早期结直肠癌患者的代谢功能障碍、肥胖与生存情况
Metabolic Dysfunction, Obesity, and Survival Among Patients With Early-Stage Colorectal Cancer.
作者信息
Cespedes Feliciano Elizabeth M, Kroenke Candyce H, Meyerhardt Jeffrey A, Prado Carla M, Bradshaw Patrick T, Dannenberg Andrew J, Kwan Marilyn L, Xiao Jingjie, Quesenberry Charles, Weltzien Erin K, Castillo Adrienne L, Caan Bette J
机构信息
Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York.
出版信息
J Clin Oncol. 2016 Oct 20;34(30):3664-3671. doi: 10.1200/JCO.2016.67.4473.
PURPOSE
The effects of obesity and metabolic dysregulation on cancer survival are inconsistent. To identify high-risk subgroups of obese patients and to examine the joint association of metabolic syndrome (MetSyn) in combination with obesity, we categorized patients with early-stage (I to III) colorectal cancer (CRC) into four metabolic categories defined by the presence of MetSyn and/or obesity and examined associations with survival.
METHODS
We studied 2,446 patients diagnosed from 2006 to 2011 at Kaiser Permanente. We assumed MetSyn if patients had three or more of five components present at diagnosis: fasting glucose > 100 mg/dL or diabetes; elevated blood pressure (systolic ≥ 130 mm Hg, diastolic ≥ 85 mm Hg, or antihypertensives); HDL cholesterol < 40 mg/dL (men) or < 50 mg/dL (women); triglycerides ≥ 150 mg/dL or antilipids; and/or highest sex-specific quartile of visceral fat by computed tomography scan (in lieu of waist circumference). We then classified participants according to the presence (or absence) of MetSyn and obesity (BMI < 30 or ≥ 30 kg/m) and assessed associations with overall and CRC-related survival using Cox proportional hazards models adjusted for demographic, tumor, and treatment factors and muscle mass at diagnosis.
RESULTS
Over a median follow-up of 6 years, 601 patients died, 325 as a result of CRC. Mean (SD) age was 64 (11) years. Compared with the reference of nonobese patients without MetSyn (n = 1,225), for overall survival the hazard ratios (HR) and 95% CIs were 1.45 (1.12 to 1.82) for obese patients with MetSyn (n = 480); 1.09 (0.83 to 1.44) for the nonobese with MetSyn (n = 417), and 1.00 (0.80 to 1.26) for obese patients without MetSyn (n = 324). Obesity with MetSyn also predicted CRC-related survival: 1.49 (1.09 to 2.02). The hazard of death increased with the number of MetSyn components present, independent of obesity.
CONCLUSION
Patients with early-stage CRC with obesity and MetSyn have worse survival, overall and CRC related.
目的
肥胖和代谢失调对癌症生存的影响并不一致。为了确定肥胖患者的高危亚组，并研究代谢综合征（MetSyn）与肥胖的联合关联，我们将早期（I至III期）结直肠癌（CRC）患者根据是否存在MetSyn和/或肥胖分为四个代谢类别，并研究其与生存的关联。
方法
我们研究了2006年至2011年在凯撒医疗机构确诊的2446例患者。如果患者在诊断时存在五个组成部分中的三个或更多，则假定其患有MetSyn：空腹血糖>100mg/dL或糖尿病；血压升高（收缩压≥130mmHg，舒张压≥85mmHg，或服用抗高血压药）；高密度脂蛋白胆固醇<40mg/dL（男性）或<50mg/dL（女性）；甘油三酯≥150mg/dL或服用抗血脂药；和/或通过计算机断层扫描得出的内脏脂肪最高性别特异性四分位数（代替腰围）。然后，我们根据是否存在MetSyn和肥胖（BMI<30或≥30kg/m²）对参与者进行分类，并使用经人口统计学、肿瘤和治疗因素以及诊断时肌肉质量调整的Cox比例风险模型评估与总体生存和CRC相关生存的关联。
结果
在中位随访6年期间，601例患者死亡，其中325例死于CRC。平均（标准差）年龄为64（11）岁。与无MetSyn的非肥胖患者（n = 1225）参考组相比，对于总体生存，患有MetSyn的肥胖患者（n = 480）的风险比（HR）和95%置信区间为1.45（1.12至1.82）；患有MetSyn的非肥胖患者（n = 417）为1.09（0.83至1.44），无MetSyn的肥胖患者（n = 324）为1.00（0.80至1.26）。伴有MetSyn的肥胖也预示着与CRC相关的生存：1.49（1.09至2.02）。死亡风险随着存在的MetSyn组成部分数量的增加而增加，与肥胖无关。
结论
患有肥胖和MetSyn的早期CRC患者总体生存和与CRC相关的生存情况较差。
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