Kumar Shria, Blandon Catherine, Sikorskii Alla, Kaplan David E, Mehta Shivan J, Su Grace L, Goldberg David S, Crane Tracy E
Division of Digestive Health and Liver Diseases, Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL 33136, USA.
Sylvester Comprehensive Cancer Center, Miller School of Medicine at the University of Miami, Miami, FL 33136, USA.
Cancers (Basel). 2024 Aug 24;16(17):2950. doi: 10.3390/cancers16172950.
Prior studies are inconclusive regarding the effect of obesity on mortality in persons with colorectal cancer (CRC). We sought to determine the association of pre-diagnosis body mass index (BMI) trajectories on mortality after CRC diagnosis.
Utilizing the Multiethnic Cohort, we included adults aged 18-75 between 1 January 1993 and 1 January 2019 with a diagnosis of CRC and at least three available BMIs. The primary exposure, BMI, was subjected to group-based trajectory modeling (GBTM). We evaluated all-cause and CRC-specific mortality, using Cox proportional hazard (PH) models.
Of 924 persons, the median age was 60 years, and 54% were female. There was no statistically significant association between pre-cancer BMI trajectory and either all-cause or cancer-specific mortality. In competing risk analysis, the risk of CRC-specific mortality was higher for African Americans (HR = 1.56, 95% CI [1.00-2.43], = 0.048) and smokers (HR = 1.59, 95% CI [1.10-2.32], = 0.015). Risk of all-cause mortality was higher for Hawaiian persons (HR = 2.85, 95% CI [1.31-6.21], = 0.009) and persons with diabetes (HR = 1.83, 95% CI [1.08-3.10], = 0.026).
Pre-diagnosis BMI trajectories were not associated with mortality after CRC diagnosis, whereas race/ethnicity, diabetes, and smoking were associated with an increased risk of death. Our findings suggest the obesity paradox alone does not account for mortality after CRC diagnosis.
先前的研究对于肥胖对结直肠癌（CRC）患者死亡率的影响尚无定论。我们试图确定诊断前体重指数（BMI）轨迹与CRC诊断后死亡率之间的关联。
利用多民族队列研究，我们纳入了1993年1月1日至2019年1月1日期间年龄在18 - 75岁之间、被诊断为CRC且至少有三次可用BMI数据的成年人。主要暴露因素BMI采用基于群体的轨迹模型（GBTM）进行分析。我们使用Cox比例风险（PH）模型评估全因死亡率和CRC特异性死亡率。
在924名患者中，中位年龄为60岁，54%为女性。癌症前BMI轨迹与全因死亡率或癌症特异性死亡率之间均无统计学显著关联。在竞争风险分析中，非裔美国人（HR = 1.56，95% CI [1.00 - 2.43]，P = 0.048）和吸烟者（HR = 1.59，95% CI [1.10 - 2.32]，P = 0.015）的CRC特异性死亡风险更高。夏威夷人（HR = 2.85，95% CI [1.31 - 6.21]，P = 0.009）和糖尿病患者（HR = 1.83，95% CI [1.08 - 3.10]，P = 0.026）的全因死亡风险更高。
诊断前BMI轨迹与CRC诊断后的死亡率无关，而种族/民族、糖尿病和吸烟与死亡风险增加有关。我们的研究结果表明，仅肥胖悖论并不能解释CRC诊断后的死亡率。
