Dataset Information

Association between visceral obesity, metformin use, and recurrence risk in early-stage colorectal cancer.

ABSTRACT: We sought to investigate the association between visceral obesity with disease recurrence and survival in early-stage colorectal cancer (CRC) patients. We also wanted to examine if such an association, if exists, is influenced by metformin use. Stage I/II CRC adenocarcinoma patients treated surgically were identified. L3 level CT VFI (visceral fat index) was used as a metric of visceral obesity and was calculated as the proportion of total fat area composed of visceral fat. N = 492. 53% were males, 90% were Caucasians, 35% had stage I disease, and 14% used metformin. 20.3% patients developed a recurrence over a median follow-up of 56 months. VFI was associated with both RFS and OS in a multivariate model, but not BMI. The final multivariate model for RFS included an interaction term for VFI and metformin (p = 0.04). Confirming this result, subgroup analysis showed an increasing VFI was associated with a poor RFS (p = 0.002), and OS (p < 0.001) in metformin non-users only and metformin use was associated with a better RFS only in the top VFI tertile (p = 0.01). Visceral obesity, but not BMI, is associated with recurrence risk and poorer survival in stage I/II CRC. Interestingly, this association is influenced by metformin use.

SUBMITTER: Vedire YR

PROVIDER: S-EPMC10209144 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Association between visceral obesity, metformin use, and recurrence risk in early-stage colorectal cancer.

Vedire Yeshwanth Reddy YR Mukherjee Sarbajit S Dondapati Sumedha S Yendamuri Sai S

Scientific reports 20230524 1

We sought to investigate the association between visceral obesity with disease recurrence and survival in early-stage colorectal cancer (CRC) patients. We also wanted to examine if such an association, if exists, is influenced by metformin use. Stage I/II CRC adenocarcinoma patients treated surgically were identified. L3 level CT VFI (visceral fat index) was used as a metric of visceral obesity and was calculated as the proportion of total fat area composed of visceral fat. N = 492. 53% were mal ...[more]

PMID: 37225730

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Project description:ImportanceThe potential relationship between obesity and colorectal cancer (CRC) outcome is poorly understood in patients with late-stage disease. Increased body mass index may negate aspirin use for cancer prevention, but its role as a factor on the effectiveness of postdiagnosis aspirin use is unclear.ObjectiveTo evaluate how prediagnosis obesity and postdiagnosis aspirin use may be associated with overall survival in patients with late-stage colorectal cancer.Design, setting, and participantsThis cross-sectional study used self-reported data from patients with metastatic or treatment-refractory disease who consented to a clinical protocol at MD Anderson Cancer Center, a large US cancer treatment center. Patients were enrolled between 2010 and 2018 and followed up for mortality through July 2020. Analyses were conducted through March 2022.ExposuresBody mass index in the decade prior to initial diagnosis and regular aspirin use at survey completion.Main outcomes and measuresOverall survival was measured from stage IV diagnosis until death or last follow-up. Cox proportional hazards models were constructed to estimate associations of prediagnosis obesity and postdiagnosis aspirin use with overall survival.ResultsOf 656 patients included in this analysis, 280 (42.7%) were women, 135 (20.6%) were diagnosed with CRC before age 45 years, 414 (63.1%) were diagnosed between ages 45 and 65 years, and 107 (16.3%) were diagnosed at 65 years or older; 105 patients (16.0%) were Black or Hispanic, and 501 (76.4%) were non-Hispanic White. Controlling for age, sex, race, stage at initial diagnosis, and weight change between prediagnosis and survey date, patients with obesity in the decade prior to CRC diagnosis had significantly higher likelihood of death (hazard ratio, 1.45; 95% CI, 1.11-1.91) compared with those with normal prediagnosis body mass index. Furthermore, only patients with normal prediagnosis body mass index experienced significant survival benefit with postdiagnosis aspirin use (hazard ratio, 0.59; 95% CI, 0.39-0.90).Conclusions and relevanceIn this cross-sectional study, our findings suggest potentially differential tumor development in the long-term physiologic host environment of obesity. Confirmation and further evaluation are needed to determine whether prediagnosis body mass index may be used to estimate the benefit from postdiagnosis aspirin use.

Project description:ImportanceColorectal cancer (CRC) incidence and mortality among individuals younger than 50 years (early-onset CRC) are increasing. The reasons for such increases are largely unknown, although the increasing prevalence of obesity may be partially responsible.ObjectiveTo investigate prospectively the association between obesity and weight gain since early adulthood with the risk of early-onset CRC.Design, setting, and participantsThe Nurses' Health Study II is a prospective, ongoing cohort study of US female nurses aged 25 to 42 years at study enrollment (1989). A total of 85 256 women free of cancer and inflammatory bowel disease at enrollment were included in this analysis, with follow-up through December 31, 2011. Validated anthropomorphic measures and lifestyle information were self-reported biennially. Statistical analysis was performed from June 12, 2017, to June 28, 2018.ExposuresCurrent body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared), BMI at 18 years of age, and weight gain since 18 years of age.Main outcomes and measuresRelative risk (RR) for incident early-onset CRC.ResultsAmong the 85 256 women studied, 114 cases of early-onset CRC were documented (median age at diagnosis, 45 years; interquartile range, 41-47 years) during 1 196 452 person-years of follow-up. Compared with women with a BMI of 18.5 to 22.9, the multivariable RR was 1.37 (95% CI, 0.81-2.30) for overweight women (BMI, 25.0-29.9) and 1.93 (95% CI, 1.15-3.25) for obese women (BMI, ≥30.0). The RR for each 5-unit increment in BMI was 1.20 (95% CI, 1.05-1.38; P = .01 for trend). Similar associations were observed among women without a family history of CRC and without lower endoscopy within the past 10 years. Both BMI at 18 years of age and weight gain since 18 years of age contributed to this observation. Compared with women with a BMI of 18.5 to 20.9 at 18 years of age, the RR of early-onset CRC was 1.32 (95% CI, 0.80-2.16) for women with a BMI of 21.0 to 22.9 and 1.63 (95% CI, 1.01-2.61) for women with a BMI of 23.0 or greater at 18 years of age (P = .66 for trend). Compared with women who had gained less than 5.0 kg or had lost weight, the RR of early-onset CRC was 1.65 (95% CI, 0.96-2.81) for women gaining 20.0 to 39.9 kg and 2.15 (95% CI, 1.01-4.55) for women gaining 40.0 kg or more (P = .007 for trend).Conclusions and relevanceObesity was associated with an increased risk of early-onset CRC among women. Further investigations among men and to elucidate the underlying biological mechanisms are warranted.

Dataset Information

Association between visceral obesity, metformin use, and recurrence risk in early-stage colorectal cancer.

Publications

Association between visceral obesity, metformin use, and recurrence risk in early-stage colorectal cancer.

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