Song Hua-Chuan, Zhou Hang-Cheng, Gu Ping, Bao Bing, Sun Quan, Mei Tian-Ming, Cui Wei, Yao Kang, Yao Huan-Zhang, Zhang Shen-Yu, Wang Yong-Shuai, Song Rui-Peng, Wang Ji-Zhou
Department of General Surgery, Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, Anhui Province, China.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China.
World J Gastrointest Oncol. 2024 Feb 15;16(2):331-342. doi: 10.4251/wjgo.v16.i2.331.
Colorectal cancer is the third most prevalent malignancy globally and ranks second in cancer-related mortality, with the liver being the primary organ of metastasis. Preoperative chemotherapy is widely recommended for initially or potentially resectable colorectal liver metastases (CRLMs). Tumour pathological response serves as the most important and intuitive indicator for assessing the efficacy of chemotherapy. However, the postoperative pathological results reveal that a considerable number of patients exhibit a poor response to preoperative chemotherapy. Body mass index (BMI) is one of the factors affecting the tumorigenesis and progression of colorectal cancer as well as prognosis after various antitumour therapies. Several studies have indicated that overweight and obese patients with metastatic colorectal cancer experience worse prognoses than those with normal weight, particularly when receiving first-line chemotherapy regimens in combination with bevacizumab.
To explore the predictive value of BMI regarding the pathologic response following preoperative chemotherapy for CRLMs.
A retrospective analysis was performed in 126 consecutive patients with CRLM who underwent hepatectomy following preoperative chemotherapy at four different hospitals from October 2019 to July 2023. Univariate and multivariate logistic regression models were applied to analyse potential predictors of tumour pathological response. The Kaplan-Meier method with log rank test was used to compare progression-free survival (PFS) between patients with high and low BMI. BMI < 24.0 kg/m was defined as low BMI, and tumour regression grade 1-2 was defined as complete tumour response.
Low BMI was observed in 74 (58.7%) patients and complete tumour response was found in 27 (21.4%) patients. The rate of complete tumour response was significantly higher in patients with low BMI (29.7% 9.6%, = 0.007). Multivariate analysis revealed that low BMI [odds ratio (OR) = 4.56, 95% confidence interval (CI): 1.42-14.63, = 0.011], targeted therapy with bevacizumab (OR = 3.02, 95%CI: 1.10-8.33, = 0.033), preoperative carcinoembryonic antigen level < 10 ng/mL (OR = 3.84, 95%CI: 1.19-12.44, = 0.025) and severe sinusoidal dilatation (OR = 0.17, 95%CI: 0.03-0.90, = 0.037) were independent predictive factors for complete tumour response. The low BMI group exhibited a significantly longer median PFS than the high BMI group (10.7 mo 4.7 mo, = 0.011).
In CRLM patients receiving preoperative chemotherapy, a low BMI may be associated with better tumour response and longer PFS.
结直肠癌是全球第三大常见恶性肿瘤，在癌症相关死亡率中排名第二，肝脏是主要的转移器官。术前化疗被广泛推荐用于初始或潜在可切除的结直肠癌肝转移（CRLMs）。肿瘤病理反应是评估化疗疗效的最重要和直观的指标。然而，术后病理结果显示，相当数量的患者对术前化疗反应不佳。体重指数（BMI）是影响结直肠癌发生、发展以及各种抗肿瘤治疗后预后的因素之一。多项研究表明，转移性结直肠癌超重和肥胖患者的预后比体重正常者更差，尤其是在接受一线化疗方案联合贝伐单抗治疗时。
探讨BMI对CRLMs患者术前化疗后病理反应的预测价值。
对2019年10月至2023年7月在四家不同医院接受术前化疗后行肝切除术的126例连续CRLM患者进行回顾性分析。应用单因素和多因素逻辑回归模型分析肿瘤病理反应的潜在预测因素。采用Kaplan-Meier法和对数秩检验比较高BMI和低BMI患者的无进展生存期（PFS）。BMI<24.0 kg/m²定义为低BMI，肿瘤退缩分级1-2级定义为完全肿瘤反应。
74例（58.7%）患者BMI较低，27例（21.4%）患者出现完全肿瘤反应。低BMI患者的完全肿瘤反应率显著更高（29.7%对9.6%；P=0.007）。多因素分析显示，低BMI[比值比（OR）=4.56，95%置信区间（CI）：1.42-14.63，P=0.011]、贝伐单抗靶向治疗（OR=3.02,95%CI：1.10-8.33，P=0.033）、术前癌胚抗原水平<10 ng/mL（OR=3.84，95%CI：1.19-12.44，P=0.025）和严重的窦性扩张（OR=0.17，95%CI：0.03-0.90，P=0.037）是完全肿瘤反应的独立预测因素。低BMI组中位PFS显著长于高BMI组（10.7个月对4.7个月，P=0.011）。
在接受术前化疗的CRLM患者中，低BMI可能与更好的肿瘤反应和更长的PFS相关。
