Top

Langenbeck's Archives of Surgery

Published in:

01-03-2018 | ORIGINAL ARTICLE

Implication of visceral obesity in patients with esophageal squamous cell carcinoma

Authors: Akihiko Okamura, Masayuki Watanabe, Kotaro Yamashita, Masami Yuda, Masaru Hayami, Yu Imamura, Shinji Mine

Published in: Langenbeck's Archives of Surgery | Issue 2/2018

Abstract

Purpose

Visceral obesity is considered to be associated not only with chronic systemic inflammation but also with aggressive cancer behavior. However, the implication of visceral obesity in patients with esophageal squamous cell carcinoma (ESCC) is unclear.

Methods

Computed tomography volumetry was performed in 364 patients who underwent esophagectomy for ESCC. We calculated the ratio of the visceral fat area to the subcutaneous fat area (VS ratio), which is a valuable parameter of visceral obesity. Then, the clinicopathological characteristics were compared between patients with low VS ratio and those with high VS ratio.

Results

Overall and disease-specific survivals of patients with high VS ratio were significantly worse than those with low VS ratio (P < 0.001 in both). Patients with high VS ratio had considerably more advanced pN factor, higher prevalence of lymphatic invasion, and more number of metastatic lymph nodes than those with low VS ratio (P = 0.044, < 0.001, and 0.006, respectively). Among patients who received preoperative treatment, high VS ratio correlated with poor response to preoperative treatment (P = 0.040).

Conclusions

Visceral obesity was associated with lymphatic invasiveness and poor response to preoperative treatment in patients with ESCC, which may negatively influence their prognosis.

Available only for authorised users

Cao Y (2007) Angiogenesis modulates adipogenesis and obesity. J Clin Invest 117(9):2362–2368. https://doi.org/10.1172/JCI32239 CrossRefPubMedPubMedCentral

van Kruijsdijk RC, van der Wall E, Visseren FL (2009) Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol Biomark Prev 18(10):2569–2578. https://doi.org/10.1158/1055-9965.EPI-09-0372 CrossRef

Nieman KM, Romero IL, Van Houten B, Lengyel E (2013) Adipose tissue and adipocytes support tumorigenesis and metastasis. Biochim Biophys Acta 1831(10):1533–1541. https://doi.org/10.1016/j.bbalip.2013.02.010 CrossRefPubMedPubMedCentral

Freese KE, Kokai L, Edwards RP, Philips BJ, Sheikh MA, Kelley J, Comerci J, Marra KG, Rubin JP, Linkov F (2015) Adipose-derived stems cells and their role in human cancer development, growth, progression, and metastasis: a systematic review. Cancer Res 75(7):1161–1168. https://doi.org/10.1158/0008-5472.CAN-14-2744 CrossRefPubMed

Moon HG, Ju YT, Jeong CY, Jung EJ, Lee YJ, Hong SC, Ha WS, Park ST, Choi SK (2008) Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol 15(7):1918–1922. https://doi.org/10.1245/s10434-008-9891-4 CrossRefPubMed

Guiu B, Petit JM, Bonnetain F, Ladoire S, Guiu S, Cercueil JP, Krause D, Hillon P, Borg C, Chauffert B, Ghiringhelli F (2010) Visceral fat area is an independent predictive biomarker of outcome after first-line bevacizumab-based treatment in metastatic colorectal cancer. Gut 59(3):341–347. https://doi.org/10.1136/gut.2009.188946 CrossRefPubMed

Clark W, Siegel EM, Chen YA, Zhao X, Parsons CM, Hernandez JM, Weber J, Thareja S, Choi J, Shibata D (2013) Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation. J Am Coll Surg 216(6):1070–1081. https://doi.org/10.1016/j.jamcollsurg.2013.01.007 CrossRefPubMedPubMedCentral

Fujiwara N, Nakagawa H, Kudo Y, Tateishi R, Taguri M, Watadani T, Nakagomi R, Kondo M, Nakatsuka T, Minami T, Sato M, Uchino K, Enooku K, Kondo Y, Asaoka Y, Tanaka Y, Ohtomo K, Shiina S, Koike K (2015) Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol 63(1):131–140. https://doi.org/10.1016/j.jhep.2015.02.031 CrossRefPubMed

Okamura A, Watanabe M, Mine S, Nishida K, Imamura Y, Kurogochi T, Kitagawa Y, Sano T (2016) Clinical impact of abdominal fat distribution on prognosis after esophagectomy for esophageal squamous cell carcinoma. Ann Surg Oncol 23(4):1387–1394. https://doi.org/10.1245/s10434-015-5018-x CrossRefPubMed

10.

Sobin LH, Gospodarowicz MK, Wittekind C, International Union against Cancer (2010) TNM classification of malignant tumours. 7th ed. Chichester, West Sussex, UK; Hoboken, NJ: Wiley-Blackwell, xx, 309 p

11.

Edge SBBD, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New York, NY

12.

Japan Esophageal S (2017) Japanese classification of esophageal cancer, 11th edition: part I. Esophagus 14(1):1–36. https://doi.org/10.1007/s10388-016-0551-7 CrossRef

13.

Mariette C, Piessen G, Briez N, Triboulet JP (2008) The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg 247(2):365–371. https://doi.org/10.1097/SLA.0b013e31815aaadf CrossRefPubMed

14.

Hou X, Wei JC, Xu Y, Luo RZ, Fu JH, Zhang LJ, Lin P, Yang HX (2013) The positive lymph node ratio predicts long-term survival in patients with operable thoracic esophageal squamous cell carcinoma in China. Ann Surg Oncol 20(5):1653–1659. https://doi.org/10.1245/s10434-012-2794-4 CrossRefPubMed

15.

Zhang H, Liang H, Gao Y, Shang X, Gong L, Ma Z, Sun K, Tang P, Yu Z (2016) Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy. Sci Rep 6(1):38804. https://doi.org/10.1038/srep38804 CrossRefPubMedPubMedCentral

16.

Kuwano H, Nishimura Y, Oyama T, Kato H, Kitagawa Y, Kusano M, Shimada H, Takiuchi H, Toh Y, Doki Y, Naomoto Y, Matsubara H, Miyazaki T, Muto M, Yanagisawa A (2015) Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus 12(1):1–30. https://doi.org/10.1007/s10388-014-0465-1 CrossRefPubMed

17.

Frezza EE, Wachtel MS, Chiriva-Internati M (2006) Influence of obesity on the risk of developing colon cancer. Gut 55(2):285–291. https://doi.org/10.1136/gut.2005.073163 CrossRefPubMedPubMedCentral

18.

Tran TT, Yamamoto Y, Gesta S, Kahn CR (2008) Beneficial effects of subcutaneous fat transplantation on metabolism. Cell Metab 7(5):410–420. https://doi.org/10.1016/j.cmet.2008.04.004 CrossRefPubMedPubMedCentral

19.

Donohoe CL, Doyle SL, Reynolds JV (2011) Visceral adiposity, insulin resistance and cancer risk. Diabetol Metab Syndr 3(1):12. https://doi.org/10.1186/1758-5996-3-12 CrossRefPubMedPubMedCentral

20.

Doyle SL, Donohoe CL, Lysaght J, Reynolds JV (2012) Visceral obesity, metabolic syndrome, insulin resistance and cancer. Proc Nutr Soc 71(01):181–189. https://doi.org/10.1017/S002966511100320X CrossRefPubMed

21.

Ye S, Wen H, Jiang Z, Wu X (2016) The effect of visceral obesity on clinicopathological features in patients with endometrial cancer: a retrospective analysis of 200 Chinese patients. BMC Cancer 16(1):209. https://doi.org/10.1186/s12885-016-2230-4 CrossRefPubMedPubMedCentral

22.

Kim B, Chung MJ, Park SW, Park JY, Bang S, Park SW, Song SY, Chung JB (2016) Visceral obesity is associated with poor prognosis in pancreatic adenocarcinoma. Nutr Cancer 68(2):201–207. https://doi.org/10.1080/01635581.2016.1134600 CrossRefPubMed

23.

Park SW, Lee HL, YW J et al (2015) Inverse association between visceral obesity and lymph node metastasis in gastric cancer. J Gastrointest Surg 19(2):242–250. https://doi.org/10.1007/s11605-014-2682-2 CrossRefPubMed

24.

Park SW, Lee HL, Doo EY, Lee KN, Jun DW, Lee OY, Han DS, Yoon BC, Choi HS, Lee KH (2015) Visceral obesity predicts fewer lymph node metastases and better overall survival in colon cancer. J Gastrointest Surg 19(8):1513–1521. https://doi.org/10.1007/s11605-015-2834-z CrossRefPubMedPubMedCentral

25.

Trevellin E, Scarpa M, Carraro A, Lunardi F, Kotsafti A, Porzionato A, Saadeh L, Cagol M, Alfieri R, Tedeschi U, Calabrese F, Castoro C, Vettor R (2015) Esophageal adenocarcinoma and obesity: peritumoral adipose tissue plays a role in lymph node invasion. Oncotarget 6(13):11203–11215. 10.18632/oncotarget.3587 CrossRefPubMedPubMedCentral

26.

Incio J, Liu H, Suboj P, Chin SM, Chen IX, Pinter M, Ng MR, Nia HT, Grahovac J, Kao S, Babykutty S, Huang Y, Jung K, Rahbari NN, Han X, Chauhan VP, Martin JD, Kahn J, Huang P, Desphande V, Michaelson J, Michelakos TP, Ferrone CR, Soares R, Boucher Y, Fukumura D, Jain RK (2016) Obesity-induced inflammation and desmoplasia promote pancreatic cancer progression and resistance to chemotherapy. Cancer Discov 6(8):852–869. https://doi.org/10.1158/2159-8290.CD-15-1177 CrossRefPubMedPubMedCentral

27.

Lashinger LM, Rossi EL, Hursting SD (2014) Obesity and resistance to cancer chemotherapy: interacting roles of inflammation and metabolic dysregulation. Clin Pharmacol Ther 96(4):458–463. https://doi.org/10.1038/clpt.2014.136 CrossRefPubMed

Title: Implication of visceral obesity in patients with esophageal squamous cell carcinoma
Authors: Akihiko Okamura
Masayuki Watanabe
Kotaro Yamashita
Masami Yuda
Masaru Hayami
Yu Imamura
Shinji Mine
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 2/2018
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-017-1643-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Implication of visceral obesity in patients with esophageal squamous cell carcinoma

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

Conception of the Lübeck Toolbox curriculum for basic minimally invasive surgery skills

A modified Nissen fundoplication: subjective and objective midterm results

Outcome of concomitant resection of the replaced right hepatic artery in pancreaticoduodenectomy without reconstruction

Extended pancreatectomy as defined by the ISGPS: useful in selected cases of pancreatic cancer but invaluable in other complex pancreatic tumors

Incidental appendectomy during robotic laparoscopic prostatectomy—safe and worth to perform?

Radiofrequency ablation for locally advanced pancreatic cancer: SMAD4 analysis segregates a responsive subgroup of patients