新辅助放化疗后局部晚期直肠癌患者肥胖的肿瘤学及功能危害
Oncologic and Functional Hazards of Obesity Among Patients With Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiation Therapy.
作者信息
Park In J, You Y Nancy, Skibber John M, Rodriguez-Bigas Miguel A, Das Prajnan, Eng Cathy, Kopetz Scott, Wolff Robert A, Crane Christopher H, Krishnan Sunil, Minsky Bruce, Hu Chung-Yuan, Nguyen Sa, Chang George J
机构信息
Departments of *Surgical Oncology †Radiation Oncology ‡Gastrointestinal Medical Oncology, MD Anderson Cancer Center, University of Texas, Austin, TX.
出版信息
Am J Clin Oncol. 2017 Jun;40(3):277-282. doi: 10.1097/COC.0000000000000150.
OBJECTIVE
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.
METHODS
A retrospective cohort study of patients diagnosed (1993 to 2010) with cT3-4 or cN+ (by endorectal ultrasound, computed tomography, or magnetic resonance imaging) rectal carcinoma and treated with CXRT and total mesorectal excision was performed. Patients were classified as obese (body mass index ≥30 kg/m) or nonobese (body mass index <30 kg/m), and by response to CXRT: complete (pCR) or incomplete (pIR). Associations between obesity, tumor response, and sphincter preservation were evaluated using multivariate logistic regression analysis and survival outcomes by Cox regression.
RESULTS
A total of 753 patients met criteria and 28.7% (n=216) patients were obese. Obese and nonobese groups did not differ in age, sex, tumor location, grade, or number of examined lymph nodes. However, obesity was associated with a lower rate of pCR (ORmulti=0.60; 95% confidence interval, 0.38-0.94; P=0.04) and among mid to low rectal cancer patients, a lower rate of sphincter preservation (ORmulti=0.67; 95% confidence interval, 0.45-0.99). Among both obese and nonobese patients, CR was associated with more favorable recurrence-free survival than pIR.
CONCLUSIONS
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.
目的
肥胖是结直肠癌的主要健康问题和危险因素，可能还会影响癌症治疗及预后。直肠癌对放化疗（CXRT）的反应与长期生存及括约肌保留相关。本研究旨在评估肥胖对直肠癌新辅助CXRT治疗后疗效的影响。
方法
对1993年至2010年间诊断为cT3-4或cN+（通过直肠内超声、计算机断层扫描或磁共振成像）的直肠癌患者进行回顾性队列研究，这些患者接受了CXRT及全直肠系膜切除术治疗。患者分为肥胖组（体重指数≥30kg/m）或非肥胖组（体重指数<30kg/m），并根据对CXRT的反应分为完全缓解（pCR）或不完全缓解（pIR）。使用多因素逻辑回归分析评估肥胖、肿瘤反应和括约肌保留之间的关联，并通过Cox回归分析生存结局。
结果
共有753例患者符合标准，其中28.7%（n = 216）为肥胖患者。肥胖组和非肥胖组在年龄、性别、肿瘤位置、分级或检查的淋巴结数量方面无差异。然而，肥胖与较低的pCR率相关（多因素OR = 0.60；95%置信区间，0.38 - 0.94；P = 0.04），在中低位直肠癌患者中，肥胖与较低的括约肌保留率相关（多因素OR = 0.67；95%置信区间，0.45 - 0.99）。在肥胖和非肥胖患者中，CR均与比pIR更有利的无复发生存相关。
结论
鉴于肥胖患病率不断上升及其与CXRT反应、肿瘤学结局和括约肌保留的关联，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危险因素加以关注。
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