Radboud University Nijmegen Medical Centre, Department of Medical Oncology, Nijmegen, The Netherlands.
Eur J Cancer. 2011 Nov;47(17):2560-7. doi: 10.1016/j.ejca.2011.06.038. Epub 2011 Jul 29.
Obesity is associated with an increased risk of development and recurrence of colorectal cancer. However, the role of obesity in advanced colorectal cancer (ACC) patients is unknown. We investigated the effect of body mass index (BMI) on overall survival (OS) in ACC patients receiving systemic treatment in two large phase III studies (CAIRO and CAIRO2).
Treatment data were obtained and analysed from 796 ACC patients who were treated with chemotherapy in the CAIRO study, and from 730 ACC patients who were treated with chemotherapy plus targeted therapy in the CAIRO2 study. Baseline height and weight were used to assign patients to one of the following BMI categories: A (<18.5 kg/m(2)), B (18.5-24.9 kg/m(2)), C (25.0-29.9 kg/m(2)) and D (≥30.0 kg/m(2)).
In 796 patients of the CAIRO study a high BMI was associated with better median OS (8.0, 14.9, 18.4 and 19.5 months for BMI categories A, B, C, and D, respectively; P=0.001), and was an independent prognostic factor for OS in a multivariate analysis. BMI was not associated with OS in 730 patients who participated in the CAIRO2 study, although a trend was observed.
These results show that BMI is an independent prognostic factor for survival in patients receiving chemotherapy, but not in patients receiving chemotherapy and targeted therapy. The possible decreased efficacy of bevacizumab in obese patients may explain this discrepant result. The role of BMI in patients receiving targeted therapy should be further tested.
肥胖与结直肠癌的发生和复发风险增加有关。然而，肥胖在晚期结直肠癌（ACC）患者中的作用尚不清楚。我们在两项大型 III 期研究（CAIRO 和 CAIRO2）中调查了体质量指数（BMI）对接受系统治疗的 ACC 患者总生存期（OS）的影响。
从接受 CAIRO 研究化疗的 796 例 ACC 患者和接受 CAIRO2 研究化疗联合靶向治疗的 730 例 ACC 患者中获得并分析了治疗数据。根据基线身高和体重将患者分为以下 BMI 类别之一：A（<18.5 kg/m²）、B（18.5-24.9 kg/m²）、C（25.0-29.9 kg/m²）和 D（≥30.0 kg/m²）。
在 CAIRO 研究的 796 例患者中，高 BMI 与更好的中位 OS 相关（BMI 类别 A、B、C 和 D 的中位 OS 分别为 8.0、14.9、18.4 和 19.5 个月；P=0.001），并且是多变量分析中 OS 的独立预后因素。在参加 CAIRO2 研究的 730 例患者中，BMI 与 OS 无关，但观察到一种趋势。
这些结果表明，BMI 是接受化疗的患者生存的独立预后因素，但不是接受化疗和靶向治疗的患者的独立预后因素。贝伐珠单抗在肥胖患者中疗效降低可能解释了这一不一致的结果。BMI 在接受靶向治疗的患者中的作用应进一步测试。
