Abstract
The optimal body mass index (BMI) range for predicting survival in Asian colorectal cancer patients is unknown. We established the most appropriate cut-off point of BMI to predict better survival in Asian colorectal cancer patients using a two-stage approach. Two cohorts of colorectal cancer patients were included in this study: 5815 hospital-based development cohort and 54,043 nationwide validation cohort. To determine the optimal BMI cut-off point at diagnosis, the method of Contal and O’Quigley was used. We evaluated the association between BMI and overall survival (OS) using the Cox proportional hazard model. During a median follow-up of 5.7 and 5.1 years for the development and the validation cohort, 1180 (20.3%) and 10,244 (19.0%) deaths occurred, respectively. The optimal cut-off of BMI identified as 20.2 kg/m2 (plog-rank < 8.0 × 10−16) for differentiating between poorer and better OS in the development cohort. When compared to the patients with a BMI < 20.2 kg/m2, the patients with a BMI ≥ 20.2 kg/m2 had a significantly better OS (HR = 0.62, 95% CI = 0.54–0.72, p = 1.1 × 10−10). The association was validated in the nationwide cohort, showing better OS in patients with a BMI ≥ 20.2 kg/m2 (HR = 0.64, 95% CI = 0.60–0.67, p < 0.01). We suggest the use of a BMI value of 20.2 kg/m2 to predict survival in Asian colorectal cancer patients.
Highlights
Overweight or obesity defined by elevated body mass index (BMI) is considered an established risk factor for colorectal cancer [1]
We suggest the use of a BMI value of 20.2 kg/m2 to predict survival in Asian colorectal cancer patients
Age at diagnosis, BMI at diagnosis, sex, smoking status, hypertension, tumor site, tumor-node-metastasis (TNM) stage, perioperative chemotherapy, and perioperative radiotherapy were associated with overall survival (p < 0.05)
Summary
Overweight or obesity defined by elevated body mass index (BMI) is considered an established risk factor for colorectal cancer [1]. This finding is supported by biological mechanisms that are influenced by obesity-induced insulin and growth factors, obesity-associated chronic inflammation, altered levels of adipocyte-secreted adiponectin and leptin, and sex hormones associated with cancer development [2]. Prospective cohort studies and meta-analyses on colorectal cancer patients have reported that all-cause mortality was significantly increased in underweight and obese patients and decreased in overweight. Several Asian studies on the association between BMI and colorectal cancer prognosis have observed that overweight patients, with BMI ≥
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