Association of body mass index and colorectal cancer mortality: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIN Wuyong , PENG Jingqi , SHI Zhitao , HU Yue ,  SUN Xin

The First Department of Surgery, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, P.R.China;

Corresponding author：

SUN Xin, Email: 369942815@qq.com

Keywords：

body mass index; colorectal cancer; mortality; meta-analysis

DOI：

10.7507/1007-9424.201609075

Video：

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Objective To explore relationship between body mass index and all-cause mortality or cancer-specific mortality of colorectal cancer. Methods The published articles relevant body mass index and colorectal cancer mortality were retrieved according to the inclusion and exclusion criteria from PubMed, Elsevier-Science Direct, and Web of Science databases. The meta-analysis was performed with RevMan 5.3 software. Results A total of 14 articles were eligible for the meta-analysis, involved 53 804 patients (colorectal cancer patients with underweight 1 853 cases, colorectal cancer patients with overweight 9 088 cases, colorectal cancer patients with obesity 4 463 cases). The results of meta-analysis showed that the colorectal cancer patients with obesity and underweight had the higher all-cause mortalities 〔RR=1.11, 95% CI (1.06, 1.16), P<0.000 01; RR=1.34, 95% CI (1.11, 1.61), P=0.002〕 and colorectal cancer-specific mortalities 〔RR=1.15, 95% CI (1.05, 1.24), P=0.001; RR=1.33, 95% CI (1.09, 1.62), P=0.005〕 as compared with the colorectal cancer patients with normal weight. The all-cause mortality and colorectal cancer-specific mortality had no significant differences between the colorectal cancer patients with overweight and the colorectal cancer patients with normal weight 〔RR=0.96, 95% CI (0.89, 1.04), P=0.31; RR=1.00, 95% CI (0.90, 1.12), P=0.98〕 . Conclusion Colorectal cancer patients with obesity and underweight might have a higher mortality rate.

Citation： JIN Wuyong, PENG Jingqi, SHI Zhitao, HU Yue, SUN Xin. Association of body mass index and colorectal cancer mortality: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(7): 858-865. doi: 10.7507/1007-9424.201609075 Copy

1.	Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
2.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3.	Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin, 2012, 62(1): 30-67.
4.	De Pergola G, Silvestris F. Obesity as a major risk factor for cancer. J Obes, 2013, 2013: 291546.
5.	Alipour S, Kennecke HF, Woods R, et al. Body mass index and body surface area and their associations with outcomes in stage Ⅱ and Ⅲ colon cancer. J Gastrointest Cancer, 2013, 44(2): 203-210.
6.	Baade PD, Meng X, Youl PH, et al. The impact of body mass index and physical activity on mortality among patients with colorectal cancer in Queensland, Australia. Cancer Epidemiol Biomarkers Prev, 2011, 20(7): 1410-1420.
7.	Boyle T, Fritschi L, Platell C, et al. Lifestyle factors associated with survival after colorectal cancer diagnosis. Br J Cancer, 2013, 109(3): 814-822.
8.	Campbell PT, Newton CC, Dehal AN, et al. Impact of body mass index on survival after colorectal cancer diagnosis: the Cancer Prevention Study-Ⅱ Nutrition Cohort. J Clin Oncol, 2012, 30(1): 42-52.
9.	Chin CC, Kuo YH, Yeh CY, et al. Role of body mass index in colon cancer patients in Taiwan. World J Gastroenterol, 2012, 18(31): 4191-4198.
10.	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): 1647-1654.
11.	Doria-Rose VP, Newcomb PA, Morimoto LM, et al. Body mass index and the risk of death following the diagnosis of colorectal cancer in postmenopausal women (United States). Cancer Causes Control, 2006, 17(1): 63-70.
12.	Fedirko V, Romieu I, Aleksandrova K, et al. Pre-diagnostic anthropometry and survival after colorectal cancer diagnosis in Western European populations. Int J Cancer, 2014, 135(8): 1949-1960.
13.	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): 4109-4115.
14.	Kuiper JG, Phipps AI, Neuhouser ML, et al. Recreational physical activity, body mass index, and survival in women with colorectal cancer. Cancer Causes Control, 2012, 23(12): 1939-1948.
15.	Moghimi-Dehkordi B, Safaee A, Zali MR. Prognostic factors in 1 138 Iranian colorectal cancer patients. Int J Colorectal Dis, 2008, 23(7): 683-688.
16.	Pelser C, Arem H, Pfeiffer RM, et al. Prediagnostic lifestyle factors and survival after colon and rectal cancer diagnosis in the National Institutes of Health (NIH)-AARP Diet and Health Study. Cancer, 2014, 120(10): 1540-1547.
17.	Schlesinger S, Siegert S, Koch M, et al. Postdiagnosis body mass index and risk of mortality in colorectal cancer survivors: a prospective study and meta-analysis. Cancer Causes Control, 2014, 25(10): 1407-1418.
18.	Sinicrope FA, Foster NR, Yothers G, et al. Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer, 2013, 119(8): 1528-1536.
19.	Renehan AG, Roberts DL, Dive C. Obesity and cancer: pathophysiological and biological mechanisms. Arch Physiol Biochem, 2008, 114(1): 71-83.
20.	Flegal KM, Kit BK, Orpana H, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA, 2013, 309(1): 71-82.
21.	Hede P, Sörensson MÅ, Polleryd P, et al. Influence of BMI on short-term surgical outcome after colorectal cancer surgery: a study based on the Swedish national quality registry. Int J Colorectal Dis, 2015, 30(9): 1201-1207.
22.	Flegal KM, Graubard BI, Williamson DF, et al. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA, 2007, 298(17): 2028-2037.
23.	O’Gorman P, McMillan DC, McArdle CS. Prognostic factors in advanced gastrointestinal cancer patients with weight loss. Nutr Cancer, 2000, 37(1): 36-40.
24.	Chung YW, Han DS, Park YK, et al. Association of obesity, serum glucose and lipids with the risk of advanced colorectal adenoma and cancer: a case-control study in Korea. Dig Liver Dis, 2006, 38(9): 668-672.
25.	Wolpin BM, Meyerhardt JA, Chan AT, et al. Insulin, the insulin-like growth factor axis, and mortality in patients with nonmetastatic colorectal cancer. J Clin Oncol, 2009, 27(2): 176-185.
26.	Clancy C, O’Leary DP, Burke JP, et al. A meta-analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery. Colorectal Dis, 2015, 17(6): 482-490.
27.	Brändstedt J, Wangefjord S, Nodin B, et al. Associations of anthropometric factors with KRAS and BRAF mutation status of primary colorectal cancer in men and women: a cohort study. PLoS One, 2014, 9(2): e98964.
28.	Hughes LA, Williamson EJ, van Engeland M, et al. Body size and risk for colorectal cancers showing BRAF mutations or microsatellite instability: a pooled analysis. Int J Epidemiol, 2012, 41(4): 1060-1072.
29.	Morikawa T, Kuchiba A, Lochhead P, et al. Prospective analysis of body mass index, physical activity, and colorectal cancer risk associated with β-catenin (CTNNB1) status. Cancer Res, 2013, 73(5): 1600-1610.
30.	Sairenchi T, Iso H, Irie F, et al. Underweight as a predictor of diabetes in older adults: a large cohort study. Diabetes Care, 2008, 31(3): 583-584.
31.	Kenchaiah S, Pocock SJ, Wang D, et al. Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Circulation, 2007, 116(6): 627-636.
32.	Meyerhardt JA, Tepper JE, Niedzwiecki D, et al. Impact of body mass index on outcomes and treatment-related toxicity in patients with stage Ⅱ and Ⅲ rectal cancer: findings from Intergroup Trial 0114. J Clin Oncol, 2004, 22(4): 648-657.
33.	Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Ottawa Hospital/Research Institute web site]. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
34.	Jeon JY, Jeong DH, Park MG, et al. Impact of diabetes on oncologic outcome of colorectal cancer patients: colon vs. rectal cancer. PLoS One, 2013, 8(2): e55196.
35.	Boereboom CL, Williams JP, Leighton P, et al. Forming a consensus opinion on exercise prehabilitation in elderly colorectal cancer patients: a Delphi study. Tech Coloproctol, 2015, 19(6): 347-354.
36.	Boereboom C, Doleman B, Lund JN, et al. Systematic review of pre-operative exercise in colorectal cancer patients. Tech Coloproctol, 2016, 20(2): 81-89.
37.	Sandler RS, Halabi S, Baron JA, et al. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med, 2003, 348(10): 883-890.

1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
2. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3. Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin, 2012, 62(1): 30-67.
4. De Pergola G, Silvestris F. Obesity as a major risk factor for cancer. J Obes, 2013, 2013: 291546.
5. Alipour S, Kennecke HF, Woods R, et al. Body mass index and body surface area and their associations with outcomes in stage Ⅱ and Ⅲ colon cancer. J Gastrointest Cancer, 2013, 44(2): 203-210.
6. Baade PD, Meng X, Youl PH, et al. The impact of body mass index and physical activity on mortality among patients with colorectal cancer in Queensland, Australia. Cancer Epidemiol Biomarkers Prev, 2011, 20(7): 1410-1420.
7. Boyle T, Fritschi L, Platell C, et al. Lifestyle factors associated with survival after colorectal cancer diagnosis. Br J Cancer, 2013, 109(3): 814-822.
8. Campbell PT, Newton CC, Dehal AN, et al. Impact of body mass index on survival after colorectal cancer diagnosis: the Cancer Prevention Study-Ⅱ Nutrition Cohort. J Clin Oncol, 2012, 30(1): 42-52.
9. Chin CC, Kuo YH, Yeh CY, et al. Role of body mass index in colon cancer patients in Taiwan. World J Gastroenterol, 2012, 18(31): 4191-4198.
10. 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): 1647-1654.
11. Doria-Rose VP, Newcomb PA, Morimoto LM, et al. Body mass index and the risk of death following the diagnosis of colorectal cancer in postmenopausal women (United States). Cancer Causes Control, 2006, 17(1): 63-70.
12. Fedirko V, Romieu I, Aleksandrova K, et al. Pre-diagnostic anthropometry and survival after colorectal cancer diagnosis in Western European populations. Int J Cancer, 2014, 135(8): 1949-1960.
13. 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): 4109-4115.
14. Kuiper JG, Phipps AI, Neuhouser ML, et al. Recreational physical activity, body mass index, and survival in women with colorectal cancer. Cancer Causes Control, 2012, 23(12): 1939-1948.
15. Moghimi-Dehkordi B, Safaee A, Zali MR. Prognostic factors in 1 138 Iranian colorectal cancer patients. Int J Colorectal Dis, 2008, 23(7): 683-688.
16. Pelser C, Arem H, Pfeiffer RM, et al. Prediagnostic lifestyle factors and survival after colon and rectal cancer diagnosis in the National Institutes of Health (NIH)-AARP Diet and Health Study. Cancer, 2014, 120(10): 1540-1547.
17. Schlesinger S, Siegert S, Koch M, et al. Postdiagnosis body mass index and risk of mortality in colorectal cancer survivors: a prospective study and meta-analysis. Cancer Causes Control, 2014, 25(10): 1407-1418.
18. Sinicrope FA, Foster NR, Yothers G, et al. Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer, 2013, 119(8): 1528-1536.
19. Renehan AG, Roberts DL, Dive C. Obesity and cancer: pathophysiological and biological mechanisms. Arch Physiol Biochem, 2008, 114(1): 71-83.
20. Flegal KM, Kit BK, Orpana H, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA, 2013, 309(1): 71-82.
21. Hede P, Sörensson MÅ, Polleryd P, et al. Influence of BMI on short-term surgical outcome after colorectal cancer surgery: a study based on the Swedish national quality registry. Int J Colorectal Dis, 2015, 30(9): 1201-1207.
22. Flegal KM, Graubard BI, Williamson DF, et al. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA, 2007, 298(17): 2028-2037.
23. O’Gorman P, McMillan DC, McArdle CS. Prognostic factors in advanced gastrointestinal cancer patients with weight loss. Nutr Cancer, 2000, 37(1): 36-40.
24. Chung YW, Han DS, Park YK, et al. Association of obesity, serum glucose and lipids with the risk of advanced colorectal adenoma and cancer: a case-control study in Korea. Dig Liver Dis, 2006, 38(9): 668-672.
25. Wolpin BM, Meyerhardt JA, Chan AT, et al. Insulin, the insulin-like growth factor axis, and mortality in patients with nonmetastatic colorectal cancer. J Clin Oncol, 2009, 27(2): 176-185.
26. Clancy C, O’Leary DP, Burke JP, et al. A meta-analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery. Colorectal Dis, 2015, 17(6): 482-490.
27. Brändstedt J, Wangefjord S, Nodin B, et al. Associations of anthropometric factors with KRAS and BRAF mutation status of primary colorectal cancer in men and women: a cohort study. PLoS One, 2014, 9(2): e98964.
28. Hughes LA, Williamson EJ, van Engeland M, et al. Body size and risk for colorectal cancers showing BRAF mutations or microsatellite instability: a pooled analysis. Int J Epidemiol, 2012, 41(4): 1060-1072.
29. Morikawa T, Kuchiba A, Lochhead P, et al. Prospective analysis of body mass index, physical activity, and colorectal cancer risk associated with β-catenin (CTNNB1) status. Cancer Res, 2013, 73(5): 1600-1610.
30. Sairenchi T, Iso H, Irie F, et al. Underweight as a predictor of diabetes in older adults: a large cohort study. Diabetes Care, 2008, 31(3): 583-584.
31. Kenchaiah S, Pocock SJ, Wang D, et al. Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Circulation, 2007, 116(6): 627-636.
32. Meyerhardt JA, Tepper JE, Niedzwiecki D, et al. Impact of body mass index on outcomes and treatment-related toxicity in patients with stage Ⅱ and Ⅲ rectal cancer: findings from Intergroup Trial 0114. J Clin Oncol, 2004, 22(4): 648-657.
33. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Ottawa Hospital/Research Institute web site]. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
34. Jeon JY, Jeong DH, Park MG, et al. Impact of diabetes on oncologic outcome of colorectal cancer patients: colon vs. rectal cancer. PLoS One, 2013, 8(2): e55196.
35. Boereboom CL, Williams JP, Leighton P, et al. Forming a consensus opinion on exercise prehabilitation in elderly colorectal cancer patients: a Delphi study. Tech Coloproctol, 2015, 19(6): 347-354.
36. Boereboom C, Doleman B, Lund JN, et al. Systematic review of pre-operative exercise in colorectal cancer patients. Tech Coloproctol, 2016, 20(2): 81-89.
37. Sandler RS, Halabi S, Baron JA, et al. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med, 2003, 348(10): 883-890.

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Association of body mass index and colorectal cancer mortality: a meta-analysis

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