Obese Cancer Patients Research Articles

Perioperative, functional, and oncologic outcomes in obese patients undergoing Da Vinci robot-assisted radical prostatectomy: a systematic review and meta-analysis

ObjectiveThe influence of robot-assisted radical prostatectomy (RARP) in obese (OB) and non-obese (NOB) prostate cancer patients remains a topic of debate. The objective of this study was to juxtapose the perioperative, functional, and oncologic outcomes of RARP in OB and NOB cohorts.Materials and methodsWe systematically searched the databases such as PubMed, Embase, Web of Science, and the Cochrane Library database to identify relevant studies published in English up to September 2023. Review Manager was used to compare various parameters. The study was registered with PROSPERO (CRD42023473136). Sixteen comparative trials were included for 8434 obese patients compared with 55,266 non-obese patients.ResultsThe OB group had a longer operative time (WMD 17.8 min, 95% CI 9.7,25.8; p < 0.0001), a longer length of hospital stay (WMD 0.18 day, 95% CI 0.12,0.24; p < 0.00001, a higher estimated blood loss (WMD 50.6 ml, 95% CI 11.7,89.6; p = 0.01), and higher pelvic lymphadenectomy rate (RR 1.08, 95% CI 1.04,1.12; p < 0.0001)and lower nerve sparing rate (RR 0.95, 95% CI 0.91,0.99; p < 0.01), but there was no difference between unilateral (RR 1.0, 95% CI 0.8,1.3; p = 0.8)and bilateral (RR 0.9, 95% CI 0.9,1.0; p = 0.06)nerve sparing rate. Then, complication rates (RR 1.6, 95% CI 1.5,1.7; p < 0.00001) were higher in the OB group, and both major (RR 1.4, 95% CI 1.1,1.8; p = 0.01)and minor (RR 1.4, 95% CI 1.1,1.7; p < 0.01)complication rates were higher in the OB group. Moreover, obese patients showed significantly higher probabilities of incontinence (RR 1.17, 95% CI 1.03,1.33; p = 0.01) and impotency (RR 1.08, 95% CI 1.01,1.15; p = 0.02) at 1 year. Last, the positive surgical margin (RR 1.2, 95% CI 1.1,1.3; p < 0.01) was higher in the OB group.ConclusionIn the obese group, perioperative outcomes, total complications, functional outcomes, and oncologic outcomes were all worse for RARP. Weight loss before RARP may be a feasible strategy to improve the prognosis of patients.

Laparoscopic versus open colectomy for locally advanced colon cancer in obese patients: a nationwide, multicenter, propensity score-based analysis of short- and long-term outcomes

Abstract Objective This study evaluated the short-and long-term outcomes of laparoscopic colectomy versus open surgery in obese patients (body mass index ≥25 kg/m2) with locally advanced colon cancer to ascertain the non-inferiority of laparoscopic surgery to open surgery. Methods In this large cohort study (UMIN-ID: UMIN000033529), we retrospectively reviewed prospectively collected data from consecutive patients who underwent laparoscopic or open surgery for pathological stage II–III colon cancer between 2009 and 2013. A comparative analysis was performed after propensity score matching between the laparoscopic and open surgery groups. The primary endpoint was the 3-year relapse-free survival (RFS). Results We identified 1575 eligible patients from 46 institutions. Each group comprised 526 propensity score-matched patients. Comparing the laparoscopic versus open surgery group, laparoscopic surgery was significantly associated with increased median operating time (225 vs. 192.5 min; P &amp;lt; .0001) and decreased median estimated blood loss (20 vs. 140 ml; P &amp;lt; .0001). Lymph node retrieval (20 vs. 19; P = 0.4392) and postoperative complications (4.6% vs. 5.7%; P = 0.4851) were similar, postoperative hospital stay was shorter (10 vs. 12 days; P &amp;lt; .0001), and the 3-year RFS rates were similar (82.8 vs. 81.2%). The hazard ratio (HR) for relapse-free survival for laparoscopic versus open surgery was 0.927 (90% confidence interval [CI], 0.747–1.150, one-sided P for non-inferiority = .001), indicating that for obese patients with colon cancer, laparoscopic surgery was non-inferior to open surgery. Conclusion Laparoscopic surgery in obese patients with colon cancer offers advantages in terms of short-term outcomes and no disadvantages in terms of long-term outcomes.

Obesity and the Risk of Thyroid Cancer: A Literature Review

Introduction and aim of the study: Thyroid cancer is considered the most common endocrine malignant worldwide in recent years. Also, obesity has become a true pandemic. The correlation between the increase in cases of not only obesity but also thyroid cancer could not be explained solely by earlier and more meticulous cancer diagnoses. This study aims to review the literature on the relationship between obesity and the risk of thyroid cancer. Materials and Methods: The authors conducted a comprehensive review of the literature available in PubMed and Medline databases focusing on the terms "thyroid cancer" and "obesity". Results: Obesity is associated with a state of chronic inflammation and nonspecific activation of the immune system, leading to the production of cytokines and adipokines. These elements, through complex mechanisms, directly and indirectly promote carcinogenesis. Despite the association of excessive body weight with malignant tumor development, oncological treatment cannot rely solely on lifestyle changes and should be conducted precisely as it is for individuals with normal body weight. Another popular research topic in recent years has been circadian rhythm disorders. These disorders are confirmed to be a pro-carcinogenic factor but are also considered as an element that could accelerate diagnosis. Conclusions: Understanding the relationship between obesity and thyroid cancer, primarily molecular mechanisms is essential for developing effective preventive and therapeutic strategies to reduce the risk of thyroid cancer in obese patients.

Reviewing the recurrence rates in stage I-III HR or ER positive breast cancer in obese patients given multi-modal weight loss plan post-treatment with aromatase inhibitors.

15 Background: Aromatase inhibitors (AIs) in the treatment of endocrine recepter positive breast cancer stages I-III, poses significant challenges in the management of obesity. Obesity is not only associated with an increased risk of breast cancer incidence but also with higher rates of cancer recurrence and poorer treatment outcomes. Moreover, the use of AIs, while effective in reducing estrogen levels and preventing ER or HR positive breast cancer recurrence, may exacerbate weight gain and metabolic disturbances in obese individuals. Weight management strategies have experienced increased attention in breast cancer survivors in recent years, especially overweight or obese individuals. Novel data makes it possible to infer that obesity management activities and multimodal programs that incorporate dietary counseling and physical activity can reduce recurrence rates. Methods: Participants in this study were individuals with Stage I-III endocrine receptor positive breast cancer who had completed adjuvant therapy and had a BMI in the 40s or 50s, increasing risk of recurrence. Eligible patients were identified based on the start date for endocrine therapy. High-risk patients were then assigned to either the intervention or control group. Those in the intervention group received access to a dietician, along with informational pamphlets on physiology and weight loss strategies. Additionally, they were offered discounts to certain gyms or provided free access to fitness facilities. Both intervention and control groups were briefed about the study, with those in the intervention group encouraged to utilize the provided resources for weight management. Results: The evidence from our study will underscore the potential benefits of multimodal weight loss interventions in overweight or obese breast cancer survivors, particularly in improving anthropometric outcomes and enhancing overall quality of life. Conclusions: While the studies included in our analysis demonstrated reductions in body weight, BMI, and waist circumference, as well as improvements in quality of life measures, there remains a notable gap in understanding the impact of these interventions on breast cancer recurrence rates, especially in the context of endocrine-positive breast cancer treated with Aromatase Inhibitors (AIs).

Construction of an immune-related gene prognostic model for obese endometrial cancer patients based on bioinformatics analysis

BackgroundThe tumor microenvironment (TME) affected the prognosis of tumors. However, its effect on the outcomes of obese endometrial cancer (EC) patients had not been reported. MethodsThis research performed a retrospective analysis of the transcriptome profiles and medical data of 503 EC patients. Immune scores were assessed by estimation algorithms. Cox and LASSO regression analyses were utilized to pinpoint key genes linked to prognosis, and the RPS was created to forecast the outcomes of obese EC patients. The relationship among genetic mutations and RPS was examined using CNV and somatic mutation information. ssGSEA and GSVA were employed to detect immune infiltration and immune pathway enrichment associated with key genes. The TIDE algorithm and GDSC database were utilized to forecast patients’ responses of patients to immunotherapy and chemotherapy, respectively. Finally, we employed the 'rms' R software package to construct the nomogram. ResultsThe prognosis of obese EC patients was associated with immune scores. Three key genes (EYA4, MBOAT2 and SCGB2A1) were identified. The risk prognosis score (RPS) for obese EC patients was established by risk stratification and prognostic prediction using prognostic genes. The higher the RPS, the worse the prognosis, and the more malignant the genomic alterations. The high RPS group had a significantly reduced proportion of most immune cells in comparison to the low RPS group. The high RPS group was linked to G2M, MYC and E2F related pathways such as cell proliferation, cell cycle and cell death. Cisplatin, tamoxifen and topotecan had a greater effect on the low RPS group. Notably, the nomogram had a good predictive ability. ConclusionOur study designed a reliable RPS for obese EC patients to forecast their prognosis, immune aggressiveness, and responses to immunotherapy and drug treatments.

The intestinal flora and nutritional status and immune function characteristics of obese colon cancer patients

BackgroundThe research aims to explore the characteristics of intestinal flora, nutritional status and immune function in patients with different types of obese colon cancer.MethodsA retrospective analysis is conducted on 64 cases of obese colon cancer diagnosed from June 2018 to January 2020. According to the histological staging of the cancer, they are classified into adenocarcinoma, adenosquamous carcinoma and undifferentiated carcinoma, with corresponding cases of 24, 22 and 18, respectively. The intestinal flora (Bifidobacterium, Lactobacillus, Enterococcus faecalis, Escherichia coli, and yeast), nutritional status (Hb, Alb, PA, TFN, and PNI), immune function (IgG, IgM, IgA, CD4+, CD8+, and CD4+/CD8+) are analyzed in the different groups of patients. Survival curves are evaluated by Kaplan-Meier method and log-rank test for tumour death, local recurrence, and distant metastasis.ResultsThere were no statistically significant differences in intestinal flora (Bifidobacterium, Lactobacillus, Enterococcus faecalis, Escherichia coli, and yeast), nutritional status (Hb, Alb, PA, TFN, and PNI) and immune function (IgG, IgM, IgA, CD4+, CD8+, and CD4+/CD8+) between different groups. There was a significant correlation between intestinal flora, nutritional status and immune function for all three. The survival curves of tumour death, local recurrence and distant metastasis in different groups of obese colon cancer patients were statistically significant. The tumor mortality rate, local recurrence, and distant metastasis rate in adenocarcinoma were 78.65%, 54.25% and 48.26% respectively.ConclusionThere are differences in intestinal flora, nutritional status and immune function among different types of obese colon cancer patients, but adenocarcinoma has the least benefit in intestinal flora, poor nutritional status, and weakest immune function.

Safety and feasibility of single-incision laparoscopic distal gastrectomy in overweight and obese gastric cancer patients: a propensity score-matched analysis

BackgroundThe technical challenges and safety concerns of single-incision laparoscopic gastrectomy for overweight and obese gastric cancer patients remain unclear. This study aimed to evaluate the safety and feasibility of single-incision laparoscopic distal gastrectomy (SIDG) compared to multiport laparoscopic distal gastrectomy (MLDG) in overweight and obese gastric cancer patients.MethodsThis study retrospectively analyzed overweight and obese patients (body mass index ≥ 25 kg/m2) and pathologic stage T1 primary gastric adenocarcinoma treated with either SIDG or MLDG. The SIDG and MLDG groups were propensity score matched at a 1:2 ratio using age, sex, height, body weight, American Society of Anesthesiologists classification, year of surgery, pathologic N stage, and anastomosis method as covariates.ResultsAfter 1:2 matching, the study included patients who underwent SIDG (n = 179) and MLDG (n = 358). No significant difference in the number of retrieved lymph nodes was found between the SIDG and MLDG groups (52.8 ± 19.3 vs. 53.9 ± 21.0, P = 0.56). Operation times were significantly shorter in the SIDG group (170.8 ± 60.0 min vs. 186.1 ± 52.6 min, P = 0.004). The postoperative hospital length of stay was comparable between the 2 groups (SIDG: 5.9 ± 3.4 days vs. MLDG: 6.3 ± 5.1 days, P = 0.23), as was postoperative complication rate (SIDG: 13.4% vs. MLDG: 12.8%, P = 0.89).ConclusionsSIDG was shown to be as safe and feasible as MLDG for overweight and obese gastric cancer patients, with comparable early postoperative complication rates without compromising operation time compared to MLDG.

Rising Trends in Metabolically Healthy Obesity in Cancer Patients and Its Impact on Cardiovascular Events: Insights from a Contemporary Nationwide Analysis in the USA (2016-2020).

Background: Obesity or overweight raises the risk of developing 13 types of cancer, representing 40% of all cancers diagnosed in the United States annually. Given the ongoing debate surrounding the impact of metabolically healthy obesity (MHO) on cardiovascular outcomes, it is crucial to comprehend the incidence of Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) and the influence of MHO on these outcomes in cancer patients. Methods: Data of hospitalized cancer patients with and without obesity were analyzed from the National Inpatient Sample 2016-2020. Metabolically healthy patients were identified by excluding diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity software, v.2022.1. After that, we performed a multivariable regression analysis for in-hospital MACCEs and other individual outcomes. Results: We identified 3,111,824 cancer-related hospitalizations between 2016 and 2020. The MHO cohort had 199,580 patients (6.4%), whereas the MHnO (metabolically healthy non-obese) cohort had 2,912,244 patients (93.6%). The MHO cohort had a higher proportion of females, Blacks, and Hispanics. Outcomes including in-hospital MACCEs (7.9% vs. 9.5%; p < 0.001), all-cause mortality (6.1% vs. 7.5%; p < 0.001), and acute myocardial infarction (AMI) (1.5% vs. 1.6%; p < 0.001) were lower in the MHO cohort compared to the MHnO cohort. Upon adjusting for the baseline characteristics, the MHO group had lower odds of in-hospital MACCEs [adjusted odds ratio (AOR) = 0.93, 95% CI (0.90-0.97), p < 0.001], all-cause mortality [AOR = 0.91, 95% CI (0.87-0.94); p < 0.001], and acute ischemic stroke (AIS) [AOR = 0.76, 95% CI (0.69-0.84); p < 0.001], whereas there were higher odds of acute myocardial infarction (AMI) [AOR = 1.08, 95% CI (1.01-1.16); p < 0.001] and cardiac arrest (CA) [AOR = 1.26, 95% CI (1.01-1.57); p = 0.045] in the MHO cohort compared to the MHnO cohort. Conclusions: Hospitalized cancer patients with MHO exhibited a lower prevalence of in-hospital MACCEs than those with MHnO. Additional prospective studies and randomized clinical trials are imperative to validate these findings, particularly in stratifying MHO across various cancer types and their corresponding risks of in-hospital MACCEs.

Abstract SY38-02: Clinical investigations of obesity in cancer: BMI and other confounders

Abstract SY38-02: Clinical investigations of obesity in cancer: BMI and other confounders

Abstract 4427: Do changes in lipid metabolism link obesity to pancreatic cancer

Abstract The near equal incidence and mortality rates of pancreatic cancer, combined with projections that pancreatic cancer will become the second-most common cancer-related deaths by 2050, underscore the need to identify patients with early disease and interrupt this trajectory. Obesity, weight gain and waistline have been implicated in increasing the risk of pancreatic cancer. Although metabolomic analyses of pancreatic cancer patients have established correlations between phospholipids, lysophospholipids with treatment outcomes, the association between metabolites, obesity, and pancreatic cancer remains largely understudied. The objective of this pilot study was to determine differences in serum metabolites in obese and overweight pancreatic cancer patients compared with healthy non-obese subjects. Our long-term goal is to develop serum marker(s) that may be used to prevent advanced pancreatic cancer and thus improve outcomes for these patients. Serum was obtained from healthy subjects (n=11; BMI range from 18-25), overweight (n=9; 25-30) and obese (n=7; &amp;gt;30) pancreatic cancer patients from an IRB approved study. Males (n=12) and females (n=15) were represented in the study. Global metabolic profiles were determined using Ultrahigh performance liquid chromatography-tandem mass spectroscopy. Raw data was extracted, peaks were identified and processed at Metabolon using the Laboratory Information Management System. Comparison between overweight pancreatic cancer patients and healthy controls identified 403 biochemicals (111 upregulated and 292 downregulated; p &amp;lt;0.05) and 93 biochemicals (40 upregulated and 53 downregulated; 0.05&amp;lt;p&amp;lt;0.10). Comparison of the differences in biochemicals between obese pancreatic cancer patients and healthy controls showed changes in 293 biochemicals (71 upregulated and 222 downregulated; p &amp;lt;0.05) and 123 biochemical changes at 0.05&amp;lt;p&amp;lt;0.10 (42 increased and 81 decreased). 38 (p &amp;lt;0.05) and 47 (0.05&amp;lt;p&amp;lt;0.10) differential levels of biochemicals were identified when obese and overweight pancreatic cancer patients were compared. Random forest analysis showed that the 30 top ranking biochemicals were involved in lipid metabolism, amino acid metabolism, nucleotide metabolism, peptide, xenobiotics, and carbohydrate metabolism. These data suggest an association between changes in lipid metabolism may be another link between obesity and pancreatic cancer. This project was funded in part by VA-Merit Award (I01 BX003876). Citation Format: Rita Ghosh, Deepa Ajit, Jillian Woodworth, Danielle Fritze, Francisco G. Cigarroa, Glenn A. Halff, Addanki Pratap Kumar. Do changes in lipid metabolism link obesity to pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4427.

Abstract 3935: Involvement of nanoscale physical communication in obesity-associated breast cancer severity

Abstract Obesity is a risk factor for several cancers, including breast cancer, and contributes up to 20% of cancer-related deaths. Growing evidence from both clinical and preclinical studies indicates that increased obesity is associated with increases in cancer incidence, progression, metastasis, and therapeutic resistance. According to the Centers for Disease Control and Prevention (CDC), more than 70% and 40% of American adults can be classified as overweight and obese, respectively. However, treatment strategies for dealing with cancer in obese patients have not advanced apart from lifestyle interventions. However, several signaling mechanisms have been proposed related to the inflammatory and metabolic impact of obese adipocytes in promoting cancer progression. However, a lack of mechanistic understanding led to no specific treatment strategies have been proposed which can specifically downregulate the key regulator by which obese adipocytes promote cancer progression. Thus, translational research initiatives are immediately needed to provide mechanistic justifications for these striking statistics in order to better serve this growing segment of the population. Here, we have shown the role of nanoscale physical communication between breast cancer cells and adipose tissue in promoting cancer progression. Using high-resolution optical and electron microscopy, we have found that breast cancer cells form nanoscale tubular communications with obese adipocytes. Moreover, the cancer cells hijack mitochondria from obese adipocytes. However, coculturing cancer cells and obese adipocytes in the Boyden chamber, allowing exosomal and paracrine communication but blocking direct physical communication, revealed negligible mitochondria transfer. This observation indicates an active transfer of mitochondria via nanotube. A significantly higher rate of mitochondria transfer from obese adipocytes to cancer cells has been observed than non-differentiated pre-adipocytes. The transfer of mitochondria results in an increase in the metabolism of the cancer cells. The mechanistic investigation of the nanotube formation revealed actin's presence as the major component in the nanotube. The exocyst-GTPase protein complex has a prime contribution in actin remodeling and nanotube formation. Inhibition of exocyst-GTPase using a pharmacological inhibitor results in a significant reduction in nanotube-mediated mitochondria transfer. Conclusion: Our goal is to (i) investigate the direct physical connection between adipocytes and cancer cells and the effect on cancer progression and (ii) eliminate mortality related to obesity-associated breast cancer severity by introducing a new therapeutic strategy. Here, we have shown how cancer cells communicate with obese adipocytes and receive additional metabolic power for proliferation. The in vivo investigation of the same is under progress. Citation Format: Tanmoy Saha, Balaaji Baanupriya Srinivasan, Shiladitya Sengupta. Involvement of nanoscale physical communication in obesity-associated breast cancer severity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3935.

Abstract 7349: Ligand-receptor signaling analysis and tumor-immune microenvironment deconvolution reveal differential adipose-tumor crosstalk in lean and obese colon cancer patients

Abstract Obesity is a well-defined risk factor for colon cancer (CC). In the current study, we investigated the paracrine influences between tumors and adjacent adipose tissue to understand the interactions between adipose-tumor using transcriptomics data. Stage I-III newly diagnosed CC patients (n = 130) as part of the ColoCare Study at the Huntsman Cancer Institute, University of Utah, and University of Heidelberg, Germany were included in the current study. Fresh-frozen colon tumor tissues and adjacent adipose tissues naïve to neoadjuvant treatment were collected during surgery. RNA sequencing was done using the NovaSeq X. Patients were classified as having a BMI &amp;lt;30 kg∙m−2 (lean) or BMI ≥30 kg∙m−2 (obese). Tumor-adipose signaling was investigated separately for lean versus obese patients. Differentially expressed genes (DEGs, FDRq&amp;lt;0.05 and |log2FC|&amp;gt;2) between paired tumor-adipose samples were identified through DESeq2, respectively for lean and obese participants. DEGs were filtered to obtain exclusively up-regulated genes for 1) tumor tissue in the obese 2) tumor tissue in the lean 3) adipose tissue in the obese 4) adipose tissue in the lean. Ligand-receptor pairs for adipose-adipose signaling (A-A), tumor-tumor signaling (T-T), adipose-tumor signaling (A-T), and tumor-adipose signaling (T-A) in tissues from lean versus obese patients were determined by mapping the exclusively up-regulated genes in the FANTOM 5 database. Single sample Gene Set Enrichment Analysis (ssGSEA) was performed to score each sample based on signatures of interest, i.e. TIMEx immune cell types. The associations of signatures between tumor-adipose were assessed by evaluating Spearman’s correlation coefficients on the enrichment scores of each signature for paired tumor-adipose samples. From RNA-seq, there were 430 protein-coding DEGs (144 up-regulated in the tumor, 286 up-regulated in the adipose) identified exclusively in the obese and; 704 protein-coding DEGs (421 up-regulated in the tumor, 283 up-regulated in the adipose) identified exclusively in the lean patients. In the obese, we observed ligand-receptor-mediated T-T signaling through FGF5-FGFR3 and PYY-NPY4R; T-A signaling through GCG-GCGR; A-A signaling through ICAM1-IL2RA. In the lean, we found ligand-receptor-mediated T-T signaling through ADAM2-ITGA6 and LAMB3-ITGA6; T-A signaling through DLL3-NOTCH2; A-A signaling through DLK1-NOTCH2. In addition, ssGSEA analysis showed different association patterns for the lean versus obese regarding the TIMEx immune cell types. Our results suggest differential cross-talk between adipose and tumor tissue in lean vs. obese patients could influence the progression of CC. The next steps are to validate these interactions by using in vivo preclinical models to interrogate novel therapeutic targets for reducing the impact of obesity on CC. Citation Format: Tengda Lin, Victoria M. Bandera, Elaine M. Glenny, Caroline Himbert, Jennifer Ose, Christy Warby, Olena Aksonova, Alessandro Carpanese, Chris Stubben, David Nix, Kenneth M. Boucher, Peter Schirmacher, Ildiko Strehli, Jolanta Jedrzkiewicz, Courtney L. Scaife, Bartley Pickron, Alexander Brobeil, Martin Schneider, Christoph Kahlert, Erin M. Siegel, Adetunji T. Toriola, David Shibata, Christopher I. Li, Jane C. Figueiredo, Jatin Roper, Biljana Gigic, Stephen D. Hursting, Cornelia M. Ulrich, Aik Choon Tan. Ligand-receptor signaling analysis and tumor-immune microenvironment deconvolution reveal differential adipose-tumor crosstalk in lean and obese colon cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7349.

Impact of electronic medical record utilization on obesity screening and intervention for obese patients with endometrial cancer

ObjectiveTo identify the prevalence of obesity documented within the electronic medical record problem list.MethodsWe conducted a retrospective cohort study of adult patients with obesity and endometrial cancer receiving care from...

Comparison of surgical and oncological outcomes between different surgical approaches for overweight or obese cervical cancer patients

The purpose was to investigate the safety and advantages of different surgical approaches applied to overweight or obese cervical cancer patients by comparing their surgical and oncological outcomes. This is a retrospective cohort study. 382 patients with a body mass index of at least 24.0 kg/m2 and stage IB-IIA (The International Federation of Gynecology and Obstetrics, FIGO 2009) cervical cancer were enrolled, and then were divided into three groups: open radical hysterectomy (ORH) group, laparoscopic radical hysterectomy (LRH) group, and robot-assisted radical hysterectomy (RRH) group according to the surgical approach. IBM SPSS version 25.0 was used to analyze data. There were 51 patients in ORH group, 225 patients in LRH group and 106 patients in RRH group. In the comparison of surgical outcomes, compared to LRH and ORH, RRH had the shortest operating time, the least estimated blood loss, the shortest postoperative hospital stay, and the shortest recovery time for bowel function (P < 0.05). In the comparison of postoperative complications, ORH has the highest rate of postoperative infection and wound complication compared to LRH and RRH (P < 0.05), and RRH has the highest proportion of urinary retention. After a median follow-up time of 61 months, there was no statistically significant difference between the three groups in terms of 5-year overall survival (OS) rate and 5-year recurrence-free survival (RFS) rate, (P = 0.262, P = 0.453). In patients with overweight or obese cervical cancer, the long-term outcomes of the three surgical approaches were comparable, with RRH showing significant advantages over ORH and LRH in terms of surgical outcomes.

Risk factors for anastomotic leakage after low anterior resection for obese patients with rectal cancer.

We aimed to analyze the risk factors for anastomotic leakage (AL) after low anterior resection (LAR) in obese patients (body mass index [BMI] ≥ 25kg/m2) with rectal cancer. Data were collected from four hundred two obese patients who underwent LAR for rectal cancer in 51 institutions. Forty-six (11.4%) patients had clinical AL. The median BMI (27kg/m2) did not differ between the AL and non-AL groups. In the AL group, comorbid respiratory disease was more common (p = 0.025), and the median tumor size was larger (p = 0.002). The incidence of AL was 11.5% in the open surgery subgroup and 11.4% in the laparoscopic surgery subgroup. Among the patients who underwent open surgery, the AL group showed a male predominance (p = 0.04) in the univariate analysis, but it was not statistically significant in the multivariate analysis. Among the patients who underwent laparoscopic surgery, the AL group included a higher proportion of patients with comorbid respiratory disease (p = 0.003) and larger tumors (p = 0.007). Comorbid respiratory disease and tumor size were risk factors for AL in obese patients with rectal cancer. Careful perioperative respiratory management and appropriate selection of surgical procedures are required for obese rectal cancer patients with respiratory diseases.

Obesity and Cancer Rehabilitation for Functional Recovery and Quality of Life in Breast Cancer Survivors: A Comprehensive Review

Obesity is a global health challenge with increasing prevalence, and its intricate relationship with cancer has become a critical concern in cancer care. As a result, understanding the multifactorial connections between obesity and breast cancer is imperative for risk stratification, tailored screening, and rehabilitation treatment planning to address long-term survivorship issues. The review follows the SANRA quality criteria and includes an extensive literature search conducted in PubMed/Medline, Web of Science, and Scopus. The biological basis linking obesity and cancer involves complex interactions in adipose tissue and the tumor microenvironment. Various mechanisms, such as hormonal alterations, chronic inflammation, immune system modulation, and mitochondrial dysfunction, contribute to cancer development. The review underlines the importance of comprehensive oncologic rehabilitation, including physical, psychological, and nutritional aspects. Cancer rehabilitation plays a crucial role in managing obesity-related symptoms, offering interventions for physical impairments, pain management, and lymphatic disorders, and improving both physical and psychological well-being. Personalized and technology-driven approaches hold promise for optimizing rehabilitation effectiveness and improving long-term outcomes for obese cancer patients. The comprehensive insights provided in this review contribute to the evolving landscape of cancer care, emphasizing the importance of tailored rehabilitation in optimizing the well-being of obese cancer patients.

Obesity-Senescence-Breast Cancer: Clinical Presentation of a Common Unfortunate Cycle.

There are few convincing studies establishing the relationship between endogenous factors that cause obesity, cellular aging, and telomere shortening. Without a functional telomerase, a cell undergoing cell division has progressive telomere shortening. While obesity influences health and longevity as well as telomere dynamics, cellular senescence is one of the major drivers of the aging process and of age-related disorders. Oxidative stress induces telomere shortening, while decreasing telomerase activity. When progressive shortening of telomere length reaches a critical point, it triggers cell cycle arrest leading to senescence or apoptotic cell death. Telomerase activity cannot be detected in normal breast tissue. By contrast, maintenance of telomere length as a function of human telomerase is crucial for the survival of breast cancer cells and invasion. Approximately three-quarters of breast cancers in the general population are hormone-dependent and overexpression of estrogen receptors is crucial for their continued growth. In obesity, increasing leptin levels enhance aromatase messenger ribonucleic acid (mRNA) expression, aromatase content, and its enzymatic activity on breast cancer cells, simultaneously activating telomerase in a dose-dependent manner. Meanwhile, applied anti-estrogen therapy increases serum leptin levels and thus enhances leptin resistance in obese postmenopausal breast cancer patients. Many studies revealed that shorter telomeres of postmenopausal breast cancer have higher local recurrence rates and higher tumor grade. In this review, interlinked molecular mechanisms are looked over between the telomere length, lipotoxicity/glycolipotoxicity, and cellular senescence in the context of estrogen receptor alpha-positive (ERα+) postmenopausal breast cancers in obese women. Furthermore, the effect of the potential drugs, which are used for direct inhibition of telomerase and the inhibition of human telomerase reverse transcriptase (hTERT) or human telomerase RNA promoters as well as approved adjuvant endocrine therapies, the selective estrogen receptor modulator and selective estrogen receptor down-regulators are discussed.

Does leptin cause proximal gastric cancer in the obese? The role of serum leptin in the etiology of proximal gastric cancer.

The aim of the present study was to determine the correlation between obesity, serum levels of leptin and proximal gastric cancer. Sixty-four gastric cancer patients operated on with curative intent were included in the study. We determined the correlation between the preoperative serum levels of leptin and the tumor's location. Serum leptin levels were correlated significantly with the proximal third location (p=0.04), gastric outlet obstructing tumors (p<0.0001), CRP levels (p=0.03) and BMI (p<0.0001). Patients with high serum levels of leptin had significantly more intestinal types of gastric cancer (p=0.033) and better differentiation (p=0.009). The linear regression model determined the proximal tumor location (beta: 0.467; p=0.045), BMI (beta: 0.657; p=0.001), high preoperative serum albumin (beta: 0.563; p=0.016) and the presence of pyloric stenosis (beta: 0.525; p=0.006) as related significantly to serum leptin levels. The Cox proportional hazard model identified age (HR: 0.003; 95 % CI: 0-0.794; p=0.041), preoperative serum levels of leptin (HR: 0.125; 95 % CI: 0.018-0.887; p=0.037) and the number of extracted LNs (HR: 0.001; 95 % CI: 0-0.677; p=0.038) as independent prognostic factors. Serum levels of leptin were significantly elevated in patients with proximal gastric cancer, suggesting that the leptin's effect might be due to its systemic secretion. This might explain the higher incidence of proximal gastric cancer in obese patients. Elevated serum leptin levels were an independent prognostic factor.

D&C has the best concordance between preoperative and postoperative grades among morbidly obese endometrial cancer patients.

Endometrial cancer is diagnosed by obtaining uterine biopsies by pipelle, dilatation and curettage (D&C), or hysteroscopy. In 15%-25% of the cases, the preoperative and postoperative grades do not match. This discrepancy may carry significant clinical and prognostic consequences. We aimed to assess how body mass index (BMI) affects preoperative and postoperative grade mismatches and whether biopsy methods mitigate this effect. We conducted a retrospective review of patients with endometrial cancer who underwent surgery at our center between 2014 and 2022. We stratified patients into six classes of BMI based on the WHO classification. Preoperative and postoperative grades were compared for concordance with regards to patient BMI and sampling method. A total of 158 patients were included, diagnosed by pipelle (n = 99), hysteroscopy (n = 15), or D&C (n = 44). For all methods, every unit increase in BMI increased the odds of having a gap between histology grades by 5.2%. In the pipelle group, the odds of a larger gap between the histology grades was 62% higher than that of women in the other groups. Among the D&C group, the odds of having a bigger difference between histology grades were 91.8% lower compared to the other groups. Patients with BMI over 30 had nearly 50% discrepancy when diagnosed with pipelle or hysteroscopy, but less than 10% with D&C. Increasing BMI is associated with decreasing concordance between preoperative and postoperative grades in endometrial cancer, especially when it exceeds 30. This effect is much less pronounced, however, when the diagnostic method is D&C.

Short- and long-term comparison of robotic versus laparoscopic gastrectomy for gastric cancer patients with BMI≥30 kg/m2: A propensity score matched analysis

BackgroundAlthough minimally invasive surgery (MIS) for gastric patients has gained popularity in recent decades, reports on the comparison of short and long clinical outcomes between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer patients with BMI≥30 kg/m2 are still limited. MethodsA total of 226 obese gastric cancer patients who underwent either RG (n = 81) or LG (n = 145) were enrolled in this study between October 2014 and September 2022. Propensity score matching (PSM) (1:1) was performed to reduce confounding bias. Short-term and long-term outcomes were compared between the RG and LG groups. ResultsThe clinicopathological characteristics of 156 patients in the RG group (n = 79) and LG group (n = 79) were well balanced after PSM. Compared with the LG group, the RG group had a significantly shorter operation time, less estimated blood loss, more harvested lymph nodes, a faster postoperative recovery course, reduced surgical morbidity, and a shorter postoperative hospital stay. The long-term outcomes were comparable between the two groups. ConclusionsRG is a safe and feasible approach for gastric cancer with a BMI≥30 kg/m2 and has better short-term clinical outcomes than LG. However, RG is similar to LG in terms of long-term prognosis.