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

80 Citations (Scopus)

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

Fingerprint

Adjuvant Chemotherapy
Colonic Neoplasms
Body Mass Index
Clinical Trials
Survival
Thinness
Confidence Intervals
Disease-Free Survival
Obesity
Weights and Measures
Recurrence
Proportional Hazards Models
Fluorouracil
Survivors
Colon
Databases
Carcinoma
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Sinicrope, F. A., Foster, N. R., Yothers, G., Benson, A., Seitz, J. F., Labianca, R., ... 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
Sinicrope, Frank A. ; Foster, Nathan R. ; Yothers, Greg ; Benson, Al ; Seitz, Jean Francois ; Labianca, Roberto ; Goldberg, Richard M. ; Degramont, Aimery ; O'Connell, Michael J. ; Sargent, Daniel J. / Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. In: Cancer. 2013 ; Vol. 119, No. 8. pp. 1528-1536.
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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.",
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Sinicrope, FA, Foster, NR, Yothers, G, Benson, A, Seitz, JF, Labianca, R, Goldberg, RM, Degramont, A, O'Connell, MJ & Sargent, DJ 2013, 'Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy', Cancer, vol. 119, no. 8, pp. 1528-1536. https://doi.org/10.1002/cncr.27938

Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. / Sinicrope, Frank A.; Foster, Nathan R.; Yothers, Greg; Benson, Al; Seitz, Jean Francois; Labianca, Roberto; Goldberg, Richard M.; Degramont, Aimery; O'Connell, Michael J.; Sargent, Daniel J.

In: Cancer, Vol. 119, No. 8, 15.04.2013, p. 1528-1536.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy

AU - Sinicrope, Frank A.

AU - Foster, Nathan R.

AU - Yothers, Greg

AU - Benson, Al

AU - Seitz, Jean Francois

AU - Labianca, Roberto

AU - Goldberg, Richard M.

AU - Degramont, Aimery

AU - O'Connell, Michael J.

AU - Sargent, Daniel J.

PY - 2013/4/15

Y1 - 2013/4/15

N2 - 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.

AB - 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.

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KW - adjuvant therapy

KW - body mass index

KW - colon cancer

KW - obesity

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