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Liatsou E, Bellos I, Katsaros I, Michailidou S, Karela NR, Mantziari S, Rouvelas I, Schizas D. Sex differences in survival following surgery for esophageal cancer: A systematic review and meta-analysis. Dis Esophagus 2024:doae063. [PMID: 39137391 DOI: 10.1093/dote/doae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/25/2024] [Accepted: 08/03/2024] [Indexed: 08/15/2024]
Abstract
The impact of sex on the prognosis of patients with esophageal cancer remains unclear. Evidence supports that sex- based disparities in esophageal cancer survival could be attributed to sex- specific risk exposures, such as age at diagnosis, race, socioeconomic status, smoking, drinking, and histological type. The aim of our study is to investigate the role of sex disparities in survival of patients who underwent surgery for esophageal cancer. A systematic review and meta-analysis of the existing literature in PubMed, EMBASE, and CENTRAL from December 1966 to February 2023, was held. Studies that reported sex-related differences in survival outcomes of patients who underwent esophagectomy for esophageal cancer were identified. A total of 314 studies were included in the quantitative analysis. Statistically significant results derived from 1-year and 2-year overall survival pooled analysis with Relative Risk (RR) 0.93 (95% Confidence Interval (CI): 0.90-0.97, I2 = 52.00) and 0.90 (95% CI: 0.85-0.95, I2 = 0.00), respectively (RR < 1 = favorable for men). In the postoperative complications analysis, statistically significant results concerned anastomotic leak and heart complications, RR: 1.08 (95% CI: 1.01-1.16) and 0.62 (95% CI: 0.52-0.75), respectively. Subgroup analysis was performed among studies with <200 and > 200 patients, histology types, study continent and publication year. Overall, sex tends to be an independent prognostic factor for esophageal carcinoma. However, unanimous results seem rather obscure when multivariable analysis and subgroup analysis occurred. More prospective studies and gender-specific protocols should be conducted to better understand the modifying role of sex in esophageal cancer prognosis.
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Affiliation(s)
- Efstathia Liatsou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Bellos
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Styliani Michailidou
- First Department of Paediatric Surgery, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Nina-Rafailia Karela
- Second Department of Internal Medicine, Elpis General Hospital of Athens, Athens, Greece
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Ioannis Rouvelas
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Ansari SA, Suheb MZ, Rashid M, Maqsood MH, Rashid AM, Javaid SS, Siddiqi AK. Impact of Body Mass Index on outcomes in hospitalized heart failure patients with reduced versus preserved ejection fraction: a 1,699,494-individual analysis from the United States National Inpatient Sample. Minerva Cardiol Angiol 2024; 72:141-151. [PMID: 37800451 DOI: 10.23736/s2724-5683.23.06367-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND Obesity's effect on outcomes in heart failure (HF) patients with reduced versus maintained ejection fraction (HFrEF and HFpEF) remains debatable. We evaluated hospital outcomes and healthcare expenditures in these patients based on their Body Mass Index (BMI). METHODS Using the USA National Inpatient Sample (NIS) database, patients >18 years admitted with a primary diagnosis of HFrEF or HFpEF between January 1, 2004, and August 31, 2015, were studied. Patients were stratified into the following BMI categories: underweight, normal weight, overweight, obese, and morbidly obese. Adjusted multivariable analyses using Poisson regression models were used to study the association between BMI and hospital outcomes and healthcare costs. RESULTS Overall, 1,699,494 patients were included. After full adjustment, obesity (OR=1.84; 95% CI: 1.22-2.76) and morbid obesity (OR=1.81; 95% CI: 1.22-2.70) increased the odds of in-hospital mortality compared with normal weight. When stratified per ejection fraction, underweight patients had higher odds of in-hospital mortality in HFrEF (OR=1.46; 95% CI: 1.06-2.01). Obese and morbidly obese patients had higher odds of in-hospital mortality in both HFrEF and HFpEF. Furthermore, obese and morbidly obese patients had a longer mean adjusted length of stay and higher health care expenses. CONCLUSIONS Being underweight is associated with increased risk of in-hospital mortality in HFrEF patients. Obesity and morbid obesity increase the risk of in-hospital mortality and higher healthcare costs in both HFrEF and HFpEF. These findings have clinical significance for HF patients, and further research is needed to investigate the ideal weight for HF patients.
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Affiliation(s)
- Saad A Ansari
- Riverside School of Medicine, University of California, Riverside, CA, USA
| | | | - Muhammad Rashid
- Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | | | - Ahmed M Rashid
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan -
| | - Syed S Javaid
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Ahmed K Siddiqi
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
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Moukarzel LA, Ferrando L, Stylianou A, Lobaugh S, Wu M, Nobre SP, Iasonos A, Zoppoli G, Giri DD, Abu-Rustum NR, Broach VA, Iyengar NM, Weigelt B, Makker V. Impact of obesity and white adipose tissue inflammation on the omental microenvironment in endometrial cancer. Cancer 2022; 128:3297-3309. [PMID: 35793549 PMCID: PMC9976596 DOI: 10.1002/cncr.34356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND A complex relationship between adipose tissue and malignancy, involving an inflammatory response, has been reported. The goal of this work was to assess the prevalence of white adipose tissue (WAT) inflammation in patients with endometrial cancer (EC), and the association with circulating inflammation markers. Furthermore, the aim was to characterize the pathways activated in and the cell type composition of adipose tissue in patients with EC. METHODS Adipose tissue and blood samples were prospectively collected from 101 patients with EC at initial surgery. WAT inflammation was determined based on adipocytes surrounded by macrophages forming crown-like structures. Circulating levels of metabolic syndrome-associated and inflammatory markers were quantified. RNA-sequencing was performed on adipose samples (n = 55); differential gene expression, pathway, and cellular decomposition analyses were performed using state-of-the-art bioinformatics methods. RESULTS WAT inflammation was identified in 46 (45.5%) of 101 EC patients. Dyslipidemia, hypertension, and diabetes mellitus were significantly associated with WAT inflammation (p < .05). WAT inflammation was associated with greater body mass index (p < .001) and higher circulating levels of leptin, high-sensitivity C-reactive protein, and interleukin-6, as well as lower levels of adiponectin and sex hormone-binding globulin (p < .05). Transcriptomic analysis demonstrated increased levels of proinflammatory and pro-neoplastic-related gene expression in inflamed omental adipose tissue. CONCLUSIONS WAT inflammation is associated with metabolic syndrome, obesity, and inflammatory markers, as well as increased expression of proinflammatory and proneoplastic genes.
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Affiliation(s)
- Lea A. Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lorenzo Ferrando
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Anthe Stylianou
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Lobaugh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Wu
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Silvana Pedra Nobre
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gabriele Zoppoli
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Dilip D. Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nadeem R. Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of OB/GYN, Weill Cornell Medical College, New York, NY
| | - Vance A. Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of OB/GYN, Weill Cornell Medical College, New York, NY
| | - Neil M. Iyengar
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Britta Weigelt
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vicky Makker
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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The Impact of Morbid Obesity on the Health Outcomes of Hospital Inpatients: An Observational Study. J Clin Med 2021; 10:jcm10194382. [PMID: 34640400 PMCID: PMC8509550 DOI: 10.3390/jcm10194382] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Morbid obesity poses a significant burden on the health-care system. This study determined whether morbid obesity leads to worse health-outcomes in hospitalised patients. This retrospective-study examined nutritional data of all inpatients aged 18-79 years, with a body-mass-index (BMI) ≥ 18.5 kg/m2 admitted over a period of 4 years at two major hospitals in Australia. Patients were divided into 3 groups for comparison: normal/overweight (BMI 18.5-29.9 kg/m2), obese (BMI 30-39.9 kg/m2) and morbidly-obese (BMI ≥ 40 kg/m2). Outcome measures included length-of-hospital-stay (LOS), in-hospital mortality, and 30-day readmissions. Multilevel-mixed-effects regression was used to compare clinical outcomes between the groups after adjustment for potential confounders. Of 16,579 patients, 1004 (6.1%) were classified as morbidly-obese. Morbidly-obese patients had a significantly longer median (IQR) LOS than normal/overweight patients (5 (2, 12) vs. 5 (2, 11) days, p value = 0.012) and obese-patients (5 (2, 12) vs. 5 (2, 10) days, p value = 0.036). After adjusted-analysis, morbidly-obese patients had a higher incidence of a longer LOS than normal/overweight patients (IRR 1.04; 95% CI 1.02-1.07; p value < 0.001) and obese-patients (IRR 1.13; 95% CI 1.11-1.16; p value < 0.001). Other clinical outcomes were similar between the different groups. Morbid obesity leads to a longer LOS in hospitalised patients but does not adversely affect other clinical outcomes.
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Guven DC, Aksun MS, Cakir IY, Kilickap S, Kertmen N. The association of BMI and sarcopenia with survival in patients with glioblastoma multiforme. Future Oncol 2021; 17:4405-4413. [PMID: 34409854 DOI: 10.2217/fon-2021-0681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: The association between obesity and sarcopenia (via temporal muscle thickness) with overall survival (OS) has been evaluated in several glioblastoma multiforme studies, however, the data are inconclusive. Methods: The authors conducted meta-analyses via the generic inverse-variance method with a random-effects model. Results: In the pooled analysis of five studies, including 973 patients, patients with lower temporal muscle thickness had significantly decreased OS (HR: 1.62, 95% CI: 1.16-2.28, p = 0.005). The pooled analysis of five studies, including 2131 patients, demonstrated decreased OS in patients with lower BMI compared with patients with obesity (HR: 1.45, 95% CI: 1.12-1.88, p = 0.005). Conclusion: Readily available body composition parameters could be used for prognosis prediction and to aid in treatment decisions in patients with glioblastoma multiforme.
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Affiliation(s)
| | - Melek Seren Aksun
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ibrahim Yahya Cakir
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Saadettin Kilickap
- Hacettepe University Cancer Institute, Ankara 06100, Turkey.,Department of Medical Oncology, Istinye University, Istanbul 34010, Turkey
| | - Neyran Kertmen
- Hacettepe University Cancer Institute, Ankara 06100, Turkey
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Unintentional Weight Loss as a Marker of Malignancy Across Body Weight Categories. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wu J, Yang J, Lin X, Lin L, Jiang W, Xie C. Survival outcomes for patients with four treatments in stages I-III esophageal squamous cell carcinoma: a SEER analysis. Transl Cancer Res 2021; 10:2144-2152. [PMID: 35116534 PMCID: PMC8798536 DOI: 10.21037/tcr-20-2995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Esophageal cancer (EC) is globally acknowledged as one of the most common malignancies among all gastrointestinal cancers. Furthermore, in Eastern Asia, squamous cell carcinoma is the main pathological type of EC. There are different treatments for esophageal squamous cell carcinoma (ESCC), but there is still a lack of large-sample analysis of prognosis among different treatments, especially for different tumor stages. The analysis of the prognosis of ESCC patients with different treatments may be helpful to choose the treatment methods for different stages ESCC. METHODS A total of 3,346 patients with pathological ESCC between 1976 and 2016 were derived from the Surveillance, Epidemiology, and End Results (SEER) database. All clinical factors associated with prognosis were collected and analyzed to achieve the difference of prognosis among different treatments in ESCC patients, such as ages, sex, race, tumor grade, anatomic location and so on. Kaplan-Meier and Cox proportional hazard analysis were used to compare survival of different treatments in ESCC patients with stage I-III. RESULTS The overall survival (OS) in all ESCC patients who had received surgery and surgery plus radiation therapy or/and chemotherapy are superior than that had not received any treatments and radiation therapy or/and chemotherapy. The OS in ESCC patients with stage I who had received surgery and surgery plus radiation therapy or/and chemotherapy are superior than that had not received any treatments and radiation therapy or/and chemotherapy. The OS in ESCC patients with stage II/III who had received surgery and surgery plus radiation therapy or/and chemotherapy are superior than that in other groups. Age, race and grade as an independent predictive factor for survival (P<0.05). A nomogram model was constructed to show surgery group had better 1-, 3- and 5-year OS than radiation therapy or/and chemotherapy group (OS: 78.5% vs. 59.2%, 37.9% vs. 18.4%, 16.9% vs. 6.1%). CONCLUSIONS Surgery is still the first choice for all ESCC patients with stage I-III. Radiotherapy and chemotherapy could improve the survival rate in ESCC patients with stage II-III who have received surgery.
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Affiliation(s)
- Jingyang Wu
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Jiansheng Yang
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xianbin Lin
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Liang'an Lin
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Wentan Jiang
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Chengke Xie
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Petrelli F, Cortellini A, Indini A, Tomasello G, Ghidini M, Nigro O, Salati M, Dottorini L, Iaculli A, Varricchio A, Rampulla V, Barni S, Cabiddu M, Bossi A, Ghidini A, Zaniboni A. Association of Obesity With Survival Outcomes in Patients With Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e213520. [PMID: 33779745 PMCID: PMC8008284 DOI: 10.1001/jamanetworkopen.2021.3520] [Citation(s) in RCA: 208] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/08/2021] [Indexed: 12/11/2022] Open
Abstract
Importance Obesity, defined as a body mass index (BMI) greater than 30, is associated with a significant increase in the risk of many cancers and in overall mortality. However, various studies have suggested that patients with cancer and no obesity (ie, BMI 20-25) have worse outcomes than patients with obesity. Objective To assess the association between obesity and outcomes after a diagnosis of cancer. Data Sources PubMed, the Cochrane Library, and EMBASE were searched from inception to January 2020. Study Selection Studies reporting prognosis of patients with obesity using standard BMI categories and cancer were included. Studies that used nonstandard BMI categories, that were limited to children, or that were limited to patients with hematological malignant neoplasms were excluded. Screening was performed independently by multiple reviewers. Among 1892 retrieved studies, 203 (17%) met inclusion criteria for initial evaluation. Data Extraction and Synthesis The Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were reporting guideline was followed. Data were extracted by multiple independent reviewers. Risk of death, cancer-specific mortality, and recurrence were pooled to provide an adjusted hazard ratio (HR) with a 95% CI . A random-effects model was used for the retrospective nature of studies. Main Outcomes and Measures The primary outcome of the study was overall survival (OS) in patients with cancer, with and without obesity. Secondary end points were cancer-specific survival (CSS) and progression-free survival (PFS) or disease-free survival (DFS). The risk of events was reported as HRs with 95% CIs, with an HR greater than 1 associated with a worse outcome among patients with obesity vs those without. Results A total of 203 studies with 6 320 365 participants evaluated the association of OS, CSS, and/or PFS or DFS with obesity in patients with cancer. Overall, obesity was associated with a reduced OS (HR, 1.14; 95% CI, 1.09-1.19; P < .001) and CSS (HR, 1.17; 95% CI, 1.12-1.23; P < .001). Patients were also at increased risk of recurrence (HR, 1.13; 95% CI, 1.07-1.19; P < .001). Conversely, patients with obesity and lung cancer, renal cell carcinoma, or melanoma had better survival outcomes compared with patients without obesity and the same cancer (lung: HR, 0.86; 95% CI, 0.76-0.98; P = .02; renal cell: HR, 0.74; 95% CI, 0.53-0.89; P = .02; melanoma: HR, 0.74; 95% CI, 0.57-0.96; P < .001). Conclusions and Relevance In this study, obesity was associated with greater mortality overall in patients with cancer. However, patients with obesity and lung cancer, renal cell carcinoma, and melanoma had a lower risk of death than patients with the same cancers without obesity. Weight-reducing strategies may represent effective measures for reducing mortality in these patients.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Alessio Cortellini
- Oncology Unit, Department of Biotechnology and Applied Clinical Sciences, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy
| | - Alice Indini
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milano, Italy
| | - Gianluca Tomasello
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milano, Italy
| | - Michele Ghidini
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milano, Italy
| | - Olga Nigro
- Oncology Unit, Azienda Socio Sanitaria Territoriale Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Massimiliano Salati
- Oncology Unit, University Hospital of Modena, Modena Cancer Centre, Modena, Italy
| | - Lorenzo Dottorini
- Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Est, Seriate, Italy
| | - Alessandro Iaculli
- Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Est, Seriate, Italy
| | - Antonio Varricchio
- Surgical Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Valentina Rampulla
- Surgical Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Sandro Barni
- Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Mary Cabiddu
- Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Antonio Bossi
- Endocrine Diseases Unit–Diabetes Regional Center, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italia
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Abstract
ABSTRACT Obesity is an increasingly prevalent state of energy imbalance that contributes to breast cancer risk and outcomes. The effects of obesity differ by breast cancer subtype and menopause. While most studies have focused on postmenopausal hormone receptor-positive disease, less is known about the relationship between obesity and triple-negative breast cancer (TNBC). Here we will review the observations linking obesity to TNBC, the socioeconomic disparities that contribute to obesity-related TNBC, and putative biologic mechanisms. Finally, we will consider the impact of obesity on surgical and medical treatment of TNBC and novel strategies to improve energy balance after cancer diagnosis.
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Huang X, Xie C, Tang J, He W, Yang F, Tian W, Li J, Yang Q, Shen J, Xia L, Lan C. Adipose tissue area as a predictor for the efficacy of apatinib in platinum-resistant ovarian cancer: an exploratory imaging biomarker analysis of the AEROC trial. BMC Med 2020; 18:267. [PMID: 33012286 PMCID: PMC7534164 DOI: 10.1186/s12916-020-01733-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF)-targeted therapy is effective in patients with ovarian cancer. Whether adipose tissue (AT) could predict the efficacy of VEGF receptor (VEGFR) inhibitors in ovarian cancer is unknown. We aimed to evaluate the ability of distinct AT depots to predict the efficacy of apatinib, a VEGFR inhibitor, in recurrent ovarian cancers included in the AEROC trial. METHODS The AEROC was a single-arm phase 2 trial of apatinib and oral etoposide in patients with platinum-resistant or platinum-refractory ovarian cancer. Apatinib was administered continuously, and oral etoposide was administered every 21 days for a maximum of six cycles. This was a post hoc study based on the AEROC trial. Areas of visceral AT (VAT), subcutaneous AT (SAT), and intermuscular AT (IMAT) were measured using computed tomography scan at baseline to assess their association with the objective response rate, progression-free survival, and overall survival. RESULTS Of the 35 treated patients, 31 patients with at least one post-baseline efficacy assessment by computed tomography scan were included in this study. After adjusting for apatinib exposure, high VAT (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03-0.90, P = 0.037) and SAT (OR, 0.16; 95% CI, 0.03-0.87, P = 0.034) were significantly associated with a higher objective response rate. Further, decreased risks of disease progression and death were associated with high VAT (hazard ratio [HR], 0.39; 95% CI, 0.17-0.92, P = 0.031, and HR, 0.12; 95% CI, 0.04-0.40, P < 0.001, respectively), SAT (HR, 0.35; 95% CI, 0.15-0.83, P = 0.027, and HR, 0.24; 95% CI, 0.08-0.67, P = 0.007, respectively), and IMAT (HR, 0.20; 95% CI, 0.06-0.74, P = 0.016, and HR, 0.13; 95% CI, 0.03-0.62, P = 0.011, respectively). CONCLUSIONS High areas of VAT, SAT, and IMAT were significantly associated with better outcomes in patients with platinum-resistant or platinum-refractory ovarian cancer who received VEGFR inhibitors. AT assessments may be valuable as patient-specific imaging biomarkers for predicting response to VEGFR inhibitors. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02867956 .
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Affiliation(s)
- Xin Huang
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Chuanbo Xie
- Department of Cancer Prevention, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jie Tang
- Department of Gynecologic Oncology, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Wenzhuo He
- VIP Region, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Fan Yang
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Wenfang Tian
- Department of Gynecologic Oncology, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jundong Li
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Qiuxia Yang
- Department of Medical Imaging, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jingxian Shen
- Department of Medical Imaging, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Liangping Xia
- VIP Region, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
| | - Chunyan Lan
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
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He Y, Liang D, Du L, Guo T, Liu Y, Sun X, Wang N, Zhang M, Wei K, Shan B, Chen W. Clinical characteristics and survival of 5283 esophageal cancer patients: A multicenter study from eighteen hospitals across six regions in China. Cancer Commun (Lond) 2020; 40:531-544. [PMID: 32845581 PMCID: PMC7571391 DOI: 10.1002/cac2.12087] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022] Open
Abstract
Objective This study aimed to investigate the potential determining epidemiological and clinical risk factors affecting the survival of esophageal cancer (EC) patients across multiple hospitals in China. Methods This was a multicenter study comprising of newly diagnosed EC cases from Beijing, Hebei, Henan, Hubei, Zhejiang, and Guangdong Province of China. Their baseline characteristics and treatment methods data were collected from their medical records. The EpiData software was used for data quality control. The Kaplan‐Meier method was used to estimate their overall survival (OS), and the Cox's proportional hazard regression model was used to estimate hazard ratios (HR) and 95% confidence interval (CI). Results The 3‐ and 5‐year OS rates of the 5283 investigated EC patients were 49.98% and 39.07%, respectively. Their median survival was 36.00 months. The median survival time of females was longer than that of males (females vs. males: 45.00 vs. 33.00, P < 0.001). The 5‐year OS rate of patients who never‐smoked was higher than that of smokers (never‐smokers vs smokers: 40.73% vs. 37.84%, P = 0.001). There was no significant difference in the 5‐year OS rate between drinkers and never‐drinkers (drinkers vs never‐drinkers: 34.22% vs. 29.65%, P = 0.330). In multivariate analysis, pathological stage (stage II: HR = 1.80, 95% CI = 1.40‐2.31; stage III: HR = 2.62, 95% CI = 2.06‐3.34; stage IV: HR = 3.90, 95% CI = 2.98‐5.09), poor differentiation/undifferentiated (HR = 1.34, 95% CI = 1.11‐1.63), not married status (HR = 2.45, 95% CI = 1.49‐4.04), production and service personnel (HR = 1.36, 95% CI = 1.01‐1.83) and farming/fishing (HR = 1.40, 95% CI = 1.12‐1.76) were independent prognostic risk factors for poor EC survival. Tumors in the thoracic or abdominal part of the esophagus, female and family history of any cancer were independent factors predictive of a good EC OS. Conclusion Gender, marital status, occupation, family history of any cancer, tumor topographical site, differentiation status, and pathological stage were associated with the survival rate of EC. This study reveals important clinical characteristics of esophageal cancer patients in China and provides helpful information for their clinical management and surveillance.
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Affiliation(s)
- Yutong He
- Cancer Institute, the Fourth Hospital of Hebei Medical University/the Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, P. R. China
| | - Di Liang
- Cancer Institute, the Fourth Hospital of Hebei Medical University/the Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, P. R. China
| | - Lingbin Du
- Zhejiang Cancer Center, Hangzhou, Zhejiang, 310000, P. R. China
| | - Tiantian Guo
- Cancer Institute, the Fourth Hospital of Hebei Medical University/the Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, P. R. China
| | - Yanyu Liu
- Cancer Institute, the Fourth Hospital of Hebei Medical University/the Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, P. R. China
| | - Xibin Sun
- Henan Cancer Hospital, Zhengzhou, Henan, 450000, P. R. China
| | - Ning Wang
- Beijing Cancer Hospital, Beijing, 100021, P. R. China
| | - Min Zhang
- Hubei Cancer Hospital, Wuhan, Hubei, 430000, P. R. China
| | - Kuangrong Wei
- Zhongshan Cancer Hospital, Zhongshan, Guangdong, 528400, P. R. China
| | - Baoen Shan
- Cancer Institute, the Fourth Hospital of Hebei Medical University/the Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, P. R. China
| | - Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100021, P. R. China
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12
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Loehrer EA, Giovannucci EL, Betensky RA, Shafer A, Christiani DC. Prediagnostic adult body mass index change and esophageal adenocarcinoma survival. Cancer Med 2020; 9:3613-3622. [PMID: 32202699 PMCID: PMC7221446 DOI: 10.1002/cam4.3015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/10/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background We examined whether body mass index (BMI) changes in adulthood, prior to disease onset, are associated with overall survival among esophageal adenocarcinoma patients. Methods We included 285 histologically confirmed patients with a complete baseline BMI questionnaire. Using extended Cox regression models, we obtained adjusted hazard ratios (HRs) for the associations between overall survival and BMI at diagnosis, BMI 6 months before diagnosis, self‐reported average adult BMI, and ΔBMI (BMI 6 months before diagnosis minus average adult BMI), categorized into tertiles <0 kg/m2 (BMI loss), ≥0 and <1.25 kg/m2 (stable BMI), and ≥1.25 kg/m2 (BMI gain). We also assessed interaction between ΔBMI and average adult BMI (≥ kg/m2 versus <27.5 kg/m2) with overall survival. Results Body mass index at diagnosis >25 and <35 kg/m2 was associated with better overall survival. Compared to patients with stable BMI in adulthood, patients who gained BMI throughout adulthood had 1.68 times the all‐cause hazard of death (95% CI: 1.17‐2.43; P < .01), independent of diagnosis BMI and percent weight loss 6 months before diagnosis. Compared to patients with average adult BMI < 27.5 who maintained stable adult BMI, patients with average adult BMI ≥ 27.5 kg/m2 who gained BMI had the worst survival (HR = 3.05; 95% CI 1.62‐5.72; P < .01). Conclusion Body mass index gain in adulthood is associated with poor overall survival, and maintaining a normal body weight throughout adulthood is associated with the best overall survival among esophageal adenocarcinoma patients, independent of BMI at diagnosis.
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Affiliation(s)
- Elizabeth A Loehrer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rebecca A Betensky
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea Shafer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Pulmonary and Critical Care Division, Massachusetts General Hospital, Boston, MA, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Pulmonary and Critical Care Division, Massachusetts General Hospital, Boston, MA, USA
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13
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Zhang Y, Zhao X, Chen M. Autocrine action of adipokine omentin-1 in the SW480 colon cancer cell line. Oncol Lett 2019; 19:892-898. [PMID: 31897204 PMCID: PMC6924134 DOI: 10.3892/ol.2019.11131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 10/10/2019] [Indexed: 01/22/2023] Open
Abstract
Omentin-1, a 34-kDa protein, has been demonstrated to be associated with colorectal cancer (CRC). Epidemiological and clinical studies have indicated that the levels of circulating omentin-1 are significantly increased in patients with CRC, but the cause of the high omentin-1 levels and whether CRC cells express this adipokine have not been determined. In the present study, human colorectal carcinoma and para-carcinoma tissues were collected from 24 patients with CRC. In addition, SW480 and HCT116 colon cancer cells were cultured in vitro. The expression and localization of omentin-1 protein in human CRC and para-carcinoma tissues were determined by immunohistochemistry. The mRNA and protein expression levels of omentin-1 in human CRC and para-carcinoma tissues were detected by reverse transcription-quantitative PCR (RT-qPCR) and western blotting, respectively. In addition, omentin-1 mRNA expression levels in SW480 and HCT116 cell lines were detected by RT-qPCR. Since SW480 cells exhibited higher omentin-1 mRNA levels compared with those of HCT116 cells, SW480 cells were selected for further experiments. The expression of omentin-1 protein in the supernatant and lysate of SW480 cells obtained at 6, 12, 24 and 48 h was determined by ELISA. The immunohistochemistry results demonstrated that the positive expression of omentin-1 protein was mainly located in the cytoplasm of cancer cells in human CRC tissues. The mRNA and protein expression levels of omentin-1 in the CRC tissues were higher compared with those in para-carcinoma tissues. The expression levels of omentin-1 were detected in the cell lysate and supernatant of SW480 cells; the expression level of omentin-1 protein in the cell lysate was higher compared with that in the supernatant. These results indicated that SW480 cells secret and express the adipokine omentin-1 endogenously. Omentin-1 may serve its potential carcinogenetic role in CRC through endocrine, autocrine and paracrine pathways.
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Affiliation(s)
- Yaqin Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Xiaotong Zhao
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Mingwei Chen
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China.,Institute of Traditional Chinese Medicine Diabetes Prevention, Anhui Academy of Traditional Chinese Medicine, Hefei, Anhui 230032, P.R. China
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14
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Loehrer E, Betensky RA, Giovannucci E, Su L, Shafer A, Hollis BW, Christiani DC. Serum Levels of 25-Hydroxyvitamin D at Diagnosis Are Not Associated with Overall Survival in Esophageal Adenocarcinoma. Cancer Epidemiol Biomarkers Prev 2019; 28:1379-1387. [PMID: 31186263 DOI: 10.1158/1055-9965.epi-18-1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/08/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Higher levels of circulating 25-hydroxyvitamin D [25(OH)D] are associated with longer survival in several cancers, but the results have differed across cancer sites. The association between serum 25(OH)D levels and overall survival (OS) time in esophageal adenocarcinoma remains unclear. METHODS We utilized serum samples from 476 patients with primary esophageal adenocarcinoma, recruited from Massachusetts General Hospital (Boston, MA) between 1999 and 2015. We used log-rank tests to test the difference in survival curves across quartiles of 25(OH)D levels and extended Cox modeling to estimate adjusted HRs. We tested for interactions between clinical stage or BMI on the association between 25(OH)D and OS. We additionally performed sensitivity analyses to determine whether race or timing of blood draw (relative to treatment) affected these results. RESULTS We found no evidence that survival differed across quartiles of 25(OH)D (log rank P = 0.48). Adjusting for confounders, we found no evidence that the hazard of death among the highest quartile of 25(OH)D (quartile 1) differed from any other quartile [quartile 2 HR = 0.90, 95% confidence interval (CI), 0.67-1.23; quartile 3 HR = 1.03, 95% CI, 0.76-1.38; quartile 4 (lowest) HR = 0.98, 95% CI, 0.72-1.33]. Sensitivity analyses yielded consistent results when accounting for race or time between diagnosis and blood draw. Moreover, we did not find evidence of interaction between 25(OH)D and clinical stage or BMI on OS. CONCLUSIONS Serum level of 25(OH)D near time of diagnosis was not associated with OS in patients with esophageal adenocarcinoma. IMPACT Screening 25(OH)D levels among patients with esophageal adenocarcinoma at diagnosis is not clinically relevant to their cancer prognosis based on present evidence.
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Affiliation(s)
- Elizabeth Loehrer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Rebecca A Betensky
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Li Su
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Andrea Shafer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Pulmonary and Critical Care Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Bruce W Hollis
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Pulmonary and Critical Care Division, Massachusetts General Hospital, Boston, Massachusetts
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15
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Deng HY, Alai G, Li G, Luo J, Zhuo ZG, Lin YD. High BMI has no impact on the survival of Chinese patients with lower thoracic esophageal adenocarcinoma treated with curative esophagectomy: a propensity score-matched study. Dis Esophagus 2019; 32:5040373. [PMID: 29931316 DOI: 10.1093/dote/doy059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Controversy still exists as to whether a high body mass index (BMI) has any impact on the long-term survival of esophageal cancer patients treated with curative esophagectomy. Therefore, we conducted this propensity score-matched (PSM) study to explore the prognostic value of high BMI in Chinese patients with lower thoracic esophageal adenocarcinoma for the first time. We retrospectively collected data of patients with lower thoracic esophageal adenocarcinoma who underwent curative esophagectomy in our department from January 2009 to December 2016. Patients were grouped into high BMI group (≥23 kg/m2) and normal BMI group (18.5-22.9 kg/m2) according to the Asian specific BMI cutoff value. Both Cox regression survival analysis and PSM analysis were applied. Finally, a total of 132 patients were included for analysis. Fifty-three patients were in the high BMI group while 79 patients were in the normal BMI group. There was no significant difference regarding age, gender, comorbidity, tumor differentiation, tumor site, lymphovascular invasion, or surgical approaches between the two groups. However, patients with a high BMI tended to have more stage III diseases but a lower rate of adjuvant therapy application than those with a normal BMI. For survival, there was no significant survival difference between patients with a high BMI and those with a normal BMI (5-year overall survival (OS): 40.8% vs. 48.1%; P = 0.398). In the multivariate analysis, high BMI was not found to be an independent prognostic factor (HR = 1.028, 95%CI: 0.621-1.667, P = 0.945). A total of 92 well-matched patients were included after PSM analysis. However, there was still no significant difference of survival between the two groups (5-year OS: 41.4% vs. 43.3%; P = 0.760). Therefore, high BMI has no impact on survival of Chinese patients with lower thoracic esophageal adenocarcinoma treated with curative esophagectomy.
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Affiliation(s)
- H-Y Deng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - G Alai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - G Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - J Luo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Z-G Zhuo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Y-D Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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16
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Chitti B, Pham A, Marcott S, Wang X, Potters L, Wernicke AG, Parashar B. Temporal Changes in Esophageal Cancer Mortality by Geographic Region: A Population-based Analysis. Cureus 2018; 10:e3596. [PMID: 30680257 PMCID: PMC6338397 DOI: 10.7759/cureus.3596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose To analyze differences in esophageal cancer survival by geographic region of the U.S. from the 1970s to the 2000s, and attribute the causes of these discrepancies. Methods Raw data were obtained from the Surveillance Epidemiology and End Results (SEER) program of the National Cancer Institute. Patients were stratified by decade of diagnosis and by geographic region (East, Hawaii/Alaska, Midwest, Southwest, and West), containing SEER registries. The Kaplan-Meier method with the log-rank test was used to compare the overall survival (OS) among these geographic groups. A multivariate Cox Proportional Hazard analysis was conducted to evaluate the impact of the following factors on differences in survival: patient age, gender, race, tumor stage, site, histology, treatment method, and metropolitan size. Results A total of 87,834 patients were identified. OS has increased significantly since 1973, with five-year OS improving from 4.9% (the 1970s) to 15.3% (2000s) (P<0.001). Residence in the East was prognostic for higher OS compared to all the other regions, with a median OS of six months in the 1970s and 12 months in the 2000s (P<0.001). The multivariate analysis revealed increased age, African American race, distant disease, non-distal tumor location, squamous cell histology, and no radiation therapy were associated with worse OS. The West and East had the highest amount of cancer centers (12 and seven, respectively). And the East had the highest number of cancer centers per person (5.7E-07) while the South had the lowest (1.6E-07). Conclusions There are disparities in esophageal cancer survival and quality of care through different geographic regions of the U.S., which may be attributed to a combination of the unbalanced distribution of medical resources, the regional differences in cancer biology, and other lifestyle and socioeconomic factors. More research should be conducted to further characterize regional differences and guide the implementation of improvements in survival.
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Affiliation(s)
- Bhargava Chitti
- Radiation Oncology, New York-Presbyterian Weill Cornell University Hospital of Columbia and Cornell, New York, USA
| | - Anthony Pham
- Radiation Oncology, Los Angeles County General / Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Stephen Marcott
- Radiation Oncology, Weill Cornell Medical Center, New York, USA
| | - Xin Wang
- Radiation Oncology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, USA
| | - Louis Potters
- Radiation Oncology, Zucker School of Medicine at Hofstra / Northwell, New York, USA
| | - A Gabriella Wernicke
- Radiation Oncology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, USA
| | - Bhupesh Parashar
- Radiation Medicine, Zucker School of Medicine at Hofstra / Northwell, New York, USA
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17
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Vendrely V, Launay V, Najah H, Smith D, Collet D, Gronnier C. Prognostic factors in esophageal cancer treated with curative intent. Dig Liver Dis 2018; 50:991-996. [PMID: 30166221 DOI: 10.1016/j.dld.2018.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023]
Abstract
The overall prognosis of patients with esophageal cancer has improved in recent decades due to surgical and medical progress, but overall survival remains poor. Better patient selection and tailored treatment are needed. Different prognostic factors linked with the patient, tumoral characteristics and treatment with curative intent have been identified and are the purpose of this review. Tumor detection at an earlier stage, the advent of new molecules and therapeutic combinations, and the centralization of management in high-volume centers should help to improve the prognosis of esophageal cancer. Improved imaging techniques and a better prediction strategy should guide future treatments.
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Affiliation(s)
- Véronique Vendrely
- Bordeaux University of Medicine, Bordeaux, France; Department of Radiation Oncology, Haut-Lévêque Hospital, Pessac, France; INSERM UMR1035 University of Bordeaux, Bordeaux, France
| | - Vincent Launay
- Esophageal and Endocrine Surgery Unit, Visceral Surgery Department, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Haythem Najah
- Esophageal and Endocrine Surgery Unit, Visceral Surgery Department, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Denis Smith
- Department of Hepatogastroenterology, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Denis Collet
- Bordeaux University of Medicine, Bordeaux, France; Esophageal and Endocrine Surgery Unit, Visceral Surgery Department, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Caroline Gronnier
- Bordeaux University of Medicine, Bordeaux, France; Esophageal and Endocrine Surgery Unit, Visceral Surgery Department, Magellan Center, Bordeaux University Hospital, Pessac, France; INSERM, UMR1053 Bordeaux Research in Translational Oncology, BaRITOn, University of Bordeaux, Bordeaux, France.
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18
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Potharaju M, Mangaleswaran B, Mathavan A, John R, Thamburaj V, Ghosh S, Ganesh S, Kalvakonda C, Loganathan M, Bapu S, Devi R, Verma RS. Body Mass Index as a Prognostic Marker in Glioblastoma Multiforme: A Clinical Outcome. Int J Radiat Oncol Biol Phys 2018; 102:204-209. [DOI: 10.1016/j.ijrobp.2018.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
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19
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Liu B, Cheng B, Wang C, Chen P, Cheng Y. The prognostic significance of metabolic syndrome and weight loss in esophageal squamous cell carcinoma. Sci Rep 2018; 8:10101. [PMID: 29973636 PMCID: PMC6031687 DOI: 10.1038/s41598-018-28268-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/18/2018] [Indexed: 02/06/2023] Open
Abstract
Our study aimed to investigate the association between metabolic syndrome and postoperative survival in patients with esophageal squamous cell carcinoma, and evaluate whether metabolic syndrome can predict the prognosis in esophageal cancer patients. The retrospective study reviewed 519 patients with esophageal squamous cell carcinoma who had received esophagetomy and lymphnode dissections in the Department of Thoracic Surgery, Qilu Hospital of Shandong University between January 2007 and December 2011. All patients were followed up until December 2016. The median follow-up time was 39.59 months (range 0.25–72 months). The 3-year and 5-year survival rate was 51.4% and 37.0%, respectively. Kaplan–Meier survival analysis revealed a significant correlation between OS and obesity (P = 0.000), weight loss (P = 0.000), diabetes (P = 0.001) and dyslipidemia (P = 0.030). Multivariate analysis indicated that advanced TNM staging (P = 0.007, HR: 1.760, 95% CI: 1.167–2.654) and more weight loss (P = 0.000, HR: 1.961, 95% CI: 1.697–2.267) were independent factors for adverse prognosis of esophageal squamous carcinoma patients. In contrast, diabetes was a protective factor in the prognosis of patients with esophageal cancer (P = 0.018, HR: 0.668, 95% CI: 0.478–0.933). Our findings suggest that TNM staging, weight changes and diabetes were independent predictors for the prognosis of esophageal cancer patients.
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Affiliation(s)
- Bowen Liu
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Bo Cheng
- Department of Radiation Oncology, Shandong Provincial Cancer Hospital, Jinan, Shandong, P.R. China
| | - Cong Wang
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Pengxiang Chen
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Yufeng Cheng
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China.
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20
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Gao H, Feng HM, Li B, Lin JP, Yang JB, Zhu DJ, Jing T. Impact of high body mass index on surgical outcomes and long-term survival among patients undergoing esophagectomy: A meta-analysis. Medicine (Baltimore) 2018; 97:e11091. [PMID: 29995752 PMCID: PMC6076106 DOI: 10.1097/md.0000000000011091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The impact of high body mass index (BMI, >23/25 kg/m) on surgical outcomes and prognosis in patients with esophageal carcinoma (EC) after undergoing esophagectomy remains controversial. We herein conducted a systematic review and meta-analysis to determine the relationship between high BMI and surgical outcomes and prognosis in patients undergoing esophagectomy for EC. METHODS The study search was conducted by retrieving publications from the PubMed, Embase, Web of Science, and CNKI (up to September 8, 2017). Nineteen studies with 13,756 patients were included in this meta-analysis. RESULTS We found that high BMI was closely associated with a higher incidence of wound infection (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.02-1.97, P = .04), cardiovascular complications (OR: 2.51, 95% CI, 1.65-3.81, P < .0001), and anastomotic leakage (OR: 1.50, 95% CI, 1.21-1.84, P = .0002), but a lower incidence of chylous leakage (OR: 0.59, 95% CI, 0.40-0.88, P = .01) when compared with normal BMI. The high BMI group was not associated with better or worse overall survival (OS) (hazard ratio [HR]: 0.95, 95% CI, 0.85-1.07, P = .4) and disease-free survival (HR: 0.95, 95% CI, 0.72-1.25, P = .72) than the normal BMI group. However, in the subgroup analysis, the pooled result of HRs generated from multivariate analyses suggested that high BMI could improve OS in EC patients (HR: 0.84, 95% CI, 0.76-0.93, P < .01). CONCLUSIONS Overweight patients with EC should not be denied surgical treatment, but intraoperative prevention and careful postoperative monitoring for several surgical complications must be stressed for this population. Besides, high BMI might be a prognostic predictor in EC patients; further studies are warranted.
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Affiliation(s)
| | - Hai-Ming Feng
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Jun-Ping Lin
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Jian-Bao Yang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Duo-Jie Zhu
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Tao Jing
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
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21
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Mengardo V, Pucetti F, Mc Cormack O, Chaudry A, Allum WH. The impact of obesity on esophagectomy: a meta-analysis. Dis Esophagus 2018; 31:4774514. [PMID: 29293968 DOI: 10.1093/dote/dox149] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 12/11/2022]
Abstract
The impact of body mass index (BMI) on postoperative outcomes after curative resection for esophageal cancer has been assessed in many studies worldwide with conflicting conclusions. The aim of this meta-analysis is to evaluate the influence of preoperative BMI on surgical and oncologic outcomes after radical surgery for esophageal cancer, in Western studies. A comprehensive electronic search was performed to identify Western publications reporting BMI and outcomes following surgery for esophageal cancer. Articles that did not report preoperative BMI, postoperative morbidity, and early mortality were excluded. Statistical analysis was performed using the OpenMetaAnalyst software (Version 10.10). One hundred and ninety records were examined and 8 studies were included with a total of 2838 patients. The study population was stratified into two groups: a nonobese group (BMI < 30 kg/m2), containing 2199 patients, and an obese group (BMI ≥ 30 kg/m2), with 639 patients. In the obese group, there was an increased risk (up to 35%) of anastomotic leak (P = 0.003; RR: 0.857, 95% CI: 0.497, 0.867). The obese group showed a significantly more favorable five-year overall survival (P = 0.011). Although there was a significant association between anastomotic leak and obesity, patients with obesity also have a better overall 5-year survival. This meta-analysis demonstrates that patients with obesity should be counseled regarding the specific risks of surgery but they can be reassured that despite these risks overall outcome is satisfactory.
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Affiliation(s)
- V Mengardo
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - F Pucetti
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - O Mc Cormack
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - A Chaudry
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - W H Allum
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
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Excessive Pretreatment Weight Loss Is a Risk Factor for the Survival Outcome of Esophageal Carcinoma Patients Undergoing Radical Surgery and Postoperative Adjuvant Chemotherapy. Can J Gastroenterol Hepatol 2018; 2018:6075207. [PMID: 29623265 PMCID: PMC5830280 DOI: 10.1155/2018/6075207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/04/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The prognostic values of weight loss and body mass index (BMI) in esophageal carcinoma remain controversial. This study aimed to evaluate the impacts of weight loss on the survival of patients undergoing radical surgery and adjuvant chemotherapy. METHODS The medical records of 189 consecutive patients with nonmetastatic esophageal carcinoma treated in our hospital between January 2012 and December 2013 were reviewed, and 121 patients were included for analysis. RESULTS Kaplan-Meier analysis revealed that the 3-year overall survival rate was significantly higher in the low pretreatment weight loss (pre-LWL) group than in the high pretreatment weight loss (pre-HWL) group (P < 0.001). In addition, the 3-year overall survival rate of normal weight group was higher than that of overweight and underweight groups (P = 0.007). Multivariate Cox proportional hazards analysis showed that pre-LWL group had a significantly better 3-year overall survival than pre-HWL group (P = 0.027, HR = 1.89, and 95% CI = 1.07-3.32). pN stage and age were also the survival prognostic factors. CONCLUSIONS Our study showed that low pretreatment weight loss predicted a better survival outcome in the esophageal carcinoma patients with radical surgery and adjuvant chemotherapy. However, BMI and weight loss during treatment had no impact on the survival outcome.
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McDonald AM, Fiveash JB, Kirkland RS, Cardan RA, Jacob R, Kim RY, Dobelbower MC, Yang ES. Subcutaneous adipose tissue characteristics and the risk of biochemical recurrence in men with high-risk prostate cancer. Urol Oncol 2017; 35:663.e15-663.e21. [DOI: 10.1016/j.urolonc.2017.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/08/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
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Saeed N, Shridhar R, Almhanna K, Hoffe S, Chuong M, Meredith K. CT-based assessment of visceral adiposity and outcomes for esophageal adenocarcinoma. J Gastrointest Oncol 2017; 8:833-841. [PMID: 29184687 DOI: 10.21037/jgo.2017.07.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Various methods of quantifying and correlating obesity to outcomes for patients with esophageal adenocarcinoma (EA) have been evaluated. Published data suggest that quantification of adiposity may be more accurate than body mass index (BMI) as a prognostic factor. We report our analysis of adiposity as a prognostic factor in a series of patients with EA. Methods This single institution retrospective review included patients with EA who underwent esophagectomy from 1994-2008. Patients with BMI <20 were excluded. Using the preoperative CT scan, the visceral (VFA), subcutaneous (SFA), and total abdominal fat (TFA) areas were calculated. Each was contoured on a Siemens Leonardo workstation at the level of the iliac crest (L4/5). The Hounsfield threshold was -30 to -130. Outcomes were analyzed using Kaplan-Meier method and log-rank analysis. Multivariate analysis (MVA) was performed using the Cox proportion hazard regression model. Results We identified 126 patients for the analysis. There were no statistically significant differences in overall survival or disease-free survival between groups above and below the medians for TFA, SFA, or VFA/SFA ratio. However, an increase in VFA was significantly associated with worsened OS and DFS when we further classified patients into quartiles. Patients with VFA ≥182 cm2 had larger tumor size (P=0.016), fewer involved lymph nodes (P=0.047), longer operating times (P=0.032), and were more likely to be males (P=0.042). Conclusions Published data have demonstrated an association between treatment outcomes and degree of adiposity; our study found a correlation between VFA and OS and DFS in patients with EA. Median TFA, SFA, and VFA/SFA were not prognostic on MVA. While VFA >182 cm2 was associated with larger tumors, there were also fewer lymph nodes harvested in this group.
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Affiliation(s)
- Nadia Saeed
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Ravi Shridhar
- Department of Radiation Oncology, University of Central Florida, Orlando, FL, USA
| | - Khaldoun Almhanna
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Sarah Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael Chuong
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kenneth Meredith
- Department Gastrointestinal Oncology, Florida State University, Sarasota Memorial Hospital, Sarasota, FL, USA
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Positive Effect of Higher Adult Body Mass Index on Overall Survival of Digestive System Cancers Except Pancreatic Cancer: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1049602. [PMID: 28948163 PMCID: PMC5602622 DOI: 10.1155/2017/1049602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/27/2017] [Accepted: 05/31/2017] [Indexed: 02/08/2023]
Abstract
High body mass index (BMI) has been inconsistently associated with overall survival (OS) of digestive system cancers (DSCs). This meta-analysis was conducted to investigate whether high BMI was associated with DSCs prognosis. 34 studies were accepted, with a total of 23,946 DSC cases. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) for OS in BMI categories from individual studies were extracted and pooled by random-effect model. The overall HR of DSCs except pancreatic cancer for OS of adult overweight cases was 0.76 (95% CI = 0.67–0.85). DSC individuals except pancreatic cancer with adult obesity were at decreased risk for OS (HR = 0.85, 95% CI = 0.72–0.98). Among DSC patients except pancreatic cancer, the overall HR for the highest versus the lowest BMI category was 0.82 (95% CI = 0.71–0.92). Additionally, comparing the highest and lowest BMI categories, the combined HR of pancreatic cancer was 1.22 (95% CI = 1.01–1.43). Our meta-analysis suggested an increased OS among adult overweight and obese DSC survivors except pancreatic cancer. Overweight and obesity in adulthood may be important prognostic factors that indicate an increased survival from DSC patients except pancreatic cancer.
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Gama RR, Song Y, Zhang Q, Brown MC, Wang J, Habbous S, Tong L, Huang SH, O'Sullivan B, Waldron J, Xu W, Goldstein D, Liu G. Body mass index and prognosis in patients with head and neck cancer. Head Neck 2017; 39:1226-1233. [PMID: 28323362 DOI: 10.1002/hed.24760] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/04/2017] [Accepted: 02/01/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Body mass index (BMI) has been associated variably with head and neck cancer outcomes. We evaluated the association between BMI at either diagnosis or at early adulthood head and neck cancer outcomes. METHODS Patients with invasive head and neck squamous cell cancer at Princess Margaret Cancer Centre in Toronto, Canada, were surveyed on tobacco and alcohol exposure, performance status, comorbidities, and BMI at diagnosis. A subset also had data collected for BMI at early adulthood. RESULTS With a median follow-up of 2.5 years, in 1279 analyzed patients, being overweight (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.4-0.8; p = .001) at diagnosis was associated with improved survival when compared with individuals with normal weight. In contrast, underweight patients at diagnosis were associated with a worse outcome (HR, 1.89; 95% CI, 1.2-3.1; p < .01). CONCLUSION Being underweight at diagnosis was an independent, adverse prognostic factor, whereas being overweight conferred better prognosis. BMI in early adulthood was not associated strongly with head and neck cancer outcomes. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1226-1233, 2017.
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Affiliation(s)
| | - Yuyao Song
- Biostatistics Department, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Qihuang Zhang
- Biostatistics Department, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - M Catherine Brown
- Department of Medicine, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jennifer Wang
- Department of Otolaryngology and Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Steven Habbous
- Department of Medicine, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Li Tong
- Department of Medicine, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Wei Xu
- Biostatistics Department, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David Goldstein
- Department of Otolaryngology and Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Department of Medicine, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Kruhlikava I, Kirkegård J, Mortensen FV, Kjær DW. Impact of Body Mass Index on Complications and Survival after Surgery for Esophageal and Gastro-Esophageal-Junction Cancer. Scand J Surg 2017; 106:305-310. [PMID: 28737095 DOI: 10.1177/1457496916683097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The impact of body mass index on complications and survival in patients undergoing esophagectomy has been extensively studied with conflicting results. In this study, we assess the impact of body mass index on complications and survival following surgery for esophageal and gastro-esophageal-junction cancer in a Danish population. MATERIAL AND METHODS We identified 285 consecutive patients, who underwent curative-intended treatment for esophageal and gastro-esophageal-junction cancer in the period 2003-2010. We manually reviewed the electronic medical records of all patients included in the study. Body mass index was calculated as weight in kilograms divided by height in meters squared. We grouped patients according to their body mass index, using the World Health Organization definition, as underweight (body mass index < 18.5 kg/m2), normal weight (body mass index: 18.5-24.9 kg/m2), overweight (body mass index: 25-29.9 kg/m2), and obese (body mass index ⩽ 30 kg/m2). RESULTS Median age at surgery was 65 years (range: 27-84 years), of which 207 (72.6%) were males. Patients with the lowest body mass index and the obese patients seemed to have a higher frequency of minor complications. Anastomotic leakage occurred in less than 10% of the patients and was equally distributed across the groups as was the other major complications. There were no differences in the 1-, 2-, or 5-year survival rates between the four body mass index groups after adjustment for possible confounders. Five-year survival rates for the four body mass index groups were 31.8%, 28.7%, 27.9%, and 26.1%, respectively. CONCLUSION Body mass index over 30 or under 18.5 does not seem to affect survival rates or the presence of serious postoperative complications following esophagectomy in patients with esophageal and gastro-esophageal-junction cancers not receiving neoadjuvant oncological treatment.
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Affiliation(s)
- I Kruhlikava
- Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery), Aarhus University Hospital, Aarhus, Denmark
| | - J Kirkegård
- Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery), Aarhus University Hospital, Aarhus, Denmark
| | - F V Mortensen
- Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery), Aarhus University Hospital, Aarhus, Denmark
| | - D W Kjær
- Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery), Aarhus University Hospital, Aarhus, Denmark
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Thompson KL, Elliott L, Fuchs-Tarlovsky V, Levin RM, Voss AC, Piemonte T. Oncology Evidence-Based Nutrition Practice Guideline for Adults. J Acad Nutr Diet 2017; 117:297-310.e47. [DOI: 10.1016/j.jand.2016.05.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 01/04/2023]
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The prognostic influence of body mass index, resting energy expenditure and fasting blood glucose on postoperative patients with esophageal cancer. BMC Gastroenterol 2016; 16:142. [PMID: 28003023 PMCID: PMC5175390 DOI: 10.1186/s12876-016-0549-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/22/2016] [Indexed: 01/04/2023] Open
Abstract
Background Body mass index (BMI), resting energy expenditure (REE) and fasting blood glucose (FBG) are major preoperative assessments of patients’ nutrition and metabolic state. The relations and effects of these indices on esophageal cancer patients’ postoperative short-term and long-term outcomes remain controversial and unclear. We aimed to study the impact of BMI, REE and FBG in esophageal cancer patients undergoing esophagectomy. Methods Three hundred and six esophageal cancer patients who underwent esophagectomy were observed retrospectively. Clinical characteristics, postoperative complications and survival analysis were compared among different BMI, REE and FBG groups. Results There were significant linear relationships between REE, BMI and FBG indices, patients with low BMI tended to have low REE (p < 0.001) and low FBG (p = 0.003). No significant difference was found in case of mortality and postoperative complications among different groups. Low BMI (X2 = 6.141, p = 0.046), REE (X2 = 6.630, p = 0.010) and FBG (X2 = 5.379, p = 0.020) were related to poor survival. FBG ≤90 mg/dL was independently associated with poor survival (HR = 0.695; 95 % CI 0.489–0.987, p = 0.042). BMI and REE came to be stronger prognostic factors on lymph node-negative patients and proved to be independent prognostic indicators (HR = 0.540; 95 % CI 0.304–0.959, p = 0.035 and HR = 0.457; 95 % CI 0.216–0.967, p = 0.041, respectively). Conclusions BMI, REE and FBG are important prognostic factors in patients with esophageal cancer undergoing esophagectomy and preoperative evaluation of these indices help to determine the prognosis in these patients.
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Abstract
The prevalence of overweight (body mass index [BMI], 25 to 29.9 kg/m2) and obesity (BMI ≥ 30 kg/m2) have increased dramatically in the United States. Because increasing BMI is associated with the development of multiple different cancer types, including most GI cancers, providers will frequently encounter patients with GI cancer who are overweight or obese. Mounting evidence associates overweight and/or obesity with worsened prognosis in multiple GI cancers, including esophageal, gastric, hepatocellular, pancreatic, and colorectal. However, these data are observational and may be subject to bias and/or confounding. Furthermore, in some cancer types, the associations between BMI and outcomes is not linear, where overweight and class I obese patients may have an improvement in outcome. This report provides a brief highlight of existing studies that have linked overweight and/or obesity to prognosis in GI cancer; provides recommendations on best management practices; and discusses limitations, controversies, and future directions in this rapidly evolving area. There are multiple areas of promise that warrant continued investigation: What are the comparative contributions of energy balance, including weight, dietary patterns, and physical activity on cancer prognosis? What are the specific physiologic pathways that mediate the relationship between energy balance and prognosis? What is the relationship between low muscle mass (sarcopenia) or sarcopenic obesity and cancer prognosis? Are there subsets of patients for whom purposefully altering energy balance would be deleterious to prognosis? This area is rich with opportunities to understand how states of energy (im)balance can be favorably altered to promote healthy survivorship.
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Affiliation(s)
- Justin C. Brown
- Justin C. Brown, University of Pennsylvania, Philadelphia, PA; and Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Boston, MA
| | - Jeffrey A. Meyerhardt
- Justin C. Brown, University of Pennsylvania, Philadelphia, PA; and Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Boston, MA
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Divella R, De Luca R, Abbate I, Naglieri E, Daniele A. Obesity and cancer: the role of adipose tissue and adipo-cytokines-induced chronic inflammation. J Cancer 2016; 7:2346-2359. [PMID: 27994674 PMCID: PMC5166547 DOI: 10.7150/jca.16884] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/19/2016] [Indexed: 12/12/2022] Open
Abstract
Adipose tissue in addition to its ability to keep lipids is now recognized as a real organ with both metabolic and endocrine functions. Recent studies demonstrated that in obese animals is established a status of adipocyte hypoxia and in this hypoxic state interaction between adipocytes and stromal vascular cells contribute to tumor development and progression. In several tumors such as breast, colon, liver and prostate, obesity represents a poor predictor of clinical outcomes. Dysfunctional adipose tissue in obesity releases a disturbed profile of adipokines with elevated levels of pro-inflammatory factors and a consequent alteration of key signaling mediators which may be an active local player in establishing the peritumoral environment promoting tumor growth and progression. Therefore, adipose tissue hypoxia might contribute to cancer risk in the obese population. To date the precise mechanisms behind this obesity-cancer link is not yet fully understood. In the light of information provided in this review that aims to identify the key mechanisms underlying the link between obesity and cancer we support that inflammatory state specific of obesity may be important in obesity-cancer link.
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Affiliation(s)
- Rosa Divella
- Clinical Pathology Laboratory, Department of Experimental Oncology. Giovanni Paolo II National Cancer Institute, V.Le Orazio Flacco 65, 70124 -Bari, Italy
| | - Raffaele De Luca
- Department of Surgery Oncology. Giovanni Paolo II National Cancer Institute, V.Le Orazio Flacco 65, 70124 -Bari, Italy
| | - Ines Abbate
- Clinical Pathology Laboratory, Department of Experimental Oncology. Giovanni Paolo II National Cancer Institute, V.Le Orazio Flacco 65, 70124 -Bari, Italy
| | - Emanuele Naglieri
- Department of Medical Oncology, Giovanni Paolo II National Cancer Institute, V.Le Orazio Flacco 65, 70124 -Bari, Italy
| | - Antonella Daniele
- Clinical Pathology Laboratory, Department of Experimental Oncology. Giovanni Paolo II National Cancer Institute, V.Le Orazio Flacco 65, 70124 -Bari, Italy
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Sun P, Zhang F, Chen C, Ren C, Bi XW, Yang H, An X, Wang FH, Jiang WQ. Prognostic impact of body mass index stratified by smoking status in patients with esophageal squamous cell carcinoma. Onco Targets Ther 2016; 9:6389-6397. [PMID: 27799787 PMCID: PMC5074733 DOI: 10.2147/ott.s111843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background As smoking affects the body mass index (BMI) and causes the risk of esophageal squamous cell carcinoma (ESCC), the prognostic impact of BMI in ESCC could be stratified by smoking status. We investigated the true prognostic effect of BMI and its potential modification by smoking status in ESCC. Methods We retrospectively analyzed 459 patients who underwent curative treatment at a single institution between January 2007 and December 2010. BMI was calculated using the measured height and weight before surgery. Chi-square test was used to evaluate the relationships between smoking status and other clinicopathological variables. The Cox proportional hazard models were used for univariate and multivariate analyses of variables related to overall survival. Results BMI <18.5 kg/m2 was a significantly independent predictor of poor survival in the overall population and never smokers after adjusting for covariates, but not in ever smokers. Among never smokers, underweight patients (BMI <18.5 kg/m2) had a 2.218 times greater risk of mortality than non-underweight (BMI ≥18.5 kg/m2) patients (P=0.015). Among ever smokers, BMI <18 kg/m2 increased the risk of mortality to 1.656 (P=0.019), compared to those having BMI ≥18 kg/m2. Conclusion Our study is likely the first to show that the prognostic effect of BMI was substantial in ESCC, even after stratifying by smoking status. Furthermore, the risk of death due to low BMI would be significantly increased in never smokers. We believe that the prognostic impact of BMI is modified but not eliminated by the smoking status in ESCC.
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Affiliation(s)
- Peng Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center
| | - Fei Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center
| | - Cui Chen
- Department of Oncology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Chao Ren
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center
| | - Xi-Wen Bi
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center
| | - Hang Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center
| | - Xin An
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center
| | - Feng-Hua Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center
| | - Wen-Qi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center
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Abstract
There is a common perception that excess adiposity, commonly approximated by body mass index (BMI), is associated with reduced cancer survival. A number of studies have emerged challenging this by demonstrating that overweight and early obese states are associated with improved survival. This finding is termed the "obesity paradox" and is well recognized in the cardio-metabolic literature but less so in oncology. Here, we summarize the epidemiological findings related to the obesity paradox in cancer. Our review highlights that many observations of the obesity paradox in cancer reflect methodological mechanisms including the crudeness of BMI as an obesity measure, confounding, detection bias, reverse causality, and a specific form of the selection bias, known as collider bias. It is imperative for the oncologist to interpret the observation of the obesity paradox against the above methodological framework and avoid the misinterpretation that being obese might be "good" or "protective" for cancer patients.
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Affiliation(s)
- Hannah Lennon
- Institute of Cancer Sciences, University of Manchester, Manchester, UK.
- Farr Institute, MRC Health eResearch Centre (HeRC North), University of Manchester, Manchester, UK.
| | - Matthew Sperrin
- Farr Institute, MRC Health eResearch Centre (HeRC North), University of Manchester, Manchester, UK
| | - Ellena Badrick
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
- Farr Institute, MRC Health eResearch Centre (HeRC North), University of Manchester, Manchester, UK
| | - Andrew G Renehan
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
- Farr Institute, MRC Health eResearch Centre (HeRC North), University of Manchester, Manchester, UK
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Akinyemiju T, Meng Q, Vin-Raviv N. Association between body mass index and in-hospital outcomes: Analysis of the nationwide inpatient database. Medicine (Baltimore) 2016; 95:e4189. [PMID: 27428218 PMCID: PMC4956812 DOI: 10.1097/md.0000000000004189] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Over one-third of American adults (36%) are obese and more than two-thirds (69%) are overweight. The impact of obesity on hospitalization outcomes is not well understood. OBJECTIVE To examine the association between body mass index (BMI) and overall, cancer, chronic obstructive pulmonary disease (COPD), asthma, and cardiovascular disease (CVD)-specific in-hospital mortality; postsurgical complications; and hospital length of stay (LOS). DESIGN Cross-sectional study. SETTING Representative sample of US hospitals included in the Health Cost and Utilization Project Nationwide Inpatient Sample database. PARTICIPANTS We obtained data for patients admitted with a primary diagnosis of cancer, COPD, asthma, and CVD. MAIN OUTCOME In-hospital mortality, postsurgical complications, and hospital LOS. RESULTS A total of 800,417 patients were included in this analysis. A higher proportion of Blacks (26.8%; 12.5%) and Whites (23.3%; 8.7%) had BMI of 40 to 49.9 and ≥50, respectively, compared with Hispanics (20.4%; 7.3%). Compared with normal BMI patients, the odds of in-hospital mortality increased 3.6-fold (odds ratio [OR] 3.62, 95% confidence interval [CI]: 3.37-3.89) for preobese patients, 6.5-fold (OR: 6.52, 95% CI: 5.79-7.34) for patients with BMI: 30 to 31.9, 7.5-fold (OR: 7.57, 95% CI: 6.67-8.59) for patients with BMI: 34 to 35.9, and 1.6- fold (OR: 1.77, 95% CI: 1.56-1.79) for patients with BMI ≥ 50. Compared with normal BMI patients, preobese and overweight patients had shorter hospital stays (β preobese: -1.58, 95% CI: -1.63, -1.52); however, no clear trends were observed for postsurgical complications. CONCLUSIONS The majority of hospitalized patients in this analysis had a BMI > 30, and higher BMI was associated with increased risk of mortality and longer hospital stay.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
- Correspondence: Tomi Akinyemiju, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama (e-mail: )
| | - Qingrui Meng
- Department of Epidemiology, University of Alabama at Birmingham
| | - Neomi Vin-Raviv
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado
- School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA
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Influence of Body Mass Index on the Prognostic Value of Tumor ¹⁸F-FDG Uptake in Stage I Non-Small Cell Lung Cancer. PLoS One 2015; 10:e0145020. [PMID: 26684001 PMCID: PMC4684313 DOI: 10.1371/journal.pone.0145020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/25/2015] [Indexed: 01/01/2023] Open
Abstract
Background The impact of host energy balance status on outcome of lung cancer has not been fully explored. It is also unknown if there is a potential modifying effect of body mass index (BMI) on tumor cell behavior in patients with early-stage non-small cell lung cancer (NSCLC). We therefore investigated the interactive effects of tumor [18F]-fluorodeoxyglucose (FDG) avidity and BMI. Methods We investigated 1,197 patients with stage I NSCLC who underwent preoperative FDG positron emission tomography followed by curative resection. The primary outcome measure was disease-free survival (DFS). A multivariable Cox proportional hazards model was used to assess the potential independent effects of the prognostic variables. A stratified Cox regression analysis was also performed to assess the potential modifying effects of BMI on the relationship between tumor FDG uptake and patient survival. Results There were 145 tumor recurrences and 19 deaths during a median follow-up of 30 months. Tumor-related variables, including tumor size, maximum standardized uptake value (SUVmax), histologic cell type, differentiation, lymphovascular invasion, and visceral pleural invasion, did not differ significantly according to BMI status. In multivariable Cox regression analysis, overweight or obesity [hazard ratio (HR), 0.59; 95% CI, 0.43–0.81; P = 0.001] and tumor SUVmax (HR, 1.72; 95% CI, 1.43–2.07; P < 0.001) were significantly associated with DFS. There was a significant modifying effect of BMI (P for interaction < 0.001 in multivariable analysis). High tumor SUVmax was more strongly associated with worse DFS in normal weight patients (HR, 4.72; 95% CI, 2.77–8.06; P < 0.001) than in overweight or obese patients (HR, 2.61; 95% CI, 1.58–4.31; P < 0.001). Conclusions Tumor FDG avidity is an independent predictor of DFS in patients with early-stage NSCLC and this prognostic value was strengthened in normal weight patients than in overweight or obese patients. These results suggest that the host-tumor interaction between host energy balance status and tumor glucose metabolism plays an important role in the outcome of early-stage NSCLC.
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Argolo DF, Iyengar NM, Hudis CA. Obesity and Cancer: Concepts and Challenges. Indian J Surg Oncol 2015; 6:390-8. [PMID: 27081257 DOI: 10.1007/s13193-015-0483-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/17/2015] [Indexed: 12/17/2022] Open
Abstract
The rates of overweight and obesity are increasing worldwide in both developed and developing countries. Obesity is a major public health problem as it is associated with many diseases, including diabetes, hypertension, dyslipidemia, atherosclerosis, and some types of cancer. Breast cancer is a malignancy in which both the risk of development and the prognosis are negatively impacted by the obese state. The precise mechanisms pathophysiologically linking obesity and cancer are still under investigation. The biological basis for these associations includes both systemic and local tissue effects and white adipose tissue inflammation appears to be a critical component. A comprehensive understanding of the mechanisms linking obesity, inflammation and cancer may provide an opportunity for the development of strategies to attenuate the negative impact of obesity.
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Affiliation(s)
- Daniel F Argolo
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street - 8th floor, New York, NY 10065 USA ; CLION - CAM Group, Salvador, BA Brazil
| | - Neil M Iyengar
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street - 8th floor, New York, NY 10065 USA ; Weill Cornell Medical College, New York, NY USA
| | - Clifford A Hudis
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street - 8th floor, New York, NY 10065 USA ; Weill Cornell Medical College, New York, NY USA
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Li Q, Xing H, Liu D, Li H. Negative impact of low body mass index on liver cirrhosis patients with hepatocellular carcinoma. World J Surg Oncol 2015; 13:294. [PMID: 26444667 PMCID: PMC4596284 DOI: 10.1186/s12957-015-0713-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/22/2015] [Indexed: 12/11/2022] Open
Abstract
Background The impact of obesity on the prognosis of hepatocellular carcinoma (HCC) has not been well characterized in a Chinese population. Therefore, the aim of this study was to examine the influence of BMI on the clinicopathological characteristics and mortality of patients with HCC. Methods The study cohort consisted of 379 patients who were diagnosed with HCC at the First Affiliated Hospital of Harbin Medical University between June 2012 and August 2014. Study subjects were divided into two body mass index (BMI) categories: normal weight (BMI <23 kg/m2) and overweight (BMI ≥23 kg/m2). Results Of the 379 patients, 44 (11.6 %) were underweight (<18.5 kg/m2), 172 (45.4 %) had a normal weight (18.5 ≤ BMI < 23.0), 133 (35.1 %) were overweight (23.0 ≤ BMI < 27.5), and 30 (7.9 %) were obese (BMI ≥27.5). After a median follow-up time of 296 (range, 15–720) days, 168 (44.3 %) patients died with median survival time of 159 (range, 15–690) days. Patients with lower BMIs also exhibited a higher liver-related mortality rate (60.6 vs. 22.7 %; p = 1.8 × 10−13) and a shorter survival time (353 days vs. 571 days; p = 6.2 × 10−6) than patients with higher BMIs. In multivariate analysis, the BMI class was also found to be a significant independent impact factor for overall survival (p = 2.2 × 10−8), age, alpha-fetoprotein level, Child–Pugh score, treatment strategy, antiviral treatment, extrahepatic metastasis, and tumor infiltration of the portal vein. Conclusions Our data suggest that lower BMI has a significant impact regarding poor outcomes in patients with HCC. To better understand the impact of BMI on the prognosis of HCC patients, more large-scale cohort studies will be necessary.
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Affiliation(s)
- Qinggang Li
- Department of Infectious Disease, First Affiliated Hospital of Harbin Medical University, No. 23 You Zheng Street, Harbin, 150001, People's Republic of China.
| | - Hui Xing
- Department of Gastroenterology, Second Affiliated Hospital of Harbin Medical University, Xuefu Road, Harbin, 150086, People's Republic of China.
| | - Dan Liu
- Department of Gastroenterology, Second Affiliated Hospital of Harbin Medical University, Xuefu Road, Harbin, 150086, People's Republic of China.
| | - Hui Li
- Department of Gastroenterology, Second Affiliated Hospital of Harbin Medical University, Xuefu Road, Harbin, 150086, People's Republic of China.
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Abstract
Obesity is a leading modifiable risk factor for the development of several epithelial malignancies. In addition to increasing risk, obesity also confers worse prognosis for many cancers. Obesity represents an overall state of energy imbalance frequently associated with systemic effects including insulin resistance, altered hormone signaling, and high circulating levels of proinflammatory mediators. In addition to its systemic effects, obesity causes subclinical white adipose inflammation including increased tissue levels of proinflammatory mediators. Both local and systemic effects are likely to contribute to the development and progression of cancer. An understanding of the interplay between local and systemic alterations involved in the obesity-cancer link provides the basis for developing interventions aimed at mitigating the protumorigenic effects.
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Affiliation(s)
- Neil M Iyengar
- Memorial Sloan Kettering Cancer Center, New York, NY 10065; ,
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Gucalp A, Iyengar NM, Hudis CA, Dannenberg AJ. Targeting obesity-related adipose tissue dysfunction to prevent cancer development and progression. Semin Oncol 2015; 43:154-160. [PMID: 26970134 DOI: 10.1053/j.seminoncol.2015.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The incidence of obesity, a leading modifiable risk factor for common solid tumors, is increasing. Effective interventions are needed to minimize the public health implications of obesity. Although the mechanisms linking increased adiposity to malignancy are incompletely understood, growing evidence points to complex interactions among multiple systemic and tissue-specific pathways including inflamed white adipose tissue. The metabolic and inflammatory consequences of white adipose tissue dysfunction collectively provide a plausible explanation for the link between overweight/obesity and carcinogenesis. Gaining a better understanding of these underlying molecular pathways and developing risk assessment tools that identify at-risk populations will be critical in implementing effective and novel cancer prevention and management strategies.
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Affiliation(s)
- Ayca Gucalp
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Neil M Iyengar
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Clifford A Hudis
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Londono R, Badylak SF. Regenerative Medicine Strategies for Esophageal Repair. TISSUE ENGINEERING PART B-REVIEWS 2015; 21:393-410. [PMID: 25813694 DOI: 10.1089/ten.teb.2015.0014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pathologies that involve the structure and/or function of the esophagus can be life-threatening. The esophagus is a complex organ comprising nonredundant tissue that does not have the ability to regenerate. Currently available interventions for esophageal pathology have limited success and are typically associated with significant morbidity. Hence, there is currently an unmet clinical need for effective methods of esophageal repair. The present article presents a review of esophageal disease along with the anatomic and functional consequences of each pathologic process, the shortcomings associated with currently available therapies, and the latest advancements in the field of regenerative medicine with respect to strategies for esophageal repair from benchtop to bedside.
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Affiliation(s)
- Ricardo Londono
- 1 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Stephen F Badylak
- 1 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,3 Department of Bioengineering, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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Ren C, Cai XY, Qiu MZ, Wang DS, Wang FH, Luo HY, Xu RH. Impact of body mass index on survival of esophageal squamous carcinoma patients in southern China. J Thorac Dis 2015; 7:337-45. [PMID: 25922711 DOI: 10.3978/j.issn.2072-1439.2014.10.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/17/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although high body mass index (BMI) increases risk for developing esophageal adenocarcinoma (EAC), the prognostic influence of BMI is unknown in esophageal squamous carcinoma. METHODS BMI was calculated using measured height and weight at the first diagnosis and categorized as overweight (25 to 29.9 kg/m(2)), normal (18.5 to 24.9 kg/m(2)) or underweight (<18.5 kg/m(2)). Survival was compared by using the log-rank test on the Kaplan-Meier life table. Multivariate Cox regression analysis was used to evaluate whether BMI was an independent prognostic factor for disease-specific survival (DSS). RESULTS Among 1,176 esophageal squamous carcinoma patients, 146 (12.4%) were categorized as overweight, and 277 (23.6%) underweight. More patients in the underweight group had anemia (P=0.001), weight loss (P=0.035) and R1 resection (P<0.001). Less patients in the underweight group received adjuvant chemotherapy (P=0.01). Patients in the overweight group had a higher incidence rate of high blood pressure (P<0.001), diabetes (P<0.001) and coronary artery diseases (P<0.001). Moreover, more patients in the overweight group had a lower TNM stage (P=0.003). In the univariated analysis, high BMI was significantly associated with better DSS (P=0.013). CONCLUSIONS After adjusting for covariates enrolled for study, high BMI was an independent prognostic factor in weight loss esophageal squamous carcinoma patients.
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Affiliation(s)
- Chao Ren
- 1 State Key Laboratory of Oncology in South China, Guangzhou 510060, China ; 2 Department of Medical Oncology, 3 Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiu-Yu Cai
- 1 State Key Laboratory of Oncology in South China, Guangzhou 510060, China ; 2 Department of Medical Oncology, 3 Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Miao-Zhen Qiu
- 1 State Key Laboratory of Oncology in South China, Guangzhou 510060, China ; 2 Department of Medical Oncology, 3 Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - De-Shen Wang
- 1 State Key Laboratory of Oncology in South China, Guangzhou 510060, China ; 2 Department of Medical Oncology, 3 Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Feng-Hua Wang
- 1 State Key Laboratory of Oncology in South China, Guangzhou 510060, China ; 2 Department of Medical Oncology, 3 Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hui-Yan Luo
- 1 State Key Laboratory of Oncology in South China, Guangzhou 510060, China ; 2 Department of Medical Oncology, 3 Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Rui-Hua Xu
- 1 State Key Laboratory of Oncology in South China, Guangzhou 510060, China ; 2 Department of Medical Oncology, 3 Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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Wang F, Duan H, Cai M, Fu J, Ma G, Yang H, Tan Z, Hu R, Lin P, Zhang X. Prognostic significance of the pN classification supplemented by body mass index for esophageal squamous cell carcinoma. Thorac Cancer 2015; 6:765-71. [PMID: 26557916 PMCID: PMC4632930 DOI: 10.1111/1759-7714.12259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/25/2015] [Indexed: 01/01/2023] Open
Abstract
Background Body mass index (BMI) has been associated with the risk of esophageal cancer. But the influence of BMI on postoperative complications and prognosis has always been controversial. Methods Between 2000 and 2007, 424 patients with esophageal squamous cell carcinoma (ESCC) underwent R0 esophagectomy at our center without neoadjuvant therapy. We performed univariate and multivariate analyses to identify prognostic factors for survival. Results Patients were divided into three groups according to Asian-specific BMI cut-off value: underweight (n = 45), normal weight (n = 228), and overweight and obese (n = 151). Mean follow-up time was 39 months. The five-year overall survival (OS) rate was 19%, 34%, and 42% for underweight, normal weight, and overweight and obese, respectively (P < 0.001). The five-year disease-free survival (DFS) rate was 24%, 41%, and 74% for underweight, normal weight, and overweight and obese, respectively (P < 0.001). Multivariate analysis showed that pT, pN, and BMI were independent prognostic factors for DFS and OS. The C-index to the combined model showed improved predictive ability when compared to the pN classification (0.779 vs. 0.734). Conclusion Preoperative BMI was an independent prognostic factor for OS and DFS. The proposed new prognostic model with the pN classification supplemented by BMI might improve the ability to discriminate ESCC patients’ outcome.
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Affiliation(s)
- Feixiang Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China
| | - Hao Duan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China
| | - Muyan Cai
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Pathology, Sun Yat-sen University Cancer Center Guangzhou, China
| | - Jianhua Fu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China ; Guangdong Esophageal Cancer Research Institute Guangzhou, China
| | - Guowei Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China
| | - Han Yang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China ; Guangdong Esophageal Cancer Research Institute Guangzhou, China
| | - Zihui Tan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China ; Guangdong Esophageal Cancer Research Institute Guangzhou, China
| | - Ronggui Hu
- Department of Cardio-Thoracic Surgery, Zhongshan People's Hosptial Zhongshan, China
| | - Peng Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China
| | - Xu Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China ; Guangdong Esophageal Cancer Research Institute Guangzhou, China
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Hasegawa T, Kubo N, Ohira M, Sakurai K, Toyokawa T, Yamashita Y, Yamazoe S, Kimura K, Nagahara H, Amano R, Shibutani M, Tanaka H, Muguruma K, Ohtani H, Yashiro M, Maeda K, Hirakawa K. Impact of body mass index on surgical outcomes after esophagectomy for patients with esophageal squamous cell carcinoma. J Gastrointest Surg 2015; 19:226-33. [PMID: 25398407 DOI: 10.1007/s11605-014-2686-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/16/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with overweight reportedly have more comorbidities, including diabetes mellitus and cardiovascular disease, and longer operating times as well as more blood loss during surgery compared with those with normal weight. However, the impact of overweight on the short-term outcome after transthoracic esophagectomy for patients with esophageal squamous cell carcinoma (ESCC) remains unclear. We hypothesized that overweight has a negative impact on short-term surgical outcomes after esophagectomy for patients with ESCC. METHODS A total of 304 patients who underwent transthoracic esophagectomy for ESCC were included in this study. Body mass index (BMI) was classified into three categories, <18.49, 18.50-24.99, and >25.00 (kg/m(2)), defined as low, normal, and high BMI, respectively, according to the World Health Organization criteria. We investigated the association of BMI status with patient demographics and surgical outcomes after esophagectomy for patients with ESCC. In addition, overall survival and relapse-free survival stratified by BMI were compared. RESULTS Fifty-nine (19.4 %) and 41 (13.4 %) patients were classified to low BMI and high BMI, respectively. The high-BMI group had significantly higher comorbidity rates of diabetes mellitus (p < 0.01) and anastomotic leakage (p = 0.011) than the normal-BMI group. There were no significant association between high BMI and another various complications except for an anastomotic leakage, severe complications defined by Clavien-Dindo classification and in-hospital mortality. In multivariate analysis, high BMI was a significant risk factor for anastomotic leakage (p = 0.030, hazard ratio; 3.423, 95%CI; 1.128-10.38). On the other hand, no significant association was observed between low BMI and short surgical outcomes. There were no significant differences in overall and relapse-free survival among the three BMI groups in univariate and multivariate analysis (p = 0.128 and p = 0.584, respectively). CONCLUSION The surgical treatment should not be denied for patients with ESCC due to overweight and underweight. However, intraoperative prevention and postoperative careful monitoring for anastomotic leakage might be required after esophagectomy for overweight patients with ESCC.
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Affiliation(s)
- Tsuyoshi Hasegawa
- Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Abstract
Supplemental Digital Content is available in the text. Background: Many studies have documented an obesity paradox—a survival advantage of being obese—in populations diagnosed with a medical condition. Whether obesity is causally associated with improved mortality in these conditions is unresolved. Methods: We develop the logic of collider bias as it pertains to the association between smoking and obesity in a diseased population. Data from the National Health and Nutrition Examination Survey (NHANES) are used to investigate this bias empirically among persons with diabetes and prediabetes (dysglycemia). We also use NHANES to investigate whether reverse causal pathways are more prominent among people with dysglycemia than in the source population. Cox regression analysis is used to examine the extent of the obesity paradox among those with dysglycemia. In the regression analysis, we explore interactions between obesity and smoking, and we implement a variety of data restrictions designed to reduce the extent of reverse causality. Results: We find an obesity paradox among persons with dysglycemia. In this population, the inverse association between obesity and smoking is much stronger than in the source population, and the extent of illness and weight loss is greater. The obesity paradox is absent among never-smokers. Among smokers, the paradox is eliminated through successive efforts to reduce the extent of reverse causality. Conclusion: Higher mortality among normal-weight people with dysglycemia is not causal but is rather a product of the closer inverse association between obesity and smoking in this subpopulation.
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Lynam-Lennon N, Connaughton R, Carr E, Mongan AM, O’Farrell NJ, Porter RK, Brennan L, Pidgeon GP, Lysaght J, Reynolds JV, O’Sullivan J. Excess visceral adiposity induces alterations in mitochondrial function and energy metabolism in esophageal adenocarcinoma. BMC Cancer 2014; 14:907. [PMID: 25471892 PMCID: PMC4265417 DOI: 10.1186/1471-2407-14-907] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 11/20/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Visceral obesity has a strong association with both the incidence and mortality of esophageal adenocarcinoma (EAC). Alterations in mitochondrial function and energy metabolism is an emerging hallmark of cancer, however, the potential role that obesity plays in driving these alterations in EAC is currently unknown. METHODS Adipose conditioned media (ACM) was prepared from visceral adipose tissue taken from computed tomography-determined viscerally-obese and non-obese EAC patients. Mitochondrial function in EAC cell lines was assessed using fluorescent probes, mitochondrial gene expression was assessed using qPCR-based gene arrays and intracellular ATP levels were determined using a luminescence-based kit. Glycolysis and oxidative phosphophorylation was measured using Seahorse XF technology and metabolomic analysis was performed using 1H NMR. Expression of metabolic markers was assessed in EAC tumor biopsies by qPCR. RESULTS ACM from obese EAC patients significantly increased mitochondrial mass and mitochondrial membrane potential in EAC cells, which was significantly associated with visceral fat area, and was coupled with a significant decrease in reactive oxygen species. This mitochondrial dysfunction was accompanied by altered expression of 19 mitochondrial-associated genes and significantly reduced intracellular ATP levels. ACM from obese EAC patients induced a metabolic shift to glycolysis in EAC cells, which was coupled with significantly increased sensitivity to the glycolytic inhibitor 2-deoxyglucose. Metabolomic profiling demonstrated an altered glycolysis and amino acid-related signature in ACM from obese patients. In EAC tumors, expression of the glycolytic marker PKM2 was significantly positively associated with obesity. CONCLUSION This study demonstrates for the first time that ACM from viscerally-obese EAC patients elicits an altered metabolic profile and can drive mitochondrial dysfunction and altered energy metabolism in EAC cells in vitro. In vivo, in EAC patient tumors, expression of the glycolytic enzyme PKM2 is positively associated with obesity.
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Affiliation(s)
- Niamh Lynam-Lennon
- />Department of Surgery, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ruth Connaughton
- />Department of Surgery, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
- />Nutrigenomics Research Group, University College Dublin, Dublin, Ireland
| | - Eibhlin Carr
- />Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Ann-Marie Mongan
- />Department of Surgery, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Naoimh J O’Farrell
- />Department of Surgery, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Richard K Porter
- />School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute (TBSI), Trinity College Dublin, Dublin, Ireland
| | - Lorraine Brennan
- />Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Graham P Pidgeon
- />Department of Surgery, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Joanne Lysaght
- />Department of Surgery, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - John V Reynolds
- />Department of Surgery, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jacintha O’Sullivan
- />Department of Surgery, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
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Miao L, Chen H, Xiang J, Zhang Y. A high body mass index in esophageal cancer patients is not associated with adverse outcomes following esophagectomy. J Cancer Res Clin Oncol 2014; 141:941-50. [PMID: 25428458 DOI: 10.1007/s00432-014-1878-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/13/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE There is no consensus about the impact of a high BMI on postoperative morbidity and survival after esophagectomy. The aim of this study was to determine the influence of a high BMI on postoperative complications and survival in a large cohort of esophageal cancer patients. METHODS From January 2006 to December 2012, 1,342 consecutive esophageal cancer patients who underwent esophagectomy were included in this study. Patients were divided into three groups: 950 patients were classified as normal BMI (BMI 18.5-24.9 kg/m(2)), 279 were classified as high BMI (BMI ≥ 25 kg/m(2)), and 113 as low BMI (BMI < 18.5 kg/m(2)). Multivariate logistic regression models were used to identify confounding factors associated with postoperative complications. The impact of BMI on overall survival (OS) was estimated by the Kaplan-Meier method and Cox proportional hazard models. RESULTS The predominance of pathological type was esophageal squamous cell carcinoma (n = 1,280, 95.4 %). Overall morbidity, mortality, and hospital stay did not differ among groups. The incidence of pneumonia was higher in patients with high BMI compared with those with normal BMI (14.7 vs. 9.9 %, P = 0.025). However, chylothorax was less frequent in high-BMI group (0.4 % in high-BMI group, 3.1 % in normal group, and 3.5 % in low group, P = 0.011). Logistic regression analysis revealed high BMI was independently associated with decreased incidence of chylothorax [HR 0.86; 95 % confidence interval 0.76-0.97]. Overweight and obese patients had significantly better overall survival than underweight patients (median OS 55.6 vs. 32.5 months, P = 0.013), while the pathological stage was significantly higher in underweight patients (P = 0.001). In multivariate analysis, T status, N status, differentiation grade, and tumor length were identified as independent prognostic factors. CONCLUSION A high BMI is not associated with increased overall morbidity following esophagectomy; moreover, it is associated with decreased incidence of chylothorax. The better overall survival in patients with high BMI compared with those with low BMI might be due to a relatively low pathological stage. A high BMI should therefore not be a relative contraindication for esophagectomy.
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Affiliation(s)
- Longsheng Miao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
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Abstract
The incidence of oesophageal adenocarcinoma has increased dramatically in the developed world in the last half century. Over approximately the same period there has been an increase in the prevalence of obesity. Multiple epidemiological studies and meta-analyses have confirmed that obesity, especially abdominal, visceral obesity, is a risk factor for gastro-oesophageal reflux, Barrett's oesophagus and oesophageal adenocarcinoma. Although visceral obesity enhances gastro-oesophageal reflux, the available data also show that visceral obesity increases the risk of Barrett's oesophagus and adenocarcinoma via reflux-independent mechanisms. Several possible mechanisms could link obesity with the risk of oesophageal adenocarcinoma in addition to mechanical effects increasing reflux. These include reduced gastric Helicobacter pylori infection, altered intestinal microbiome, factors related to lifestyle, the metabolic syndrome and associated low-grade inflammation induced by obesity and the secretion of mediators by adipocytes which may directly influence the oesophageal epithelium. Of these adipocyte-derived mediators, increased leptin levels have been independently associated with progression to oesophageal adenocarcinoma and in laboratory studies leptin enhances malignant behaviours in cell lines. Adiponectin is also secreted by adipocytes and levels decline with obesity: decreased serum adiponectin levels are associated with malignant progression in Barrett's oesophagus and experimentally adiponectin exerts anticancer effects in Barrett's cell lines and inhibits growth factor signalling. At present there are no proven chemopreventative interventions that may reduce the incidence of obesity-associated oesophageal cancer: observational studies suggest that the combined use of a statin and aspirin or another cyclo-oxygenase inhibitor is associated with a significantly reduced cancer incidence in patients with Barrett's oesophagus.
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Affiliation(s)
- Elizabeth Long
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Ian L P Beales
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
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Renehan AG. The 'obesity paradox' and survival after colorectal cancer: true or false? Cancer Causes Control 2014; 25:1419-22. [PMID: 25084751 DOI: 10.1007/s10552-014-0436-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 07/03/2014] [Indexed: 10/25/2022]
Abstract
Body mass index (BMI), as an approximation of general adiposity, is an established risk factor for incidence of several adult cancer types, including colorectal cancer (CRC). There is a common perception that these relationships extrapolate directly as adverse prognostic factors after diagnosis, but evidence for this is lacking. The paper from Sclesinger et al. in this issue of the journal adds a new dimension to this debate focusing on relationships of post-diagnosis BMI (as a marker of the steady-state weight among survivors) and survival, and provides evidence on a decreased mortality risk among overweight (post-diagnosis BMI 25.0-29.9 kg/m(2)) compared with normal weight (post-diagnosis BMI 18.5-24.9 kg/m(2)) CRC survivors-an example of an 'obesity paradox.' The observation of the 'obesity paradox' is well documented in the methodology literature, but perhaps, less familiar to the cancer readership. Three broad classes of explanation are posited: (1) the associations are true and plausible; (2) the associations are false and reflect methodological issues; or (3) the observations represent a specific form of selection bias, known as collider bias. The present author argues that the obesity paradox reflects the latter-a product of a statistical bias-and emphasizes that, while these findings are hypothesis generating, they will not alter clinical practice or recommendations.
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Affiliation(s)
- Andrew G Renehan
- Department of Surgery, Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK,
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