Cancer Res Treat.  2022 Jul;54(3):860-872. 10.4143/crt.2021.656.

Association of Body Mass Index with Survival in Asian Patients with Colorectal Cancer

• Lee S
• Lee DH
• Lee JH
• Shin SJ
• Lee HS
• Park EJ
• Baik SH
• Lee KY
• Kang J

• KMID: 2531332
• DOI: http://doi.org/10.4143/crt.2021.656

Abstract

Purpose
The clinical significance of body mass index (BMI) on long-term outcomes has not been extensively investigated in Asian patients with colorectal cancer (CRC). This study aims to describe the association between BMI and survival, plus providing BMI cut-off value for predicting prognosis in CRC patients.
Materials and Methods
A total of 1,182 patients who had undergone surgery for stage I-III CRC from June 2004 to February 2014 were included. BMI was categorized into four groups based on the recommendation for Asian ethnicity. The optimal BMI cut-off value was determined to maximize overall survival (OS) difference.
Results
In multivariable analysis, underweight BMI was significantly associated with poor OS (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.55 to 3.71; p < 0.001) and obese BMI was associated with better OS (HR, 0.72; 95% CI, 0.53 to 0.97; p=0.036) compared with the normal BMI. Overweight and obese BMI were associated with better recurrence-free survival (HR, 0.64; 95% CI, 0.42 to 0.99; p=0.046 and HR, 0.58; 95% CI, 0.38 to 0.89; p=0.014, respectively) compared with the normal BMI group. BMI cutoff value was 20.44 kg/m². Adding the BMI cutoff value to cancer staging could increase discriminatory performance in terms of integrated area under the curve and Harrell’s concordance index.
Conclusion
Compared to normal BMI, underweight BMI was associated with poor survival whereas obese BMI was associated with better survival. BMI cut-off value of 20.44 kg/m² is a useful discriminator in Asian patients with CRC.

Keyword

Thinness; Overweight; Obese; Survival; Colorectal neoplasms

Figure

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  Fig. 1 Kaplan-Meier survival curve according to body mass index (BMI) category. Significant survival difference was observed among different BMI categories in patients with stage I–III colorectal cancer, in terms of overall survival (p < 0.001) (A) and recurrence-free survival (p=0.001) (B).

• 

  Fig. 2 Hazard ratio plot of preoperative body mass index (BMI) values. Risk of survival as a function of BMI are illustrated according to each sex subgroup for overall survival (OS) of all patients (A), men only (B), and women only (C), and recurrence-free survival (RFS) of all patients (D), men only (E), and women only (F). BMI was prognostic of OS and RFS in a reverse J-shaped curve, and this relationship varied by patient sex. The shaded area indicates 95% confidence intervals for the risk function.

• 

  Fig. 3 Kaplan-Meier survival curve according to body mass index (BMI) cutoff value. Kaplan-Meier curves according to BMI cutoff value (20.44) in patients with stage I–III colorectal cancer for overall survival (p < 0.001) (A) and recurrence-free survival (p=0.004) (B).

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  Fig. 4 Integrated area under the curve (iAUC) between stage and stage plus body mass index (BMI) cutoff value for overall survival (A) and recurrence-free survival (B). The discriminatory power of continuous markers of overall survival and recurrence-free survival was assessed using the iAUC. The time-dependent receiver operating characteristic curve for stage+BMI cutoff value was superior to that of stage only for both overall survival (bootstrap iAUC mean difference, 0.047; 95% confidence interval [CI], 0.015 to 0.089) and recurrence-free survival (bootstrap iAUC mean difference, 0.043; 95% CI, 0.004 to 0.106) throughout follow-up.

Reference

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