Oncologic and Functional Hazards of Obesity Among Patients With Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiation Therapy.
Oncologic and Functional Hazards of Obesity Among Patients With Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiation Therapy.
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DOI：
10.1097/coc.0000000000000150
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Chang GJ
中科院分区：
文献类型：
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作者：
Park IJ;You YN;Skibber JM;Rodriguez-Bigas MA;Das P;Eng C;Kopetz S;Wolff RA;Crane CH;Krishnan S;Minsky B;Hu CY;Nguyen S;Chang GJ
肥胖是结直肠癌的主要健康问题和风险因素，也可能影响癌症治疗和结果。直肠癌对放化疗（CXRT）的反应与长期生存和括约肌保留相关。本研究的目的是评估肥胖对直肠癌新辅助CXRT治疗后治疗结果的影响。对诊断（1993-2010年）为cT 3 -4或cN+（通过EUS、CT或MRI）直肠癌并接受CXRT和TME治疗的患者进行了回顾性队列研究。将患者分为肥胖（BMI≥30 kg/m2）或非肥胖（BMI<30 kg/m2），并根据CXRT反应：完全（ypCR）或不完全（ypIR）。采用多变量logistic回归分析和考克斯回归分析评估肥胖、肿瘤反应和括约肌保留之间的关系。753例患者符合标准，28.7%（n=216）的患者肥胖。肥胖组和非肥胖组在年龄、性别、肿瘤位置、级别或检查的淋巴结数量方面没有差异。然而，肥胖与较低的ypCR率相关（ORmulti=0.60; 95%CI：0.38-0.94，p= 0.04），在中低位直肠癌患者中，较低的保肛率相关（ORmulti= 0.67; 95%CI：0.45 - 0.99）。在肥胖和非肥胖患者中，CR比iCR与更有利的无复发生存率相关。考虑到肥胖患病率的增加及其与CXRT反应、肿瘤学结局和括约肌保留的相关性，需要进一步研究肥胖对新辅助治疗反应的影响。此外，肥胖应作为直肠癌多模式治疗后不良结局的可改变风险因素。
Obesity is a major health concern and risk factor for colorectal cancer that may also impact cancer treatment and outcomes. Rectal cancer response to chemoradiotherapy (CXRT) is associated with long-term survival and sphincter preservation. The purpose of this study was to evaluate the impact of obesity on treatment outcomes after neoadjuvant CXRT for rectal cancer. A retrospective cohort study of patients diagnosed (1993–2010) with cT3-4 or cN+ (by EUS, CT, or MRI) rectal carcinoma and treated with CXRT and TME was performed. Patients were classified as obese (BMI≥30 kg/m2) or non-obese (BMI<30 kg/m2),and by response to CXRT: complete (ypCR) or incomplete (ypIR). Associations between obesity, tumor response, and sphincter preservation were evaluated using multivariate logistic regression analysis and survival outcomes by Cox regression. 753 patients met criteria and 28.7% (n=216) patients were obese. Obese and non-obese groups did not differ in age, gender, tumor location, grade, or number of examined lymph nodes. However, obesity was associated with a lower rate of ypCR (ORmulti=0.60; 95% CI:0.38–0.94, p=.04) and among mid-to-low rectal cancer patients, a lower rate of sphincter preservation (ORmulti=.67; 95% CI:.45 to.99). Both among obese and non-obese patients, CR was associated with more favorable recurrence-free survival than iCR. Considering the increasing obesity prevalence and its association with CXRT response, oncologic outcomes, and sphincter preservation, further study is needed regarding the impact of obesity on neoadjuvant treatment response. Moreover, obesity should be targeted as a modifiable risk factor for adverse outcomes following multimodality treatment for rectal cancer.