TY - JOUR
T1 - Post-diagnosis adiposity and colorectal cancer prognosis
T2 - A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis
AU - Becerra-Tomas, Nerea
AU - Markozannes, Georgios
AU - Cariolou, Margarita
AU - Balducci, Katia
AU - Vieira, Rita
AU - Kiss, Sonia
AU - Aune, Dagfinn
AU - Greenwood, Darren C.
AU - Dossus, Laure
AU - Copson, Ellen
AU - Renehan, Andrew G.
AU - Bours, Martijn
AU - Demark-Wahnefried, Wendy
AU - Hudson, Melissa M.
AU - May, Anne M.
AU - Odedina, Folakemi T.
AU - Skinner, Roderick
AU - Steindorf, Karen
AU - Tjonneland, Anne
AU - Velikova, Galina
AU - Baskin, Monica L.
AU - Chowdhury, Rajiv
AU - Hill, Lynette
AU - Lewis, Sarah J.
AU - Seidell, Jaap
AU - Weijenberg, Matty P.
AU - Krebs, John
AU - Cross, Amanda J.
AU - Tsilidis, Konstantinos K.
AU - Chan, Doris S. M.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m(2)). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m(2)), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.
AB - The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m(2)). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m(2)), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.
KW - adiposity
KW - colorectal cancer
KW - evidence grading
KW - systematic review
KW - BODY-MASS INDEX
KW - ADVANCED RECTAL-CANCER
KW - LONG-TERM SURVIVAL
KW - CURATIVE LAPAROSCOPIC SURGERY
KW - TREATMENT-RELATED TOXICITY
KW - TOTAL MESORECTAL EXCISION
KW - SKELETAL-MUSCLE INDEX
KW - LIFE-STYLE FACTORS
KW - III COLON-CANCER
KW - POOR-PROGNOSIS
U2 - 10.1002/ijc.34905
DO - 10.1002/ijc.34905
M3 - (Systematic) Review article
SN - 0020-7136
VL - 155
SP - 400
EP - 425
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 3
ER -