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Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database.

Publication ,  Journal Article
Renfro, LA; Loupakis, F; Adams, RA; Seymour, MT; Heinemann, V; Schmoll, H-J; Douillard, J-Y; Hurwitz, H; Fuchs, CS; Diaz-Rubio, E; Porschen, R ...
Published in: J Clin Oncol
January 10, 2016

PURPOSE: 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. PATIENTS AND METHODS: 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). RESULTS: 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. CONCLUSION: 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.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

January 10, 2016

Volume

34

Issue

2

Start / End Page

144 / 150

Location

United States

Related Subject Headings

  • Signal Transduction
  • Selection Bias
  • Risk Factors
  • Risk Assessment
  • Prognosis
  • Predictive Value of Tests
  • Oncology & Carcinogenesis
  • Obesity
  • Male
  • Kaplan-Meier Estimate
 

Citation

APA
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Renfro, L. A., Loupakis, F., Adams, R. A., Seymour, M. T., Heinemann, V., Schmoll, H.-J., … Lenz, H.-J. (2016). Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database. J Clin Oncol, 34(2), 144–150. https://doi.org/10.1200/JCO.2015.61.6441
Renfro, Lindsay A., Fotios Loupakis, Richard A. Adams, Matthew T. Seymour, Volker Heinemann, Hans-Joachim Schmoll, Jean-Yves Douillard, et al. “Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database.J Clin Oncol 34, no. 2 (January 10, 2016): 144–50. https://doi.org/10.1200/JCO.2015.61.6441.
Renfro LA, Loupakis F, Adams RA, Seymour MT, Heinemann V, Schmoll H-J, et al. Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database. J Clin Oncol. 2016 Jan 10;34(2):144–50.
Renfro, Lindsay A., et al. “Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database.J Clin Oncol, vol. 34, no. 2, Jan. 2016, pp. 144–50. Pubmed, doi:10.1200/JCO.2015.61.6441.
Renfro LA, Loupakis F, Adams RA, Seymour MT, Heinemann V, Schmoll H-J, Douillard J-Y, Hurwitz H, Fuchs CS, Diaz-Rubio E, Porschen R, Tournigand C, Chibaudel B, Falcone A, Tebbutt NC, Punt CJA, Hecht JR, Bokemeyer C, Van Cutsem E, Goldberg RM, Saltz LB, de Gramont A, Sargent DJ, Lenz H-J. Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database. J Clin Oncol. 2016 Jan 10;34(2):144–150.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

January 10, 2016

Volume

34

Issue

2

Start / End Page

144 / 150

Location

United States

Related Subject Headings

  • Signal Transduction
  • Selection Bias
  • Risk Factors
  • Risk Assessment
  • Prognosis
  • Predictive Value of Tests
  • Oncology & Carcinogenesis
  • Obesity
  • Male
  • Kaplan-Meier Estimate