Prognostic influence of body mass index and body weight gain during adjuvant FOLFOX chemotherapy in Korean colorectal cancer patients

Post-diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis

The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.

Incentives for Innovation in Robotics and Automated Construction: Based on a Tripartite Evolutionary Game Analysis

The current construction industry faces many challenges, such as low productivity, low material application rates, and poor environmental benefits. Robotic and automated construction (RAAC) technologies represent a breakthrough from traditional construction methods and are considered an effective way to improve productivity, ecological efficiency, and sustainability in the construction industry. However, the high cost of research and development and the lack of investment in the construction field have discouraged Chinese construction companies from innovating. In this paper, an evolutionary game model between the government, construction firms, and public universities is constructed around the choice of RAAC innovation, and the evolutionary stabilization strategy (ESS) of the three parties is discussed. Establishing a compound incentive policy of financial and reputational rewards and increasing the share of RAAC scores in academic evaluations can accelerate the realization of ESS among the government, construction companies, and public universities. This study informs policymakers to develop RAAC innovation strategies, and stakeholders such as the government, construction companies, and public universities should consider and jointly promote the development and application of RAAC technologies to improve productivity and environmental sustainability in the construction industry.

Body mass index and body weight change during adjuvant chemotherapy in colon cancer patients: results from the AVANT trial

While obesity increases colorectal cancer incidence, there are inconsistent results in the prognostic role of obesity or body weight change on survival. This study investigated the prognostic impact of body weight and weight change in stage III or high risk stage II colon cancer patients. We used data from patients enrolled in the phase III AVANT trial. The AVANT trial investigated the efficacy of adding bevacizumab to standard adjuvant chemotherapy (FOFOX or XELOX). Weight change during the first 6 months of adjuvant chemotherapy was measured. Cox proportional hazard model was used to assess the prognostic influence of body weight and weight change. Among 3451 intention-to-treat population, body weight and weight change was measured in 3449 (99.9%) and 2455 (71.1%) patients, respectively. Among 2455 patients, 651 (26.5%) had weight gain over 5 kg and 179 (7.3%) had weight loss over 5 kg. Weight gain was more frequently observed in Asian and male. Neither baseline BMI nor weight change affected recurrence or survival in the Cox proportional hazard model.

Impact of adiposity on staging and prognosis of colorectal cancer

Abdominal visceral fat is a well-recognized a risk for colorectal cancer (CRC). In contrast to the risk for CRC, the impact of adiposity in disease staging and patient survival is less well-established. Our aim was to critically review the literature on the influence of adiposity assessed by different methods routinely used in clinical settings, on CRC staging and prognosis. In the 32 studies reviewed, overweight was initially identified as a survival advantage, an evidence that was later challenged by studies suggesting that body adiposity is likely to have a deleterious effect in CRC outcomes, particularly in males. Hence, whether obesity has a negative impact in CRC staging or prognosis remains controversial. In sum, addressing the impact of body fat in CRC biological behavior is still an unmet need. Understanding how adiposity influences CRC staging and prognosis could allow further patient risk stratification for devising targeted interventions and improve clinical outcomes.

Pre-to-post diagnosis weight trajectories in colorectal cancer patients with non-metastatic disease

PURPOSE

Previous studies have shown that > 50% of colorectal cancer (CRC) patients treated with adjuvant chemotherapy gain weight after diagnosis. This may affect long-term health. Therefore, prevention of weight gain has been incorporated in oncological guidelines for CRC with a focus on patients that undergo adjuvant chemotherapy treatment. It is, however, unknown how changes in weight after diagnosis relate to weight before diagnosis and whether weight changes from pre-to-post diagnosis are restricted to chemotherapy treatment. We therefore examined pre-to-post diagnosis weight trajectories and compared them between those treated with and without adjuvant chemotherapy.

METHODS

We included 1184 patients diagnosed with stages I-III CRC between 2010 and 2015 from an ongoing observational prospective study. At diagnosis, patients reported current weight and usual weight 2 years before diagnosis. In the 2 years following diagnosis, weight was self-reported repeatedly. We used linear mixed models to analyse weight trajectories.

RESULTS

Mean pre-to-post diagnosis weight change was -0.8 (95% CI -1.1, -0.4) kg. Post-diagnosis weight gain was + 3.5 (95% CI 2.7, 4.3) kg in patients who had lost ≥ 5% weight before diagnosis, while on average clinically relevant weight gain after diagnosis was absent in the groups without pre-diagnosis weight loss. Pre-to-post diagnosis weight change was similar in patients treated with (-0.1 kg (95%CI -0.8, 0.6)) and without adjuvant chemotherapy (-0.9 kg (95%CI -1.4, -0.5)).

CONCLUSIONS

Overall, hardly any pre-to-post diagnosis weight change was observed among CRC patients, because post-diagnosis weight gain was mainly observed in patients who lost weight before diagnosis. This was observed independent of treatment with adjuvant chemotherapy.

Pancreatic Cancer and Obesity: Molecular Mechanisms of Cell Transformation and Chemoresistance

Cancer and obesity are the two major epidemics of the 21st century. Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of death, with a five-year overall survival rate of only 8%. Its incidence and mortality have increased in recent years, and this cancer type is expected to be among the top five leading causes of cancer-related death by 2030 in the United States (US). In the last three decades, the prevalence of overweight people has boosted with a consequent increase in obesity-related diseases. Considerable epidemiologic evidence correlates overweight and obese conditions to an increased risk of several types of cancer, including PDAC. Besides being a risk factor for multiple metabolic disorders, the tumor-promoting effects of obesity occur at the local level via inflammatory mediators that are associated with adipose inflammation and metabolic or hormones mediators and microbiota dysbiosis. Although an excess of body mass index (BMI) represents the second most modifiable risk factor for PDAC with an increased cancer related-death of more than 20–40%, still little is known about the molecular mechanisms that underlie this strong association. In this review, we focused on the role of obesity as a preventable risk factor of PDAC, discussing the molecular mechanisms linking obesity to cancer initiation and progression. Moreover, we highlighted the role of obesity in defining chemoresistance, showing how a high BMI can actually reduce response to chemotherapy.

The relationship between body mass index changes during chemotherapy and prognosis of patients with advanced colorectal cancer: A retrospective cohort study

We investigated the relationships between body mass index change (ΔBMI) and prognoses and clinical effects of patients with advanced colorectal cancer (CRC).From January 2008 to December 2012, 224patients with stage IV CRC were diagnosed in our hospital, and their clinical and pathological data were collected for this retrospective study. These patients were divided into lowΔ BMI group (ΔBMI ≤-0.45 kg/m) and high ΔBMI (ΔBMI >-0.45 kg/m) group.After 2 cycles of chemotherapy, there were no significant differences between prediagnosis BMI, ΔBMI, and clinical effects (P = .196; P = .59).There was also no significant difference in median progression-free survival of the high ΔBMI and low ΔBMI groups (P = .530). The overall survival (OS) time of the high ΔBMI group was significantly longer than that of the low ΔBMI group (P = .002). Family history (P = .041), eastern cooperative oncology group performance status (ECOG PS) score (P = .001), ΔBMI (P = .023), and carcinoembryonic antigen, (P = 0.02) were independent predictive factors of OS rates in patients with CRC. The relative risk was 0.72-fold for patients with CRC patients with high ΔBMI levels, relative to those with lower ΔBMI levels.Our results demonstrate that ΔBMI decreases predict poor prognoses for patients with advanced CRC, and elevated ΔBMI was a predictive factor for high survival rate. Thus, ΔBMI appears to be an independent predictive factor of CRC survival rates.