Meyerhardt Jeffrey A, Catalano Paul J, Haller Daniel G, Mayer Robert J, Benson Al B, Macdonald John S, Fuchs Charles S
Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
Cancer. 2003 Aug 1;98(3):484-95. doi: 10.1002/cncr.11544.
Obesity is a risk factor for the development of colon carcinoma. The influence of body mass index (BMI) on long-term outcomes and treatment-related toxicity in patients with colon carcinoma has not been well characterized.
This cohort study was conducted within a large, randomized adjuvant chemotherapy trial of 3759 men and women with high-risk, Stage II and Stage III colon carcinoma who were treated between 1988 and 1992 throughout the United States. With a median follow-up of 9.4 years, the authors examined the influence of BMI on disease recurrence, overall survival, and treatment-related toxicity.
Compared with women of normal weight (BMI, 21.0-24.9 kg/m(2)), obese women with colon carcinoma (BMI > or = 30.0 kg/m(2)) experienced significantly worse overall mortality (hazard ratio [HR], 1.34; 95% confidence interval [95% CI], 1.07-1.67) and a nonsignificant increase in the risk of disease recurrence (HR, 1.24; 95% CI, 0.98-1.59). The influence of BMI among women was not related to any differences in chemotherapy dose-intensity across categories of BMI. In contrast, BMI was not related significantly to long-term outcomes among male patients in this cohort. Among all study participants, obese patients had significantly lower rates of Grade 3-4 leukopenia and lower rates of any Grade > or = 3 toxicity compared with patients of normal weight.
Among women with Stage II-III colon carcinoma, obesity was associated with a significant increase in overall mortality as well as a borderline significant increase in disease recurrence. Nonetheless, obesity was not associated with any increase in chemotherapy-related toxicity.
肥胖是结肠癌发生的一个风险因素。体重指数（BMI）对结肠癌患者长期预后及治疗相关毒性的影响尚未得到充分描述。
这项队列研究是在一项大型随机辅助化疗试验中进行的，该试验纳入了1988年至1992年期间在美国各地接受治疗的3759例高危II期和III期结肠癌男性和女性患者。中位随访时间为9.4年，作者研究了BMI对疾病复发、总生存期和治疗相关毒性的影响。
与体重正常的女性（BMI，21.0 - 24.9 kg/m²）相比，肥胖的结肠癌女性患者（BMI≥30.0 kg/m²）的总死亡率显著更高（风险比[HR]，1.34；95%置信区间[95%CI]，1.07 - 1.67），疾病复发风险虽有增加但不显著（HR，1.24；95%CI，0.98 - 1.59）。女性中BMI的影响与不同BMI类别间化疗剂量强度的任何差异均无关。相比之下，该队列中男性患者的BMI与长期预后无显著相关性。在所有研究参与者中，与体重正常的患者相比，肥胖患者3 - 4级白细胞减少的发生率显著更低，任何≥3级毒性的发生率也更低。
在II - III期结肠癌女性患者中，肥胖与总死亡率显著增加以及疾病复发的临界显著增加相关。尽管如此，肥胖与化疗相关毒性的任何增加均无关。
