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Premorbid Obesity and Mortality in Patients With Pancreatic Cancer: A Systematic Review and Meta-analysis.

ABSTRACT: Obesity is associated with an increased risk for pancreatic cancer, but it is unclear whether it affects mortality. We performed a systematic review and meta-analysis to assess the association between premorbid obesity and mortality from pancreatic cancer.We performed a systematic search through January 2015 and identified studies of the association between premorbid obesity (at least 1 year prior to pancreatic cancer diagnosis) and pancreatic cancer-related mortality. We estimated summary adjusted hazard ratio (aHR) with 95% confidence interval (CI), comparing data from obese (body mass index [BMI] ?30 kg/m(2)) and overweight subjects (BMI, 25.0-29.9 kg/m(2)) with those from individuals with a normal BMI (controls) by using random-effects model.We identified 13 studies (including 3 studies that pooled multiple cohorts); 5 studies included only patients with pancreatic cancer, whereas 8 studies evaluated pancreatic cancer-related mortality in cancer-free individuals at inception. In the meta-analysis, we observed increase in pancreatic cancer-related mortality among overweight (aHR, 1.06; 95% CI, 1.02-1.11; I(2) = 0) and obese individuals (aHR, 1.31; 95% CI, 1.20-1.42; I(2) = 43%), compared with controls; the association remained when we analyzed data from only subjects with pancreatic cancer. Each 1 kg/m(2) increase in BMI was associated with 10% increase in mortality (aHR, 1.10; 95% CI, 1.05-1.15) with minimal heterogeneity (I(2) = 0). In the subgroup analysis, obesity was associated with increased mortality in Western populations (11 studies; aHR, 1.32; 95% CI, 1.22-1.42) but not in Asia-Pacific populations (2 studies; aHR, 0.98; 95% CI, 0.76-1.27).In a systematic review and meta-analysis, we associated increasing level of obesity with increased mortality in patients with pancreatic cancer in Western but not Asia-Pacific populations. Strategies to reduce obesity-induced metabolic abnormalities might be developed to treat patients with pancreatic cancer.

SUBMITTER: Majumder K

PROVIDER: S-EPMC4919073 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Premorbid Obesity and Mortality in Patients With Pancreatic Cancer: A Systematic Review and Meta-analysis.

Majumder Kaustav K Gupta Arjun A Arora Nivedita N Singh Preet Paul PP Singh Siddharth S

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 20151014 3

<h4>Background & aims</h4>Obesity is associated with an increased risk for pancreatic cancer, but it is unclear whether it affects mortality. We performed a systematic review and meta-analysis to assess the association between premorbid obesity and mortality from pancreatic cancer.<h4>Methods</h4>We performed a systematic search through January 2015 and identified studies of the association between premorbid obesity (at least 1 year prior to pancreatic cancer diagnosis) and pancreatic cancer-rel ...[more]

PMID: 26460214

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Project description:Coronavirus disease 2019 (COVID-19) has already raised serious concern globally as the number of confirmed or suspected cases have increased rapidly. Epidemiological studies reported that obesity is associated with a higher rate of mortality in patients with COVID-19. Yet, to our knowledge, there is no comprehensive systematic review and meta-analysis to assess the effects of obesity and mortality among patients with COVID-19. We, therefore, aimed to evaluate the effect of obesity, associated comorbidities, and other factors on the risk of death due to COVID-19. We did a systematic search on PubMed, EMBASE, Google Scholar, Web of Science, and Scopus between January 1, 2020, and August 30, 2020. We followed Cochrane Guidelines to find relevant articles, and two reviewers extracted data from retrieved articles. Disagreement during those stages was resolved by discussion with the main investigator. The random-effects model was used to calculate effect sizes. We included 17 articles with a total of 543,399 patients. Obesity was significantly associated with an increased risk of mortality among patients with COVID-19 (RRadjust: 1.42 (95%CI: 1.24-1.63, p < 0.001). The pooled risk ratio for class I, class II, and class III obesity were 1.27 (95%CI: 1.05-1.54, p = 0.01), 1.56 (95%CI: 1.11-2.19, p < 0.01), and 1.92 (95%CI: 1.50-2.47, p < 0.001), respectively). In subgroup analysis, the pooled risk ratio for the patients with stroke, CPOD, CKD, and diabetes were 1.80 (95%CI: 0.89-3.64, p = 0.10), 1.57 (95%CI: 1.57-1.91, p < 0.001), 1.34 (95%CI: 1.18-1.52, p < 0.001), and 1.19 (1.07-1.32, p = 0.001), respectively. However, patients with obesity who were more than 65 years had a higher risk of mortality (RR: 2.54; 95%CI: 1.62-3.67, p < 0.001). Our study showed that obesity was associated with an increased risk of death from COVID-19, particularly in patients aged more than 65 years. Physicians should aware of these risk factors when dealing with patients with COVID-19 and take early treatment intervention to reduce the mortality of COVID-19 patients.

Project description:BACKGROUND:Pancreatic cancer is the fourth leading cause of cancer mortality. Most patients are diagnosed with advanced pancreatic cancer, either at locally advanced or metastatic stages, and have a high rate of malnutrition and weight loss which are associated with poor outcomes. Pancreatic exocrine insufficiency is one of the causes of malnutrition and weight loss in these patients. The prevalence and clinical consequences of pancreatic exocrine insufficiency in advanced pancreatic cancer are poorly investigated with heterogeneous results. We sought to determine the prevalence and clinical consequences of pancreatic exocrine insufficiency and the effect of pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer by systematic review and meta-analysis. METHODS:Scopus, Medline, and Embase were searched for cohort studies or randomised clinical trials reporting pancreatic exocrine insufficiency and/or the effect of pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer. We considered pancreatic exocrine insufficiency as an abnormal result on direct and/or indirect pancreatic exocrine function tests. Pancreatic enzyme replacement therapy was evaluated by its effect on survival and quality of life in patients with advanced pancreatic cancer. RESULTS:A total of 11 studies were included; seven studies reported the prevalence of pancreatic exocrine insufficiency and seven the effect of pancreatic enzyme replacement therapy in advanced pancreatic cancer. The pooled prevalence of pancreatic exocrine insufficiency in advanced pancreatic cancer was 72% (95% confidence interval: 55-86%), being significantly higher when tumours were located in the pancreatic head (relative risk?=?3.36, 1.07-10.54; p?=?0.04) six studies investigated the impact of pancreatic enzyme replacement therapy on survival/quality of life. Pancreatic enzyme replacement therapy was associated with 3.8 months (95% confidence interval: 1.37-6.19) survival benefit. Patients receiving pancreatic enzyme replacement therapy had a trend towards a better quality of life.Conclusions The prevalence of pancreatic exocrine insufficiency in advanced pancreatic cancer is substantial and its treatment can improve the outcomes of these patients.

Dataset Information

Premorbid Obesity and Mortality in Patients With Pancreatic Cancer: A Systematic Review and Meta-analysis.

Publications

Premorbid Obesity and Mortality in Patients With Pancreatic Cancer: A Systematic Review and Meta-analysis.

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