Analysis of Body Mass Index and Mortality in Patients With Colorectal Cancer Using Causal Diagrams
Analysis of Body Mass Index and Mortality in Patients With Colorectal Cancer Using Causal Diagrams
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DOI：
10.1001/jamaoncol.2016.0732
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发表时间：
2016-09-01
期刊：
影响因子：
28.4
通讯作者：
Caan, Bette J.
中科院分区：
文献类型：
--
作者：
Kroenke, Candyce H.;Neugebauer, Romain;Caan, Bette J.
重要性医生和研究人员试图确定体重指数之间的关系，（BMI [计算为体重（公斤）除以身高（米）的平方]）和结直肠癌（CRC）的结果，但方法学的局限性，包括抽样选择偏差，反向因果关系，和碰撞者偏差阻止了得出明确结论的能力。设计、设置和参与者本回顾性观察性研究前瞻性收集了3408名男性和女性的数据，年龄18 - 80岁，来自Kaiser Permanente北方加州人群，在2006年至2011年期间被诊断为I期至III期CRC并接受手术的患者。暴露诊断时和诊断后15个月的体重指数。主要结局和指标与正常人相比，全因死亡率和CRC特异性死亡率的风险比（HR）。体重患者，调整社会人口统计学，疾病严重程度，治疗和诊断前BMI.结果这项研究调查了一个队列的3408名男性和女性，年龄18至80岁，诊断为I至III期CRC在2006年和2011年之间谁也有手术。诊断时BMI与全因死亡率呈非线性相关，与正常低体重患者（BMI 18.5至18.5）相比，体重不足患者（BMI = 35; HR，1.33; 95%CI，0.89-1.98）的死亡风险升高。
IMPORTANCE Physicians and investigators have sought to determine the relationship between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and colorectal cancer (CRC) outcomes, but methodologic limitations including sampling selection bias, reverse causality, and collider bias have prevented the ability to draw definitive conclusions.OBJECTIVE To evaluate the association of BMI at the time of, and following, colorectal cancer (CRC) diagnosis with mortality in a complete population using causal diagrams.DESIGN, SETTING, AND PARTICIPANTS This retrospective observational study with prospectively collected data included a cohort of 3408 men and women, ages 18 to 80 years, from the Kaiser Permanente Northern California population, who were diagnosed with stage I to III CRC between 2006 and 2011 and who also had surgery.EXPOSURES Body mass index at diagnosis and 15 months following diagnosis.MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) for all-cause mortality and CRC-specific mortality compared with normal-weight patients, adjusted for sociodemographics, disease severity, treatment, and prediagnosis BMI.RESULTS This study investigated a cohort of 3408 men and women ages 18 to 80 years diagnosed with stage I to III CRC between 2006 and 2011 who also had surgery. At-diagnosis BMI was associated with all-cause mortality in a nonlinear fashion, with patients who were underweight (BMI = 35; HR, 1.33; 95% CI, 0.89-1.98) exhibiting elevated mortality risks, compared with patients who were low-normal weight (BMI 18.5 to