Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Eur J Cancer. 2022 Sep;172:237-251. doi: 10.1016/j.ejca.2022.05.020. Epub 2022 Jul 5.
The impact of body mass index (BMI) on long-term survival outcomes after colorectal cancer surgery is debated.
A systematic literature review and meta-analysis was performed to compare long-term survival outcomes of patients of different BMI categories after colorectal cancer surgery.
Of the 2588 articles screened, 56 articles met the inclusion criteria, reporting on 72,582 participants. Patients with BMI <18.5 had significantly worse overall survival [hazard ratio (HR) 1.91; P < 0.0001], cancer-specific survival (HR = 1.91; P < 0.0001), disease-free survival (HR = 1.50; P < 0.0001) and recurrence-free survival (HR = 1.13; P = 0.007) compared to patients with a BMI of 18.5-25. There was no significant difference between those with BMI 25-30 and 18.5-25 in overall survival, cancer-specific survival, disease-free survival and recurrence-free survival, except for the subgroup of patients with colon cancer where patients with BMI 25-30 had significantly improved overall survival (HR = 0.90; P = 0.05) and disease-free survival (HR = 0.90; P = 0.04). Patients with BMI >30 had significantly worse disease-free survival (HR = 1.05; P = 0.03) compared to patients with a BMI of 18.5-25, but no significant difference in overall survival, cancer-specific survival and recurrence-free survival. Patients with BMI >35 compared to 18.5-25 had significantly worse overall survival (HR = 1.24; P = 0.02), cancer-specific survival (HR = 1.36; P = 0.01), disease-free survival (HR = 1.15; P = 0.03) and recurrence-free survival for colon (HR = 1.11; P = 0.04) and rectal (HR = 4.10; P = 0.04) cancer.
Being underweight (BMI < 18.5) or class II/III obese (BMI > 35) at the time of colorectal cancer surgery may result in worse long-term survival outcomes, whereas being overweight (BMI 25-30) may improve survival in a subgroup of patients with colon cancer. Optimising BMI may preoperatively improve long-term survival after surgery for colorectal cancer.
体质量指数（BMI）对结直肠癌手术后长期生存结局的影响存在争议。
对不同 BMI 类别患者的结直肠癌手术后长期生存结局进行比较，开展了系统文献复习和荟萃分析。
在筛选出的 2588 篇文章中，有 56 篇符合纳入标准，报告了 72582 名参与者。BMI＜18.5 的患者总生存[风险比（HR）1.91；P＜0.0001]、癌症特异性生存（HR 1.91；P＜0.0001）、无病生存（HR 1.50；P＜0.0001）和无复发生存（HR 1.13；P=0.007）明显更差，与 BMI 为 18.5-25 的患者相比。BMI 为 25-30 的患者与 BMI 为 18.5-25 的患者相比，在总生存、癌症特异性生存、无病生存和无复发生存方面没有显著差异，但在结肠癌亚组中，BMI 为 25-30 的患者的总生存（HR 0.90；P=0.05）和无病生存（HR 0.90；P=0.04）明显改善。BMI＞30 的患者无病生存（HR 1.05；P=0.03）明显更差，与 BMI 为 18.5-25 的患者相比，但总生存、癌症特异性生存和无复发生存没有显著差异。BMI＞35 的患者与 BMI 为 18.5-25 的患者相比，总生存（HR 1.24；P=0.02）、癌症特异性生存（HR 1.36；P=0.01）、无病生存（HR 1.15；P=0.03）和无复发生存（colon，HR 1.11；P=0.04）和直肠（HR 4.10；P=0.04）癌明显更差。
结直肠癌手术时体重过轻（BMI＜18.5）或 II/III 度肥胖（BMI＞35）可能导致长期生存结局较差，而超重（BMI 25-30）可能改善结肠癌亚组患者的生存。优化 BMI 可能会术前改善结直肠癌手术后的长期生存。
