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Published in: Current Nutrition Reports 1/2016

01-03-2016 | Cancer (MF Leitzmann, Section Editor)

The Association Between Adiposity and Survival in Patients with Colorectal Cancer

Published in: Current Nutrition Reports | Issue 1/2016

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Abstract

Multiple studies confirm the impact of obesity on high incidence of colorectal cancer (CRC). There is a common perception that adiposity and related metabolic dysfunctions result in worse prognosis and decreased survival among patients with a CRC diagnosis. Several epidemiologic studies confirm this observation, however the results are not always consistent, probably due to different techniques used for evaluating the degree of adiposity. Many authors suggest that the most adequate method for assessing this parameter is computer tomography of the abdomen which allows to precisely quantify the amount of adipose tissue. Excess adipose tissue is considered a metabolically active organ releasing numerous adipohormones and cytokines that stimulate chronic inflammation, insulin resistance and contribute to increased cell proliferation. However, adiposity biomarker expression are well-documented risk factors for CRC development, little is known about their prognostic value in this disease.
Literature
1.
go back to reference Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.CrossRefPubMed Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.CrossRefPubMed
2.
go back to reference Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–81.CrossRefPubMedPubMedCentral Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–81.CrossRefPubMedPubMedCentral
3.
go back to reference Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78.CrossRefPubMed Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78.CrossRefPubMed
4.
go back to reference Ning Y, Wang L, Giovannucci EL. A quantitative analysis of body mass index and colorectal cancer: findings from 56 observational studies. Obes Rev. 2010;11:19–30.CrossRefPubMed Ning Y, Wang L, Giovannucci EL. A quantitative analysis of body mass index and colorectal cancer: findings from 56 observational studies. Obes Rev. 2010;11:19–30.CrossRefPubMed
5.
go back to reference Moghaddam AA, Woodward M, Huxley R. Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events. Cancer Epidemiol Biomarkers Prev. 2007;16:2533–47.CrossRefPubMed Moghaddam AA, Woodward M, Huxley R. Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events. Cancer Epidemiol Biomarkers Prev. 2007;16:2533–47.CrossRefPubMed
6.
go back to reference Nam SY, Kim BC, Han KS, et al. Abdominal visceral adipose tissue predicts risk of colorectal adenoma in both sexes. Clin Gastroenterol Hepatol. 2010;8:443–50.CrossRefPubMed Nam SY, Kim BC, Han KS, et al. Abdominal visceral adipose tissue predicts risk of colorectal adenoma in both sexes. Clin Gastroenterol Hepatol. 2010;8:443–50.CrossRefPubMed
7.••
go back to reference Lee CS, Murphy DJ, McMahon C, et al. Visceral adiposity is a risk factor for poor prognosis in colorectal cancer patients receiving adjuvant chemotherapy. J Gastrointest Cancer. 2015;46(3):243–50. A recent retrospective study providing data on the negative impact of visceral adiposity on survival after colorectal cancer (CRC) diagnosis. Authors prove that visceral fat area measured on computer tomography scans correspond to poor prognosis in this disease. Presented results confirm that BMI is not an adequate method to evaluate the impact of adiposity on survival in CRC.CrossRefPubMed Lee CS, Murphy DJ, McMahon C, et al. Visceral adiposity is a risk factor for poor prognosis in colorectal cancer patients receiving adjuvant chemotherapy. J Gastrointest Cancer. 2015;46(3):243–50. A recent retrospective study providing data on the negative impact of visceral adiposity on survival after colorectal cancer (CRC) diagnosis. Authors prove that visceral fat area measured on computer tomography scans correspond to poor prognosis in this disease. Presented results confirm that BMI is not an adequate method to evaluate the impact of adiposity on survival in CRC.CrossRefPubMed
8.
go back to reference Malietzis G, Aziz O, Bagnall NM, et al. The role of body composition evaluation by computerized tomography in determining colorectal cancer treatment outcomes: a systematic review. Eur J Surg Oncol. 2015;41(2):186–96.CrossRefPubMed Malietzis G, Aziz O, Bagnall NM, et al. The role of body composition evaluation by computerized tomography in determining colorectal cancer treatment outcomes: a systematic review. Eur J Surg Oncol. 2015;41(2):186–96.CrossRefPubMed
9.
go back to reference Gutierez DA, Puglisi MJ, Hasty AH. Impact of increased adipose tissue mass on inflammation, insulin resistance, and dyslipidemia. Curr Diab Rep. 2009;9(1):26–32.CrossRef Gutierez DA, Puglisi MJ, Hasty AH. Impact of increased adipose tissue mass on inflammation, insulin resistance, and dyslipidemia. Curr Diab Rep. 2009;9(1):26–32.CrossRef
10.
go back to reference Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4:579–91.CrossRefPubMed Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4:579–91.CrossRefPubMed
12.
go back to reference Janiak A, Oset P, Talar-Wojnarowska R, Kumor A, Małecka-Panas E. Insulin, insulin-like growth factor 1 and insulin-like growth factor binding protein 3 serum concentrations in patients with adenomatous colon polyps. Prz Gastroenterol. 2013;8(5):308–14.PubMedPubMedCentral Janiak A, Oset P, Talar-Wojnarowska R, Kumor A, Małecka-Panas E. Insulin, insulin-like growth factor 1 and insulin-like growth factor binding protein 3 serum concentrations in patients with adenomatous colon polyps. Prz Gastroenterol. 2013;8(5):308–14.PubMedPubMedCentral
13.
go back to reference Harriss DJ, Atkinson G, Batterham A, George K, et al. Lifestyle factors and colorectal cancer risk : a systematic review and meta-analysis of associations with leisure-time physical activity. Color Dis. 2009;11(7):689–701.CrossRef Harriss DJ, Atkinson G, Batterham A, George K, et al. Lifestyle factors and colorectal cancer risk : a systematic review and meta-analysis of associations with leisure-time physical activity. Color Dis. 2009;11(7):689–701.CrossRef
14.
go back to reference Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123(3):627–35.CrossRefPubMed Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123(3):627–35.CrossRefPubMed
15.
go back to reference Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2011;4(4):486–501.CrossRef Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2011;4(4):486–501.CrossRef
16.
go back to reference Parkin E, O’Reilly DA, Sherlock DJ, Manoharan P, Renehan AG. Excess adiposity and survival in patients with colorectal cancer: a systematic review. Obes Rev. 2014;15(5):434–51.CrossRefPubMed Parkin E, O’Reilly DA, Sherlock DJ, Manoharan P, Renehan AG. Excess adiposity and survival in patients with colorectal cancer: a systematic review. Obes Rev. 2014;15(5):434–51.CrossRefPubMed
17.
go back to reference Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38.CrossRefPubMed Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38.CrossRefPubMed
18.
go back to reference Demark-Wahnefried W, Platz EA, Ligibel JA, et al. The role of obesity in cancer survival and recurrence. Cancer Epidemiol Biomarkers Prev. 2012;21(8):1244–59.CrossRefPubMedPubMedCentral Demark-Wahnefried W, Platz EA, Ligibel JA, et al. The role of obesity in cancer survival and recurrence. Cancer Epidemiol Biomarkers Prev. 2012;21(8):1244–59.CrossRefPubMedPubMedCentral
19.
go back to reference Dignam JJ, Polite BN, Yothers G, et al. Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst. 2006;98(22):1647–54.CrossRefPubMed Dignam JJ, Polite BN, Yothers G, et al. Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst. 2006;98(22):1647–54.CrossRefPubMed
20.
go back to reference Meyerhardt JA, Niedzwiecki D, Hollis D, et al. Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from cancer and leukemia group B 89803. J Clin Oncol. 2008;26(25):4109–15.CrossRefPubMedPubMedCentral Meyerhardt JA, Niedzwiecki D, Hollis D, et al. Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from cancer and leukemia group B 89803. J Clin Oncol. 2008;26(25):4109–15.CrossRefPubMedPubMedCentral
21.
go back to reference Han TS, van Leer EM, Seidell JC, Lean ME. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ. 1995;311(7017):1401–5.CrossRefPubMedPubMedCentral Han TS, van Leer EM, Seidell JC, Lean ME. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ. 1995;311(7017):1401–5.CrossRefPubMedPubMedCentral
22.
23.
go back to reference Schoen RE, Tangen CM, Kuller LH, et al. Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst. 1999;91(13):1147–54.CrossRefPubMed Schoen RE, Tangen CM, Kuller LH, et al. Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst. 1999;91(13):1147–54.CrossRefPubMed
24.
go back to reference Haydon AM, Macinnis RJ, English DR, Giles GG. Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut. 2006;55(1):62–7.CrossRefPubMedPubMedCentral Haydon AM, Macinnis RJ, English DR, Giles GG. Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut. 2006;55(1):62–7.CrossRefPubMedPubMedCentral
25.
go back to reference Yoshizumi T, Nakamura T, Yamane M, et al. Abdominal fat: standardized technique for measurement at CT. Radiology. 1999;211(1):283–6.CrossRefPubMed Yoshizumi T, Nakamura T, Yamane M, et al. Abdominal fat: standardized technique for measurement at CT. Radiology. 1999;211(1):283–6.CrossRefPubMed
26.
go back to reference Hunter GR, Snyder SW, Kekes-Szabo T, et al. Intra-abdominal adipose tissue values associated with risk of possessing elevated blood lipids and blood pressure. Obes Res. 1994;2(6):563–8.CrossRefPubMed Hunter GR, Snyder SW, Kekes-Szabo T, et al. Intra-abdominal adipose tissue values associated with risk of possessing elevated blood lipids and blood pressure. Obes Res. 1994;2(6):563–8.CrossRefPubMed
27.
go back to reference Després JP, Lamarche B. Effects of diet and physical activity on adiposity and body fat distribution: implications for the prevention of cardiovascular disease. Nutr Res Rev. 1993;6(1):137–59.CrossRefPubMed Després JP, Lamarche B. Effects of diet and physical activity on adiposity and body fat distribution: implications for the prevention of cardiovascular disease. Nutr Res Rev. 1993;6(1):137–59.CrossRefPubMed
28.
go back to reference Guiu B, Petit JM, Bonnetain F, et al. Visceral fat area is an independent predictive biomarker of outcome after first-line Bevacizumab-based treatment in metastatic colorectal cancer. Gut. 2010;59(3):341–7.CrossRefPubMed Guiu B, Petit JM, Bonnetain F, et al. Visceral fat area is an independent predictive biomarker of outcome after first-line Bevacizumab-based treatment in metastatic colorectal cancer. Gut. 2010;59(3):341–7.CrossRefPubMed
29.••
go back to reference Cakir H, Heus C, Verduin WM. Visceral obesity, body mass index and risk of complications after colon cancer resection: a retrospective cohort study. Surgery. 2015;157(5):909–15. A retrospective study on large group of CRC patients who underwent surgical treatment. Authors provide data confirming the impact of adiposity evaluated by computer tomography (visceral fat area measurement - VFA) on complication rate after elective resection of CRC.CrossRefPubMed Cakir H, Heus C, Verduin WM. Visceral obesity, body mass index and risk of complications after colon cancer resection: a retrospective cohort study. Surgery. 2015;157(5):909–15. A retrospective study on large group of CRC patients who underwent surgical treatment. Authors provide data confirming the impact of adiposity evaluated by computer tomography (visceral fat area measurement - VFA) on complication rate after elective resection of CRC.CrossRefPubMed
30.••
go back to reference Watanabe J, Tatsumi K, Ota M, et al. The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Color Dis. 2014;29(3):343–51. A study on large group of patients who underwent laparoscopic resection of CRC. The authors showed that high BMI and high VFA are valuable predictive factors of postoperative complications incidence.CrossRef Watanabe J, Tatsumi K, Ota M, et al. The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Color Dis. 2014;29(3):343–51. A study on large group of patients who underwent laparoscopic resection of CRC. The authors showed that high BMI and high VFA are valuable predictive factors of postoperative complications incidence.CrossRef
31.
go back to reference Kang J, Baek SE, Kim T, et al. Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index. Int J Color Dis. 2012;27(4). Kang J, Baek SE, Kim T, et al. Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index. Int J Color Dis. 2012;27(4).
32.
go back to reference Yamamoto N, Fujii S, Sato T, et al. Impact of body mass index and visceral adiposity on outcomes in colorectal cancer. Asia Pac J Clin Oncol. 2012;8(4):337–45.CrossRefPubMed Yamamoto N, Fujii S, Sato T, et al. Impact of body mass index and visceral adiposity on outcomes in colorectal cancer. Asia Pac J Clin Oncol. 2012;8(4):337–45.CrossRefPubMed
33.
go back to reference Rickles AS, Iannuzzi JC, Mironov O, et al. Visceral obesity and colorectal cancer: are we missing the boat with BMI? J Gastrointest Surg. 2013;17(1):133–43.CrossRefPubMed Rickles AS, Iannuzzi JC, Mironov O, et al. Visceral obesity and colorectal cancer: are we missing the boat with BMI? J Gastrointest Surg. 2013;17(1):133–43.CrossRefPubMed
34.
go back to reference Kaess BM, Pedley A, Massaro JM, et al. The ratio of visceral to subcutaneous fat, a metric of body fat distribution, is a unique correlate of cardiometabolic risk. Diabetologia. 2012;55(10):2622–30.CrossRefPubMedPubMedCentral Kaess BM, Pedley A, Massaro JM, et al. The ratio of visceral to subcutaneous fat, a metric of body fat distribution, is a unique correlate of cardiometabolic risk. Diabetologia. 2012;55(10):2622–30.CrossRefPubMedPubMedCentral
35.
go back to reference Moon HG, Ju YT, Jeong CY, et al. Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol. 2008;15(7):1918–22.CrossRefPubMed Moon HG, Ju YT, Jeong CY, et al. Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol. 2008;15(7):1918–22.CrossRefPubMed
36.
go back to reference Clark W, Siegel EM, Chen YA, et al. Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation. J Am Coll Surg. 2013;216(6):1070–81.CrossRefPubMedPubMedCentral Clark W, Siegel EM, Chen YA, et al. Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation. J Am Coll Surg. 2013;216(6):1070–81.CrossRefPubMedPubMedCentral
37.
go back to reference Meyerhardt JA, Catalano PJ, Haller DG, et al. Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer. 2003;98(3):484–95.CrossRefPubMed Meyerhardt JA, Catalano PJ, Haller DG, et al. Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer. 2003;98(3):484–95.CrossRefPubMed
38.
go back to reference Prizment AE, Flood A, Anderson KE, Folsom AR. Survival of women with colon cancer in relation to precancer anthropometric characteristics: the Iowa Women’s health study. Cancer Epidemiol Biomarkers Prev. 2010;19(9):2229–37.CrossRefPubMedPubMedCentral Prizment AE, Flood A, Anderson KE, Folsom AR. Survival of women with colon cancer in relation to precancer anthropometric characteristics: the Iowa Women’s health study. Cancer Epidemiol Biomarkers Prev. 2010;19(9):2229–37.CrossRefPubMedPubMedCentral
39.
go back to reference Aleksandrova K, Nimptsch K, Pischon T. Influence of obesity and related metabolic alterations on colorectal cancer risk. Curr Nutr Rep. 2013;2(1):1–9.CrossRefPubMedPubMedCentral Aleksandrova K, Nimptsch K, Pischon T. Influence of obesity and related metabolic alterations on colorectal cancer risk. Curr Nutr Rep. 2013;2(1):1–9.CrossRefPubMedPubMedCentral
40.
go back to reference Muc-Wierzgon M, Nowakowska-Zajdel E, Dziegielewska-Gesiak S. Specific metabolic biomarkers as risk and prognostic factors in colorectal cancer. World J Gastroenterol. 2014;20(29):9759–74.CrossRefPubMedPubMedCentral Muc-Wierzgon M, Nowakowska-Zajdel E, Dziegielewska-Gesiak S. Specific metabolic biomarkers as risk and prognostic factors in colorectal cancer. World J Gastroenterol. 2014;20(29):9759–74.CrossRefPubMedPubMedCentral
41.
go back to reference Siddiqui AA, Spechler SJ, Huerta S, et al. Elevated HbA1c is an independent predictor of aggressive clinical behavior in patients with colorectal cancer: a case–control study. Dig Dis Sci. 2008;53(9):2486–94.CrossRefPubMed Siddiqui AA, Spechler SJ, Huerta S, et al. Elevated HbA1c is an independent predictor of aggressive clinical behavior in patients with colorectal cancer: a case–control study. Dig Dis Sci. 2008;53(9):2486–94.CrossRefPubMed
42.
go back to reference Miao Jonasson J, Cederholm J, Eliasson B, et al. HbA1C and cancer risk in patients with type 2 diabetes--a nationwide population-based prospective cohort study in Sweden. PLoS One. 2012;7(6), e38784.CrossRefPubMedPubMedCentral Miao Jonasson J, Cederholm J, Eliasson B, et al. HbA1C and cancer risk in patients with type 2 diabetes--a nationwide population-based prospective cohort study in Sweden. PLoS One. 2012;7(6), e38784.CrossRefPubMedPubMedCentral
43.
go back to reference Fuchs CS, Goldberg RM, Sargent DJ, et al. Plasma insulin-like growth factors, insulin-like binding protein-3, and outcome in metastatic colorectal cancer: results from intergroup trial N9741. Clin Cancer Res. 2008;14(24):8263–9.CrossRefPubMedPubMedCentral Fuchs CS, Goldberg RM, Sargent DJ, et al. Plasma insulin-like growth factors, insulin-like binding protein-3, and outcome in metastatic colorectal cancer: results from intergroup trial N9741. Clin Cancer Res. 2008;14(24):8263–9.CrossRefPubMedPubMedCentral
44.
go back to reference Liou JM, Shun CT, Liang JT, et al. Plasma insulin-like growth factor-binding protein-2 levels as diagnostic and prognostic biomarker of colorectal cancer. J Clin Endocrinol Metab. 2010;95(4):1717–25.CrossRefPubMed Liou JM, Shun CT, Liang JT, et al. Plasma insulin-like growth factor-binding protein-2 levels as diagnostic and prognostic biomarker of colorectal cancer. J Clin Endocrinol Metab. 2010;95(4):1717–25.CrossRefPubMed
45.
go back to reference Stryjkowska-Gora A, Karczmarek-Borowska B, Gora T, Krawczak K. Statins and cancer. Contemp Oncol. 2015;19(3):167–75. Stryjkowska-Gora A, Karczmarek-Borowska B, Gora T, Krawczak K. Statins and cancer. Contemp Oncol. 2015;19(3):167–75.
46.
go back to reference Nielsen SF, Nordestgaard BG, Bojesen SE. Statin use and reduced cancer-related mortality. N Engl J Med. 2013;368(6):576–7.PubMed Nielsen SF, Nordestgaard BG, Bojesen SE. Statin use and reduced cancer-related mortality. N Engl J Med. 2013;368(6):576–7.PubMed
47.
go back to reference Ng K, Ogino S, Meyerhardt JA, et al. Relationship between statin use and colon cancer recurrence and survival: results from CALGB 89803. J Natl Cancer Inst. 2011;103:1540–51.CrossRefPubMedPubMedCentral Ng K, Ogino S, Meyerhardt JA, et al. Relationship between statin use and colon cancer recurrence and survival: results from CALGB 89803. J Natl Cancer Inst. 2011;103:1540–51.CrossRefPubMedPubMedCentral
48.
go back to reference Mace AG, Gantt GA, Skacel M, Pai R, Hammel JP, Kalady MF. Statin therapy is associated with improved pathologic response to neoadjuvant chemoradiation in rectal cancer. Dis Colon Rectum. 2013;56:1217–27.CrossRefPubMed Mace AG, Gantt GA, Skacel M, Pai R, Hammel JP, Kalady MF. Statin therapy is associated with improved pathologic response to neoadjuvant chemoradiation in rectal cancer. Dis Colon Rectum. 2013;56:1217–27.CrossRefPubMed
Metadata
Title
The Association Between Adiposity and Survival in Patients with Colorectal Cancer
Publication date
01-03-2016
Published in
Current Nutrition Reports / Issue 1/2016
Electronic ISSN: 2161-3311
DOI
https://doi.org/10.1007/s13668-016-0157-7

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