/28/2022] Open
Abstract
Nutrition and exercise interventions are strongly recommended for most cancer patients; however, much debate exists about the best prescription. Combining fasting with exercise is relatively untouched within the oncology setting. Separately, fasting has demonstrated reductions in chemotherapy-related side effects and improved treatment tolerability and effectiveness. Emerging evidence suggests fasting may have a protective effect on healthy cells allowing chemotherapy to exclusively target cancer cells. Exercise is commonly recommended and attenuates treatment- and cancer-related adverse changes to body composition, quality of life, and physical function. Given their independent benefits, in combination, fasting and exercise may induce synergistic effects and further improve cancer-related outcomes. In this narrative review, we provide a critical appraisal of the current evidence of fasting and exercise as independent interventions in the cancer population and discuss the potential benefits and mechanisms of combined fasting and exercise on cardiometabolic, body composition, patient-reported outcomes, and cancer-related outcomes. Our findings suggest that within the non-cancer population combined fasting and exercise is a viable strategy to improve health-related outcomes, however, its safety and efficacy in the oncology setting remain unknown. Therefore, we also provide a discussion on potential safety issues and considerations for future research in the growing cancer population.
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Alifano M, Daffré E, Iannelli A, Brouchet L, Falcoz PE, Le Pimpec Barthes F, Bernard A, Pages PB, Thomas PA, Dahan M, Porcher R. The Reality of Lung Cancer Paradox: The Impact of Body Mass Index on Long-Term Survival of Resected Lung Cancer. A French Nationwide Analysis from the Epithor Database. Cancers (Basel) 2021; 13:cancers13184574. [PMID: 34572801 PMCID: PMC8471205 DOI: 10.3390/cancers13184574] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/27/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Obesity could have a protective effect in patients with lung cancer. We assessed the prognostic role of preoperative BMI on survival in patients who underwent lung resection for NSCLC. A total of 54,631 consecutive patients with resectable lung cancer within a 15-year period were extracted from Epithor (the French Society of Thoracic and Cardiovascular Surgery database). Patient subgroups were defined according to body mass index (BMI): underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2). Underweight was associated with lower survival (unadjusted HRs 1.24 (1.16-1.33)) compared to normal weight, whereas overweight and obesity were associated with improved survival (0.95 (0.92-0.98) and 0.88 (0.84-0.92), respectively). The impact of BMI was confirmed when stratifying for sex or Charlson comorbidities index (CCI). Among patients with obesity, a higher BMI was associated with improved survival. After adjusting for period of study, age, sex, WHO performance status, CCI, side of tumor, extent of resection, histologic type, and stage of disease, the HRs for underweight, overweight, and obesity were 1.51 (1.41-1.63), 0.84 (0.81-0.87), and 0.80 (0.76-0.84), respectively. BMI is a strong and independent predictor of survival in patients undergoing surgery for NSCLC.
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Affiliation(s)
- Marco Alifano
- Thoracic Surgery Department, Cochin Hospital, University of Paris, 75014 Paris, France;
- Correspondence:
| | - Elisa Daffré
- Thoracic Surgery Department, Cochin Hospital, University of Paris, 75014 Paris, France;
| | - Antonio Iannelli
- Digestive Surgery Unit, Archet 2 Hospital, University Hospital of Nice, 06108 Nice, France;
| | - Laurent Brouchet
- Thoracic Surgery Department, Hôpital Larrey, CHU Toulouse, 31000 Toulouse, France; (L.B.); (M.D.)
| | - Pierre Emmanuel Falcoz
- Thoracic Surgery Department, Nouvel Hôpital Civil de Strasbourg, University of Strasbourg, 67000 Strasbourg, France;
| | | | - Alain Bernard
- Thoracic Surgery Department, Dijon University Hospital, 21000 Dijon, France; (A.B.); (P.B.P.)
| | - Pierre Benoit Pages
- Thoracic Surgery Department, Dijon University Hospital, 21000 Dijon, France; (A.B.); (P.B.P.)
| | - Pascal Alexandre Thomas
- Thoracic Surgery Department, Hopital-Nord-APHM, Aix-Marseille University, 13005 Marseille, France;
| | - Marcel Dahan
- Thoracic Surgery Department, Hôpital Larrey, CHU Toulouse, 31000 Toulouse, France; (L.B.); (M.D.)
| | - Raphael Porcher
- Centre of Research Epidemiology and Statistics (CRESS), University of Paris, INSERM U1153, 75014 Paris, France;
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Boyle EA, Elliott JA, McIntyre TV, Barnes ME, Donlon NE, Umair M, Gillis AE, Ridgway PF. Body composition is associated with operative and oncologic outcomes in the management of retroperitoneal and trunk soft tissue sarcoma. Am J Surg 2021; 223:729-737. [PMID: 34389158 DOI: 10.1016/j.amjsurg.2021.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/27/2021] [Accepted: 08/03/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sarcopenia, myosteatosis and obesity in cancer may confer negative clinical outcomes, but their prevalence and impact among patients with retroperitoneal and trunk soft tissue sarcoma have not been systematically studied. The aim of this study was to determine body composition among patients with retroperitoneal and trunk sarcoma, and assess impact on operative and oncologic outcomes. METHODS Consecutive patients undergoing treatment with curative intent from 2009 to 2019 were studied. Subcutaneous fat area and visceral fat areas, intramuscular adipose, lean body mass and fat mass were determined at diagnosis by CT at L3. Univariable and multivariable linear, logistic and Cox proportional hazards regression were performed. RESULTS 95 patients (43.2% retroperitoneal, 48.4% trunk, 46.3% multivisceral resection) were studied. Visceral obesity was evident in 47.4%. Postoperative morbidity occurred in 25.9%, with preoperative radiotherapy (OR10.53 [95% CI 1.08-102.39], P = 0.042) and fat mass (OR1.41 [1.12-1.79], P = 0.004) independently predictive on multivariable analysis, while intramuscular adipose independently predicted inpatient LOS (P < 0.001), wound infection (P = 0.024, OR1.20 [1.02-1.40]) and major postoperative morbidity (P = 0.027, OR1.15 [1.02-1.31]). Increasing fat mass, subcutaneous fat area and intramuscular adipose were associated with greater tumor size (all P < 0.01), while intramuscular adipose predicted disease progression during neoadjuvant therapy (P = 0.024), and independently predicted disease specific survival (DSS) (P = 0.005, HR1.11 [1.03-1.20]) and overall survival (OS) on multivariable analysis (P < 0.001, HR1.19 [1.08-1.31]). CONCLUSION Visceral obesity is common in retroperitoneal and trunk sarcoma, and measures of adiposity are associated with adverse operative, but not oncologic outcomes. Myosteatosis is independently associated with postoperative morbidity and adverse oncologic outcomes. Body composition may represent a marker of risk among patients with retroperitoneal and trunk sarcoma.
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Affiliation(s)
- Ellen A Boyle
- Department of Surgery, Trinity College Dublin, and Tallaght University Hospital, Dublin, 24, Ireland
| | - Jessie A Elliott
- Department of Surgery, Trinity College Dublin, and Tallaght University Hospital, Dublin, 24, Ireland.
| | - Tom V McIntyre
- Department of Surgery, Trinity College Dublin, and Tallaght University Hospital, Dublin, 24, Ireland
| | - Melissa E Barnes
- Department of Surgery, Trinity College Dublin, and Tallaght University Hospital, Dublin, 24, Ireland
| | - Noel E Donlon
- Department of Surgery, Trinity College Dublin, and Tallaght University Hospital, Dublin, 24, Ireland
| | - Muhammad Umair
- Department of Surgery, Trinity College Dublin, and Tallaght University Hospital, Dublin, 24, Ireland
| | - Amy E Gillis
- Department of Surgery, Trinity College Dublin, and Tallaght University Hospital, Dublin, 24, Ireland
| | - Paul F Ridgway
- Department of Surgery, Trinity College Dublin, and Tallaght University Hospital, Dublin, 24, Ireland
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Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model. PLoS One 2021; 16:e0253696. [PMID: 34242241 PMCID: PMC8270162 DOI: 10.1371/journal.pone.0253696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The association of body mass index (BMI) and all-cause mortality is controversial, frequently referred to as a paradox. Whether the cause is metabolic factors or statistical biases is still controversial. We assessed the association of BMI and all-cause mortality considering a wide range of comorbidities and baseline mortality risk. Methods Retrospective cohort study of Olmsted County residents with at least one BMI measurement between 2000–2005, clinical data in the electronic health record and minimum 8 year follow-up or death within this time. The cohort was categorized based on baseline mortality risk: Low, Medium, Medium-high, High and Very-high. All-cause mortality was assessed for BMI intervals of 5 and 0.5 Kg/m2. Results Of 39,739 subjects (average age 52.6, range 18–89; 38.1% male) 11.86% died during 8-year follow-up. The 8-year all-cause mortality risk had a “U” shape with a flat nadir in all the risk groups. Extreme BMI showed higher risk (BMI <15 = 36.4%, 15 to <20 = 15.4% and ≥45 = 13.7%), while intermediate BMI categories showed a plateau between 10.6 and 12.5%. The increased risk attributed to baseline risk and comorbidities was more obvious than the risk based on BMI increase within the same risk groups. Conclusions There is a complex association between BMI and all-cause mortality when evaluated including comorbidities and baseline mortality risk. In general, comorbidities are better predictors of mortality risk except at extreme BMIs. In patients with no or few comorbidities, BMI seems to better define mortality risk. Aggressive management of comorbidities may provide better survival outcome for patients with body mass between normal and moderate obesity.
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Jiménez-Cortegana C, López-Saavedra A, Sánchez-Jiménez F, Pérez-Pérez A, Castiñeiras J, Virizuela-Echaburu JA, de la Cruz-Merino L, Sánchez-Margalet V. Leptin, Both Bad and Good Actor in Cancer. Biomolecules 2021; 11:913. [PMID: 34202969 PMCID: PMC8235379 DOI: 10.3390/biom11060913] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/04/2021] [Accepted: 06/12/2021] [Indexed: 02/06/2023] Open
Abstract
Leptin is an important regulator of basal metabolism and food intake, with a pivotal role in obesity. Leptin exerts many different actions on various tissues and systems, including cancer, and is considered as a linkage between metabolism and the immune system. During the last decades, obesity and leptin have been associated with the initiation, proliferation and progression of many types of cancer. Obesity is also linked with complications and mortality, irrespective of the therapy used, affecting clinical outcomes. However, some evidence has suggested its beneficial role, called the "obesity paradox", and the possible antitumoral role of leptin. Recent data regarding the immunotherapy of cancer have revealed that overweight leads to a more effective response and leptin may probably be involved in this beneficial process. Since leptin is a positive modulator of both the innate and the adaptive immune system, it may contribute to the increased immune response stimulated by immunotherapy in cancer patients and may be proposed as a good actor in cancer. Our purpose is to review this dual role of leptin in cancer, as well as trying to clarify the future perspectives of this adipokine, which further highlights its importance as a cornerstone of the immunometabolism in oncology.
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Affiliation(s)
- Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain; (C.J.-C.); (A.L.-S.); (F.S.-J.); (A.P.-P.)
| | - Ana López-Saavedra
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain; (C.J.-C.); (A.L.-S.); (F.S.-J.); (A.P.-P.)
| | - Flora Sánchez-Jiménez
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain; (C.J.-C.); (A.L.-S.); (F.S.-J.); (A.P.-P.)
| | - Antonio Pérez-Pérez
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain; (C.J.-C.); (A.L.-S.); (F.S.-J.); (A.P.-P.)
| | - Jesús Castiñeiras
- Urology Service, Virgen Macarena University Hospital, University of Seville, 41009 Sevilla, Spain;
| | - Juan A. Virizuela-Echaburu
- Medical Oncology Service, Virgen Macarena University Hospital, University of Seville, 41009 Sevilla, Spain; (J.A.V.-E.); (L.d.l.C.-M.)
| | - Luis de la Cruz-Merino
- Medical Oncology Service, Virgen Macarena University Hospital, University of Seville, 41009 Sevilla, Spain; (J.A.V.-E.); (L.d.l.C.-M.)
| | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology, and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, 41009 Seville, Spain; (C.J.-C.); (A.L.-S.); (F.S.-J.); (A.P.-P.)
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Drami I, Pring ET, Gould L, Malietzis G, Naghibi M, Athanasiou T, Glynne-Jones R, Jenkins JT. Body Composition and Dose-limiting Toxicity in Colorectal Cancer Chemotherapy Treatment; a Systematic Review of the Literature. Could Muscle Mass be the New Body Surface Area in Chemotherapy Dosing? Clin Oncol (R Coll Radiol) 2021; 33:e540-e552. [PMID: 34147322 DOI: 10.1016/j.clon.2021.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/07/2021] [Accepted: 05/21/2021] [Indexed: 12/25/2022]
Abstract
Chemotherapy dosing is traditionally based on body surface area calculations; however, these calculations ignore separate tissue compartments, such as the lean body mass (LBM), which is considered a big pool of drug distribution. In our era, colorectal cancer patients undergo a plethora of computed tomography scans as part of their diagnosis, staging and monitoring, which could easily be used for body composition analysis and LBM calculation, allowing for personalised chemotherapy dosing. This systematic review aims to evaluate the effect of muscle mass on dose-limiting toxicity (DLT), among different chemotherapy regimens used in colorectal cancer patients. This review was carried out according to the PRISMA guidelines. MEDLINE and EMBASE databases were searched from 1946 to August 2019. The primary search terms were 'sarcopenia', 'myopenia', 'chemotherapy toxicity', 'chemotherapy dosing', 'dose limiting toxicity', 'colorectal cancer', 'primary colorectal cancer' and 'metastatic colorectal cancer'. Outcomes of interest were - DLT and chemotoxicity related to body composition, and chemotherapy dosing on LBM. In total, 363 studies were identified, with 10 studies fulfilling the selection criteria. Seven studies were retrospective and three were prospective. Most studies used the same body composition analysis software but the chemotherapy regimens used varied. Due to marked study heterogeneity, quantitative data synthesis was not possible. Two studies described a toxicity cut-off value for 5-fluorouracil and one for oxaliplatin based on LBM. The rest of the studies showed an association between different body composition metrics and DLTs. Prospective studies are required with a larger colorectal cancer cohort, longitudinal monitoring of body composition changes during treatment, similar body composition analysis techniques, agreed cut-off values and standardised chemotherapy regimens. Incorporation of body composition analysis in the clinical setting will allow early identification of sarcopenic patients, personalised dosing based on their LBM and early optimisation of these patients undergoing chemotherapy.
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Affiliation(s)
- I Drami
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK; Department of Infectious Diseases, Imperial College London, School of Medicine St Mary's Hospital, London, UK.
| | - E T Pring
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK; Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - L Gould
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK; Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - G Malietzis
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - M Naghibi
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK; Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - T Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - R Glynne-Jones
- Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - J T Jenkins
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK; Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
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Association of BMI with Clinicopathological Features of Papillary Thyroid Cancer: A Systematic Review and Meta-Analysis. World J Surg 2021; 45:2805-2815. [PMID: 34136926 DOI: 10.1007/s00268-021-06193-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Papillary thyroid cancer (PTC) is the most common subtype of thyroid cancer. The incidence of PTC is rising in tandem with an obesity epidemic. Associations have been demonstrated between increased body mass index (BMI) and worse oncological outcomes in a number of malignancies. However, research on this topic in PTC to date has been inconsistent, often due to limited data. This study aimed to measure the association between BMI and potentially adverse clinicopathological features of PTC. METHODS A meta-analysis of studies reporting outcomes after surgical treatment of PTC was performed. PubMed, Embase and the Cochrane Library were searched systematically to identify studies which provided data on BMI and clinicopathologic features of PTC. Relevant data were extracted and synthesis performed using adjusted odds ratios where available and crude values when not. Data were analysed by inverse variance using random and fixed effects models. RESULTS Data on 35,237 patients from 15 studies met the criteria for inclusion. Obesity was associated with larger tumour size (MD = 0.17 cm [0.05, 0.29]), increased rates of multifocality (OR = 1.41 [1.16, 1.70]), extrathyroidal extension (OR = 1.70 [1.39, 2.07]) and nodal spread (OR = 1.18 [1.07, 1.30]). Associations were more pronounced as BMI increased. There was no association between BMI and bilaterality, vascular invasion or metastatic spread. CONCLUSION Increased BMI is significantly associated with multiple potentially adverse features of PTC. The effect on long-term oncological outcomes requires further evaluation.
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Visceral Obesity Promotes Lung Cancer Progression-Toward Resolution of the Obesity Paradox in Lung Cancer. J Thorac Oncol 2021; 16:1333-1348. [PMID: 34144926 DOI: 10.1016/j.jtho.2021.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Although obesity is associated with adverse cancer outcomes in general, most retrospective clinical studies suggest a beneficial effect of obesity in NSCLC. METHODS Hypothesizing that this "obesity paradox" arises partly from the limitations of using body mass index (BMI) to measure obesity, we quantified adiposity using preoperative computed tomography images. This allowed the specific determination of central obesity as abdominal visceral fat area normalized to total fat area (visceral fat index [VFI]). In addition, owing to the previously reported salutary effect of metformin on high-BMI patients with lung cancer, metformin users were excluded. We then explored associations between visceral obesity and outcomes after surgical resection of stage I and II NSCLC. We also explored potential immunologic underpinnings of such association using complimentary analyses of tumor gene expression data from NSCLC tumors and the tumor transcriptome and immune microenvironment in an immunocompetent model of lung cancer with diet-induced obesity. RESULTS We found that in 513 patients with stage I and II NSCLC undergoing lobectomy, a high VFI is associated with decreased recurrence-free and overall survival. VFI was also inversely related to an inflammatory transcriptomic signature in NSCLC tumors, consistent with observations made in immunocompetent murine models wherein diet-induced obesity promoted cancer progression while exacerbating elements of immune suppression in the tumor niche. CONCLUSIONS In all, this study uses multiple lines of evidence to reveal the adverse effects of visceral obesity in patients with NSCLC, which align with those found in animal models. Thus, the obesity paradox may, at least in part, be secondary to the use of BMI as a measure of obesity and the confounding effects of metformin use.
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Fernandez CJ, George AS, Subrahmanyan NA, Pappachan JM. Epidemiological link between obesity, type 2 diabetes mellitus and cancer. World J Methodol 2021; 11:23-45. [PMID: 34026577 PMCID: PMC8127420 DOI: 10.5662/wjm.v11.i3.23] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/02/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
There exists a complex interaction between obesity, type 2 diabetes mellitus (T2DM) and cancer, and an increase in the incidence of cancer is expected with the growing obesity-diabetes pandemic. The association of cancer with diabetes mellitus and obesity appears to be site-specific, the highest risk being for post-menopausal breast cancer, endometrial cancer, and colorectal cancer. Moreover, there is worsening of hyperglycaemia with the onset of cancer, evidencing a bi-directional link between cancer and diabetes mellitus and the need for monitoring for diabetes in cancer survivors. In this review, we look at the epidemiological evidence from observational studies and Mendelian randomization studies linking obesity, diabetes, and cancer, as well as the complex pathophysiological mechanisms involved, including insulin resistance with associated hyperinsulinaemia, the effect of chronic low-grade inflammation, and the effect of various adipokines that are associated with obesity and T2DM. Additionally, we describe the novel therapeutic strategies, based on their role on the discrete pathophysiological mechanisms involved in the tumourigenesis.
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Affiliation(s)
- Cornelius J Fernandez
- Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Annu Susan George
- Department of Medical Oncology, VPS Lakeshore Hospital, Cochin 682040, India
| | | | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
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Anderson AS, Martin RM, Renehan AG, Cade J, Copson ER, Cross AJ, Grimmett C, Keaver L, King A, Riboli E, Shaw C, Saxton JM. Cancer survivorship, excess body fatness and weight-loss intervention-where are we in 2020? Br J Cancer 2021; 124:1057-1065. [PMID: 33235316 PMCID: PMC7961062 DOI: 10.1038/s41416-020-01155-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/24/2020] [Accepted: 10/22/2020] [Indexed: 01/29/2023] Open
Abstract
Earlier diagnosis and more effective treatments mean that the estimated number of cancer survivors in the United Kingdom is expected to reach 4 million by 2030. However, there is an increasing realisation that excess body fatness (EBF) is likely to influence the quality of cancer survivorship and disease-free survival. For decades, the discussion of weight management in patients with cancer has been dominated by concerns about unintentional weight loss, low body weight and interventions to increase weight, often re-enforced by the existence of the obesity paradox, which indicates that high body weight is associated with survival benefits for some types of cancer. However, observational evidence provides strong grounds for testing the hypothesis that interventions for promoting intentional loss of body fat and maintaining skeletal muscle in overweight and obese cancer survivors would bring important health benefits in terms of survival outcomes and long-term impact on treatment-related side effects. In this paper, we outline the need for studies to improve our understanding of the health benefits of weight-loss interventions, such as hypocaloric healthy-eating plans combined with physical activity. In particular, complex intervention trials that are pragmatically designed are urgently needed to develop effective, clinically practical, evidence-based strategies for reducing EBF and optimising body composition in people living with and beyond common cancers.
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Affiliation(s)
- Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Division of Population Health & Genomics, University of Dundee Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Richard M Martin
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, G11, Stead House, University of Leeds, Leeds, LS2 9JT, UK
| | - Ellen R Copson
- Wessex Genomic Medicine Centre, Cancer Sciences Academic Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Laura Keaver
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, F91 YW50, Ireland
| | - Angela King
- NIHR Cancer and Nutrition Collaboration, Level E and Pathology Block (mailpoint 123), Southampton General Hospital, Tremona Road, Southampton, SO 16 6YD, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Clare Shaw
- Biomedical Research Centre at The Royal Marsden and the Institute of Cancer Research, Fulham Road, London, SW3 6JJ, UK
| | - John M Saxton
- Department of Sport, Exercise & Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Northumberland Building, Newcastle upon Tyne, NE1 8ST, UK
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Jiang M, Fares AF, Shepshelovich D, Yang P, Christiani D, Zhang J, Shiraishi K, Ryan BM, Chen C, Schwartz AG, Tardon A, Shete S, Schabath MB, Teare MD, Le Marchand L, Zhang ZF, Field JK, Brenner H, Diao N, Xie J, Kohno T, Harris CC, Wenzlaff AS, Fernandez-Tardon G, Ye Y, Taylor F, Wilkens LR, Davies M, Liu Y, Barnett MJ, Goodman GE, Morgenstern H, Holleczek B, Thomas S, Brown MC, Hung RJ, Xu W, Liu G. The relationship between body-mass index and overall survival in non-small cell lung cancer by sex, smoking status, and race: A pooled analysis of 20,937 International lung Cancer consortium (ILCCO) patients. Lung Cancer 2021; 152:58-65. [PMID: 33352384 PMCID: PMC8042597 DOI: 10.1016/j.lungcan.2020.11.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The relationship between Body-Mass-Index (BMI) and lung cancer prognosis is heterogeneous. We evaluated the impact of sex, smoking and race on the relationship between BMI and overall survival (OS) in non-small-cell-lung-cancer (NSCLC). METHODS Data from 16 individual ILCCO studies were pooled to assess interactions between BMI and the following factors on OS: self-reported race, smoking status and sex, using Cox models (adjusted hazard ratios; aHR) with interaction terms and adjusted penalized smoothing spline plots in stratified analyses. RESULTS Among 20,937 NSCLC patients with BMI values, females = 47 %; never-smokers = 14 %; White-patients = 76 %. BMI showed differential survival according to race whereby compared to normal-BMI patients, being underweight was associated with poor survival among white patients (OS, aHR = 1.66) but not among black patients (aHR = 1.06; pinteraction = 0.02). Comparing overweight/obese to normal weight patients, Black NSCLC patients who were overweight/obese also had relatively better OS (pinteraction = 0.06) when compared to White-patients. BMI was least associated with survival in Asian-patients and never-smokers. The outcomes of female ever-smokers at the extremes of BMI were associated with worse outcomes in both the underweight (pinteraction<0.001) and obese categories (pinteraction = 0.004) relative to the normal-BMI category, when compared to male ever-smokers. CONCLUSION Underweight and obese female ever-smokers were associated with worse outcomes in White-patients. These BMI associations were not observed in Asian-patients and never-smokers. Black-patients had more favorable outcomes in the extremes of BMI when compared to White-patients. Body composition in Black-patients, and NSCLC subtypes more commonly seen in Asian-patients and never-smokers, may account for differences in these BMI-OS relationships.
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Affiliation(s)
- Mei Jiang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Aline F Fares
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Hospital de Base, São José do Rio Preto, São Paulo, Brazil
| | | | | | - David Christiani
- Environmental Health Department, Harvard TH Chan School of Public Health and Harvard Medical School, Boston, MA, USA
| | - Jie Zhang
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, USA; Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Research Institute, Tokyo, Japan
| | - Brid M Ryan
- Centre for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Chu Chen
- Program in Epidemiology, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Epidemiology and Department of Otolaryngology: Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Ann G Schwartz
- Barbara Ann Karmanos Cancer Institute, Wayne State University Detroit, MI, USA
| | | | - Sanjay Shete
- University of Texas MD Anderson Cancer Center, Texas, USA
| | | | | | | | - Zuo-Feng Zhang
- University of California Los Angeles School of Public Health, CA, USA
| | - John K Field
- The Roy Castle Lung Cancer Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nancy Diao
- Environmental Health Department, Harvard TH Chan School of Public Health and Harvard Medical School, Boston, MA, USA
| | - Juntao Xie
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Takashi Kohno
- Division of Genome Biology, National Cancer Research Institute, Tokyo, Japan
| | - Curtis C Harris
- Centre for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Angela S Wenzlaff
- Barbara Ann Karmanos Cancer Institute, Wayne State University Detroit, MI, USA
| | | | - Yuanqing Ye
- University of Texas MD Anderson Cancer Center, Texas, USA
| | | | | | - Michael Davies
- The Roy Castle Lung Cancer Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - Yi Liu
- Mayo Clinic, Rochester, MI, USA; PLA Hospital, Beijing, China
| | - Matt J Barnett
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Sera Thomas
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - M Catherine Brown
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Departments of Medical Biophysics, Pharmacology and Toxicity, and IMS, University of Toronto, Toronto, ON, Canada.
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Oh H, Kwak SY, Jo G, Lee J, Park D, Lee DH, Keum N, Lee JT, Giovannucci EL, Shin MJ. Adiposity and mortality in Korean adults: a population-based prospective cohort study. Am J Clin Nutr 2021; 113:142-153. [PMID: 33037431 DOI: 10.1093/ajcn/nqaa258] [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: 02/05/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Asia-Pacific obesity classification recommends using lower BMI cutoffs in Asians compared with those in Western populations. However, the supporting evidence is scarce and little is known about the exact shape of the relations between adiposity and mortality in Asians. OBJECTIVES We investigated the relations of BMI (in kg/m2), waist circumference, and predicted body fat mass with mortality using a population-based prospective cohort of Korean men and women. METHODS This analysis included 44,060 Korea National Health and Nutrition Examination Survey 2007-2014 participants who agreed to mortality follow-up through 31 December, 2016. At baseline, height, weight, and waist circumference were measured. Using DXA data, we derived predicted body fat and fat-free mass. Cox proportional hazards models were used to estimate HRs and 95% CIs for the associations with mortality, adjusting for potential confounders. We tested for nonlinearity using the likelihood ratio test comparing nonlinear restricted cubic spline models with linear models. RESULTS During ≤9.5 y of follow-up, 1682 deaths were identified. The relations of BMI with all-cause and cardiovascular mortality were J-shaped with the nadir at BMI = 25.0-29.9 (P-nonlinearity < 0.001). Among participants without a history of cancer or cardiovascular disease, waist circumference (≥95 compared with 75.0-79.9 cm: HR: 2.10; 95% CI: 1.54, 2.86) and predicted body fat mass (highest compared with lowest sextiles: 2.55; 95% CI: 1.60, 4.06) were positively associated with all-cause mortality (all P-nonlinearity ≤ 0.03), as well as cancer and cardiovascular mortality. The highest mortality was observed among participants who had both high predicted fat mass and low fat-free mass. CONCLUSIONS Our data suggest a strong positive association between adiposity and mortality in a population without pre-existing disease. We observed the lowest mortality at BMI = 25.0-29.9, suggesting that the current cutoff for overweight (BMI ≥23) may require re-evaluation and that BMI alone may not be a useful measure for indicating adiposity in Asians.
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Affiliation(s)
- Hannah Oh
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea.,Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - So-Young Kwak
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Garam Jo
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Juhee Lee
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Dahyun Park
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Dong Hoon Lee
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - NaNa Keum
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Food Science and Biotechnology, Dongguk University, Goyang, Republic of Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea.,Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Edward L Giovannucci
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Min-Jeong Shin
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea.,Division of Biosystems and Biomedical Sciences, College of Health Sciences, Korea University, Seoul, Republic of Korea
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Sanchez A, Furberg H. Understanding the obesity paradox in cancer: looking to body composition and tumor-specific biology to understand this complex association. Am J Clin Nutr 2021; 113:1-2. [PMID: 33236039 DOI: 10.1093/ajcn/nqaa317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alejandro Sanchez
- Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Looijaard SMLM, Te Lintel Hekkert ML, Wüst RCI, Otten RHJ, Meskers CGM, Maier AB. Pathophysiological mechanisms explaining poor clinical outcome of older cancer patients with low skeletal muscle mass. Acta Physiol (Oxf) 2021; 231:e13516. [PMID: 32478975 PMCID: PMC7757176 DOI: 10.1111/apha.13516] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 12/14/2022]
Abstract
Low skeletal muscle mass is highly prevalent in older cancer patients and affects 5% to 89% depending on the type and stage of cancer. Low skeletal muscle mass is associated with poor clinical outcomes such as post-operative complications, chemotherapy toxicity and mortality in older cancer patients. Little is known about the mediating pathophysiological mechanisms. In this review, we summarize proposed pathophysiological mechanisms underlying the association between low skeletal muscle mass and poor clinical outcomes in older cancer patients including a) systemic inflammation; b) insulin-dependent glucose handling; c) mitochondrial function; d) protein status and; e) pharmacokinetics of anticancer drugs. The mechanisms of altered myokine balance negatively affecting the innate and adaptive immune system, and altered pharmacokinetics of anticancer drugs leading to a relative overdosage of anticancer drugs are best-substantiated. The effects of glucose intolerance and circulating mitochondrial DNA as a consequence of low skeletal muscle mass are topics of interest for future research. Restoring myokine balance through physical exercise, exercise mimetics, neuro-muscular activation and adapting anticancer drug dosing on skeletal muscle mass could be targeted approaches to improve clinical outcomes in older cancer patients with low skeletal muscle mass.
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Affiliation(s)
- Stéphanie M L M Looijaard
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Miriam L Te Lintel Hekkert
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Rob C I Wüst
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - René H J Otten
- University Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
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45
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Morgan PT, Smeuninx B, Breen L. Exploring the Impact of Obesity on Skeletal Muscle Function in Older Age. Front Nutr 2020; 7:569904. [PMID: 33335909 PMCID: PMC7736105 DOI: 10.3389/fnut.2020.569904] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022] Open
Abstract
Sarcopenia is of important clinical relevance for loss of independence in older adults. The prevalence of obesity in combination with sarcopenia ("sarcopenic-obesity") is increasing at a rapid rate. However, whilst the development of sarcopenia is understood to be multi-factorial and harmful to health, the role of obesity from a protective and damaging perspective on skeletal muscle in aging, is poorly understood. Specifically, the presence of obesity in older age may be accompanied by a greater volume of skeletal muscle mass in weight-bearing muscles compared with lean older individuals, despite impaired physical function and resistance to anabolic stimuli. Collectively, these findings support a potential paradox in which obesity may protect skeletal muscle mass in older age. One explanation for these paradoxical findings may be that the anabolic response to weight-bearing activity could be greater in obese vs. lean older individuals due to a larger mechanical stimulus, compensating for the heightened muscle anabolic resistance. However, it is likely that there is a complex interplay between muscle, adipose, and external influences in the aging process that are ultimately harmful to health in the long-term. This narrative briefly explores some of the potential mechanisms regulating changes in skeletal muscle mass and function in aging combined with obesity and the interplay with sarcopenia, with a particular focus on muscle morphology and the regulation of muscle proteostasis. In addition, whilst highly complex, we attempt to provide an updated summary for the role of obesity from a protective and damaging perspective on muscle mass and function in older age. We conclude with a brief discussion on treatment of sarcopenia and obesity and a summary of future directions for this research field.
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Affiliation(s)
- Paul T. Morgan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Benoit Smeuninx
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Cellular & Molecular Metabolism Laboratory, Monash Institute of Pharmacological Sciences, Monash University, Parkville, VIC, Australia
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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46
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Wilson RL, Shannon T, Calton E, Galvão DA, Taaffe DR, Hart NH, Lyons-Wall P, Newton RU. Efficacy of a weight loss program prior to robot assisted radical prostatectomy in overweight and obese men with prostate cancer. Surg Oncol 2020; 35:182-188. [DOI: 10.1016/j.suronc.2020.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/03/2020] [Accepted: 08/02/2020] [Indexed: 12/24/2022]
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47
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Kałędkiewicz E, Milewska M, Panczyk M, Szostak-Węgierek D. The Prevalence of Sarcopenic Obesity in Postmenopausal Women with a History of Breast Cancer Depending on Adopted Methodology - A Case-Control Study. J Multidiscip Healthc 2020; 13:1749-1758. [PMID: 33281453 PMCID: PMC7708830 DOI: 10.2147/jmdh.s274660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/22/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Sarcopenic obesity (SO) is characterized as the cooccurrence of sarcopenia and obesity. It is associated with many adverse health consequences, also in oncological patients. The study aimed to assess the prevalence of SO in postmenopausal women with a history of breast cancer depending on adopted methodology. Materials and Methods The case–control study enrolled 103 women over the age of 50 with a history of breast cancer, including women who completed oncological treatment and had remained in remission for at least 5 years (group I, n=78) and women in whom the disease recurred (group II, n=25). The control group included women with no history of breast cancer (group III, n=73). Results In group II sarcopenia occurred significantly more commonly compared to both group I and the control group (for the skeletal muscle index (SMI) ≤29.20%: 13 (52%) in group II vs 16 (20.5%) in group I, p=0.004 and 3 (4.1%) in group III, p<0.001; for SMI ≤26.60%: 10 (40%) in group II vs 9 (11.5%) in group I, p=0.003 and 3 (4.1%) in group III, p<0.001; for SMI ≤33.87%: 17 (68%) in group II vs 21 (26.9%) in group I, p<0.001 and 5 (6.8%) in group III, p<0.001). Depending on the assessment criteria, SO was diagnosed in 0–11.5% of cases in group I, 0–40% of cases in group II and 0–4.1% in the control group. Intergroup differences were not statistically significant, irrespective of the adopted pair of diagnostic criteria. The highest detectability of SO was observed when SMI was combined with each of the diagnostic criteria for obesity used. Discussion SO diagnosis based on the percentage of fatty tissue mass in the body of >38% and SMI value were associated with a higher detection rate of SO in each study group, regardless of the adopted cut-off value. Similar results were obtained in each analyzed group when using the remaining diagnostic criteria for obesity and SMI value, regardless of the cut-off value.
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Affiliation(s)
- Emilia Kałędkiewicz
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Milewska
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
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48
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Prognostic Value of Sarcopenia for Long-Term Mortality in Extracorporeal Membrane Oxygenation for Acute Respiratory Failure. ASAIO J 2020; 66:367-372. [PMID: 31045922 DOI: 10.1097/mat.0000000000001006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
It is unclear whether sarcopenia is responsible for long-term mortality in patients who require extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. We retrospectively reviewed 127 patients who underwent computed tomography imaging before initiating ECMO from June 2014 to November 2017. The patients were divided into two groups according to the skeletal muscle index (SMI): low SMI (n = 47) and high SMI (n = 80). Mean age was lower in the high SMI group than in the low SMI group (60.2 vs. 53.9 years, p = 0.002). Mean body mass index was higher in the high SMI group than in the low SMI group (21.6 vs. 24.1 kg/m, p = 0.001). The mean Charlson comorbidity index (CCI) was lower in the high SMI group than in the low SMI group (3.0 vs. 2.2, p = 0.024). After propensity score matching for age and CCI score, no differences were observed in ECMO weaning success rate or hospital mortality between the two groups. However, the 1 year mortality rate was higher in the low SMI group than in the high SMI group (70.2% vs. 46.8%, p = 0.021). Multivariate analyses showed that renal replacement therapy (odds ratio [OR] 3.99, 95% confidence interval [CI] 1.74-9.13, p = 0.001) and low SMI (OR 5.47, 95% CI 2.31-12.98, p < 0.001) were associated with 1 year mortality. Kaplan-Meier analyses revealed that a low SMI predicted mortality (χ = 13.20, p < 0.001). Sarcopenia predicted worse 1 year mortality in patients who underwent respiratory ECMO.
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49
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A paradox between preoperative overweight/obesity and change in weight during postoperative chemotherapy and its relationship to survival in stage Ⅱ and Ⅲ colorectal cancer patients. Clin Nutr 2020; 40:2410-2419. [PMID: 33183882 DOI: 10.1016/j.clnu.2020.10.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/12/2020] [Accepted: 10/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS The roles of obesity and weight management in colorectal cancer (CRC) recurrence and survival have gained a considerable amount of attention. However, whether a change in weight affects the risk of recurrence and death remains unclear. METHODS A retrospective study was conducted using Kaplan-Meier curves, multivariable Cox proportional hazards models, and restricted cubic splines in 902 patients with stage Ⅱ and Ⅲ CRC to investigate the impact of the preoperative BMI and change in weight during postoperative chemotherapy on disease-free survival (DFS) and overall survival (OS). RESULTS The lowest risk of cancer events (recurrence/metastasis and new CRC cases) and death occurred in patients who had a normal weight (BMI range from 18.5 to 23.9 kg/m2) or had weight gain of < 5%; the patients who were underweight (BMI ≤ 18.5 kg/m2) or overweight/obese (BMI ≥ 24.0 kg/m2) and had weight loss or weight gain of ≥ 5% had a higher risk of cancer events and death. The association between preoperative BMI and the risk of cancer events and death exhibited U-shaped curves; the inflection points were at BMI = 24 kg/m2 and BMI = 25 kg/m2 for the risk of cancer events and death, respectively. The association between the change in weight and risk of death also exhibited a U-shaped curve, while the association between the change in weight and risk of cancer events was nearly linear. Multivariable Cox proportional hazards models showed that the preoperative BMI and change in weight played bidirectional roles in both the OS and DFS. CONCLUSIONS An obesity paradox exists in patients with CRC, with both weight loss and excessive weight gain being detrimental. Patients with CRC may require a reasonable weight management program, and gaining < 5% of the preoperative weight might be an appropriate goal at 6 months after surgery.
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Petrova MP, Donev IS, Radanova MA, Eneva MI, Dimitrova EG, Valchev GN, Minchev VT, Taushanova MS, Boneva MV, Karanikolova TS, Gencheva RB, Zhbantov GA, Ivanova AI, Timcheva CV, P Pavlov B, Megdanova VG, Robev BS, Conev NV. Sarcopenia and high NLR are associated with the development of hyperprogressive disease after second-line pembrolizumab in patients with non-small-cell lung cancer. Clin Exp Immunol 2020; 202:353-362. [PMID: 32757277 DOI: 10.1111/cei.13505] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022] Open
Abstract
The aim of this multi-center retrospective study was to evaluate the incidence of hyperprogressive disease (HPD) after second-line treatment with pembrolizumab in patients (n = 167) with metastatic non-small-cell lung cancer (NSCLC) whose tumors expressed programmed cell death ligand 1 (PD-L1) in ≥ 1% and to search for hematological and imaging biomarkers associated with its development. Prior to chemotherapy, neutrophil : lymphocyte ratio (NLR1) and platelet : lymphocyte ratio (PLR1), and prior to immunotherapy, NLR2 and PLR2 were retrospectively analyzed. The psoas major muscle area (PMMA) was calculated at the L3 position on computed tomography before chemotherapy (PMMA1) and before immunotherapy (PMMA2) (n = 112). Patients with ∆PMMA (1-PMMA2/PMMA1) × 100 ≥ 10% were considered to have sarcopenia (low muscle mass). After treatment with pembrolizumab on the first computerized tomography (CT) scan evaluation, patients were subdivided as follows as: hyperprogressors (HPs), progressors (Ps), non-progressors (NPs) and pseudoprogressors (PPs). HPs had significantly higher ∆PMMA levels, NLR2 and PLR2 than the other patients. Moreover, in multinomial logistic regression analysis, higher levels of ∆PMMA were associated with a decreased likelihood of being a P [odds ratio (OR) = 0·81; 95% confidence interval (CI) = 0·65-0·99; P = 0·047] or an NP (OR = 0·76; 95% CI = 0·62-0·94; P = 0·012) versus an HP. Higher NLRs tended to decrease the likelihood of being a P versus an HP (OR = 0·66; 95% CI = 0·42-1·06; P = 0·09) and significantly decreased the likelihood of being an NP versus an HP (OR = 0·44; 95% CI = 0·28-0·69; P < 0·0001). Our data suggest that a high pre-immunotherapy NLR2 and the presence of sarcopenia are potential risk factors for the development of HPD.
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Affiliation(s)
- M P Petrova
- Clinic of Medical Oncology, MHAT 'Nadezhda', Sofia, Bulgaria
| | - I S Donev
- Clinic of Medical Oncology, MHAT 'Nadezhda', Sofia, Bulgaria
| | - M A Radanova
- Department of Biochemistry and Molecular Medicine, Medical University of Varna, Varna, Bulgaria
| | - M I Eneva
- Hospital Pharmacy 'Nadezhda', Sofia, Bulgaria
| | - E G Dimitrova
- Clinic of Medical Oncology, UMHAT 'St Marina', Varna, Bulgaria
| | - G N Valchev
- Radiology Department, UMHAT 'St Marina', Varna, Bulgaria
| | - V T Minchev
- Department of Medical Oncology, University Hospital Sofiamed, Sofia, Bulgaria
| | - M S Taushanova
- Department of Medical Oncology, University Hospital Sofiamed, Sofia, Bulgaria
| | - M V Boneva
- Radiology Department, University Hospital Sofiamed, Sofia, Bulgaria
| | | | - R B Gencheva
- Clinic of Medical Oncology, MHAT 'Nadezhda', Sofia, Bulgaria
| | - G A Zhbantov
- Clinic of Medical Oncology, MHAT 'Nadezhda', Sofia, Bulgaria
| | - A I Ivanova
- Clinic of Medical Oncology, MHAT 'Nadezhda', Sofia, Bulgaria
| | - C V Timcheva
- Clinic of Medical Oncology, MHAT 'Nadezhda', Sofia, Bulgaria
| | - B P Pavlov
- Radiology Department, MHAT 'Nadezhda', Sofia, Bulgaria
| | - V G Megdanova
- Deparment of Medical Oncology, UMHAT 'St Giovanna', Sofia, Bulgaria
| | - B S Robev
- Oncology Unit, University Hospital 'St Ivan Rilski', Sofia, Bulgaria
| | - N V Conev
- Clinic of Medical Oncology, UMHAT 'St Marina', Varna, Bulgaria
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