Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy

Frank A. Sinicrope*, Nathan R. Foster, Greg Yothers, Al Benson, Jean Francois Seitz, Roberto Labianca, Richard M. Goldberg, Aimery Degramont, Michael J. O'Connell, Daniel J. Sargent

*Corresponding author for this work

Research output: Contribution to journalArticle

87 Scopus citations

Abstract

BACKGROUND: Although obesity is an established risk factor for developing colon cancer, its prognostic impact and relation to patient sex in colon cancer survivors remains unclear. METHODS: The authors examined the prognostic and predictive impact of the body mass index (BMI) in patients with stage II and III colon carcinoma (N = 25,291) within the Adjuvant Colon Cancer Endpoints (ACCENT) database. BMI was measured at enrollment in randomized trials of 5-fluorouracil-based adjuvant chemotherapy. Association of BMI with the time to recurrence (TTR), disease-free survival (DFS), and overall survival (OS) were determined using Cox regression models. Statistical tests were 2-sided. RESULTS: During a median follow-up of 7.8 years, obese and underweight patients had significantly poorer survival compared with overweight and normal-weight patients. In a multivariable analysis, the adverse prognostic impact of BMI was observed among men but not among women (Pinteraction =.0129). Men with class 2 and 3 obesity (BMI ≥35.0 kg/m2) had a statistically significant reduction in DFS (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.01-1.33; P =.0297) compared with normal-weight patients. Underweight patients had a significantly shorter TTR and reduced DFS (HR, 1.18; 95% CI, 1.09-1.28; P <.0001) that was more significant among men (HR, 1.31; 95% CI, 1.15-1.50; P <.0001) than among women (HR, 1.11; 95% CI, 1.01-1.23; P =.0362; Pinteraction =.0340). BMI was not predictive of a benefit from adjuvant treatment. CONCLUSIONS: Obesity and underweight status were associated independently with inferior outcomes in patients with colon cancer who received treatment in adjuvant chemotherapy trials.

Original languageEnglish (US)
Pages (from-to)1528-1536
Number of pages9
JournalCancer
Volume119
Issue number8
DOIs
StatePublished - Apr 15 2013

Keywords

  • BMI
  • adjuvant therapy
  • body mass index
  • colon cancer
  • obesity

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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    Sinicrope, F. A., Foster, N. R., Yothers, G., Benson, A., Seitz, J. F., Labianca, R., Goldberg, R. M., Degramont, A., O'Connell, M. J., & Sargent, D. J. (2013). Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer, 119(8), 1528-1536. https://doi.org/10.1002/cncr.27938