Tomohiro Adachi1, Takao Hinoi2, Yusuke Kinugawa3, Toshiyuki Enomoto4, Satoshi Maruyama5, Hajime Hirose6, Masanori Naito7, Keitaro Tanaka8, Yasuhiro Miyake9, Masahiko Watanabe10. 1. Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. adachitomohiro@hiroshima-u.ac.jp. 2. Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. 3. Department of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan. 4. Department of Surgery, Toho University, Ohashi Medical Center, Tokyo, Japan. 5. Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan. 6. Department of Surgery, Kinan Hospital, Wakayama, Japan. 7. Department of Surgery, Kitasato University, School of Medicine, Sagamihara, Kanagawa, Japan. 8. Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan. 9. Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyougo, Japan. 10. Department of Surgery, Kitasato University, School of Medicine, Japan Society of Laparoscopic Colorectal Surgery, Sagamihara, Kanagawa, Japan.
Abstract
BACKGROUND: High body mass index (BMI) is a risk factor for colorectal cancer. However, the prognostic impact of BMI and other factors may differ between elderly and younger colorectal cancer patients. We analyze here prognostic factors in the surgical management of octogenarians with colorectal cancer and clarify the prognostic impact of BMI. METHODS: Cox regression analysis and propensity score methods were used to retrospectively examine the association of BMI with mortality in 1613 octogenarian patients who underwent curative surgery for stage 0-III colorectal cancer. RESULTS: In the Cox regression analysis, lower BMI (<18.5 kg/m(2); p = 0.001), age ≥83 years (p = 0.008), American Society of Anesthesiology class ≥3: (p = 0.001), performance status ≥2 (p = 0.003), Union for International Cancer Control (UICC) stage ≥III (p = 0.001), and postoperative adverse events (p = 0.001) were independently associated with decreased overall survival. Lower BMI (p = 0.001) and UICC stage ≥III (p = 0.001) were independently associated with decreased cancer-specific survival. After covariate adjustment, lower BMI was a risk factor for overall [hazard ratio (HR) 1.62; 95 % confidence interval (CI) 1.26-2.05; p = 0.0004] and cancer-specific survival (HR 2.00; 95 % CI 1.39-2.87; p = 0.0038) compared with normal BMI (18.5-24.9 kg/m(2)). CONCLUSIONS: Lower BMI is significantly and independently associated with increased mortality risk in octogenarians who undergo curative surgery for colorectal cancer. Lower BMI should be used for prognosis assessment in octogenarians with colorectal cancer.
BACKGROUND: High body mass index (BMI) is a risk factor for colorectal cancer. However, the prognostic impact of BMI and other factors may differ between elderly and younger colorectal cancerpatients. We analyze here prognostic factors in the surgical management of octogenarians with colorectal cancer and clarify the prognostic impact of BMI. METHODS: Cox regression analysis and propensity score methods were used to retrospectively examine the association of BMI with mortality in 1613 octogenarian patients who underwent curative surgery for stage 0-III colorectal cancer. RESULTS: In the Cox regression analysis, lower BMI (<18.5 kg/m(2); p = 0.001), age ≥83 years (p = 0.008), American Society of Anesthesiology class ≥3: (p = 0.001), performance status ≥2 (p = 0.003), Union for International Cancer Control (UICC) stage ≥III (p = 0.001), and postoperative adverse events (p = 0.001) were independently associated with decreased overall survival. Lower BMI (p = 0.001) and UICC stage ≥III (p = 0.001) were independently associated with decreased cancer-specific survival. After covariate adjustment, lower BMI was a risk factor for overall [hazard ratio (HR) 1.62; 95 % confidence interval (CI) 1.26-2.05; p = 0.0004] and cancer-specific survival (HR 2.00; 95 % CI 1.39-2.87; p = 0.0038) compared with normal BMI (18.5-24.9 kg/m(2)). CONCLUSIONS: Lower BMI is significantly and independently associated with increased mortality risk in octogenarians who undergo curative surgery for colorectal cancer. Lower BMI should be used for prognosis assessment in octogenarians with colorectal cancer.
Entities:
Keywords:
Body mass index; Cancer-specific survival; Colorectal cancer; Octogenarian; Prognosis
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