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Title: Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database.
Austin Authors: Renfro, Lindsay A;Loupakis, Fotios;Adams, Richard A;Seymour, Matthew T;Heinemann, Volker;Schmoll, Hans-Joachim;Douillard, Jean-Yves;Hurwitz, Herbert;Fuchs, Charles S;Diaz-Rubio, Eduardo;Porschen, Rainer;Tournigand, Christophe;Chibaudel, Benoist;Falcone, Alfredo;Tebbutt, Niall C ;Punt, Cornelis J A;Hecht, J Randolph;Bokemeyer, Carsten;Van Cutsem, Eric;Goldberg, Richard M;Saltz, Leonard B;de Gramont, Aimery;Sargent, Daniel J;Lenz, Heinz-Josef
Affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY
University Hospital Leuven, Leuven, Belgium
Ohio State University, Columbus, OH
Mayo Clinic, Rochester, MN
Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy
Cardiff University, Cardiff
St James's Hospital and University of Leeds, Leeds, United Kingdom
University of Munich, Munich
University Clinic Halle (Saale), Halle
Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen
University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany
Institut de Cancerologie, Centre René Gauducheau, Nantes
University of Paris Est Creteil, Henri-Mondor Hospital, Créteil
Franco-British Institute, Levallois-Perret, France
Duke University Medical Center, Durham, NC
Dana-Farber Cancer Institute Boston, MA
Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
Austin Health, Heidelberg, Victoria, Australia
Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
David Geffen School of Medicine at the University of California at Los Angeles
University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA
Issue Date: 10-Jan-2016 2015-10-26
Publication information: Journal of Clinical Oncology 2016-01-10; 34(2): 144-50
Abstract: In recent retrospective analyses of early-stage colorectal cancer (CRC), low and high body mass index (BMI) scores were associated with worsened outcomes. Whether BMI is a prognostic or predictive factor in metastatic CRC (mCRC) is unclear. Individual data from 21,149 patients enrolled onto 25 first-line mCRC trials during 1997 to 2012 were pooled. We assessed both prognostic and predictive effects of BMI on overall survival and progression-free survival, and we accounted for patient and tumor characteristics and therapy type (targeted v nontargeted). BMI was prognostic for overall survival (P < .001) and progression-free survival (P < .001), with an L-shaped pattern. That is, risk of progression and/or death was greatest for low BMI; risk decreased as BMI increased to approximately 28 kg/m(2), and then it plateaued. Relative to obese patients, patients with a BMI of 18.5 kg/m(2) had a 27% increased risk of having a PFS event (95% CI, 20% to 34%) and a 50% increased risk of death (95% CI, 43% to 56%). Low BMI was associated with poorer survival for men than women (interaction P < .001). BMI was not predictive of treatment effect. Low BMI is associated with an increased risk of progression and death among the patients enrolled on the mCRC trials, with no increased risk for elevated BMI, in contrast to the adjuvant setting. Possible explanations include negative effects related to cancer cachexia in patients with low BMI, increased drug delivery or selection bias in patients with high BMI, and potential for an interaction between BMI and molecular signaling pathways.
DOI: 10.1200/JCO.2015.61.6441
PubMed URL: 26503203
Type: Journal Article
Appears in Collections:Journal articles

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