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Erschienen in: International Journal of Colorectal Disease 12/2012

01.12.2012 | Original Article

Does body mass index impact the number of LNs harvested and influence long-term survival rate in patients with stage III colon cancer?

verfasst von: Yi-Hung Kuo, Kam-Fai Lee, Chih-Chien Chin, Wen-Shih Huang, Chung-Hung Yeh, Jeng-Yi Wang

Erschienen in: International Journal of Colorectal Disease | Ausgabe 12/2012

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Abstract

Background

The aim of this study is to evaluate whether different body mass index (BMI) values affect lymph node (LN) retrieval and whether such variations influence long–term survival in Asian patients.

Method

From January 1995 to July 2003, 645 stage III colon cancer patients were enrolled in our study. Patients were stratified into four groups: Obese (BMI ≧ 27 kg/m2), overweight (24 ≤ BMI < 27 kg/m2), normal (18.5 ≤ BMI < 24 kg/m2), and underweight (BMI < 18.5 kg/m2).

Results

Mean BMI in the cohort was 23.3 kg/m2. Mean number of LNs harvested was 23.1, 19.5, 19.8 and 28.1 in the normal, overweight, obese and underweight groups, respectively. There was a significant difference in the mean number of LNs harvested when comparing the overweight and underweight groups to the normal group (p = 0.013 and p = 0.04, respectively). Females were overrepresented in the underweight group (p = 0.011), and patients who had proximal colon cancers were more frequently underweight (p = 0.018). The mean number of LNs harvested varied by cases of right hemicolectomy (p = 0.009) and proximal cancer location (p = 0.009) for different BMI groups. Multivariate analysis showed that underweight, proximal colon cancer, well- or moderately differentiated adenocarcinoma and stage IIIC cancer were significant variables for adequate LN recovery. BMI was not significantly associated with relapse-free survival (p = 0.523) or overall survival (p = 0.127).

Conclusion

BMI is associated with LN harvest but is not an independent variable in stage III colon cancer survival.
Literatur
1.
Zurück zum Zitat Chang GJ, Rodriguez-Bigas MA, Skibber JM et al (2007) LN evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441PubMedCrossRef Chang GJ, Rodriguez-Bigas MA, Skibber JM et al (2007) LN evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441PubMedCrossRef
2.
Zurück zum Zitat Goldstein NS (2002) LN recoveries from 2,427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered LNs based on predictive probabilities. Am J Surg Pathol 26:179–189PubMedCrossRef Goldstein NS (2002) LN recoveries from 2,427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered LNs based on predictive probabilities. Am J Surg Pathol 26:179–189PubMedCrossRef
3.
Zurück zum Zitat Chen HH, Chakravarty KD, Wang JY et al (2010) Pathological examination of 12 regional LNs and long-term survival in stage I-III colon cancer patients: an analysis of 2056 consecutive patients in two branches of same institution. Int J Colorectal Dis 25:1333–1341PubMedCrossRef Chen HH, Chakravarty KD, Wang JY et al (2010) Pathological examination of 12 regional LNs and long-term survival in stage I-III colon cancer patients: an analysis of 2056 consecutive patients in two branches of same institution. Int J Colorectal Dis 25:1333–1341PubMedCrossRef
4.
Zurück zum Zitat Nelson H, Petrelli N, Carlin A et al (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596PubMedCrossRef Nelson H, Petrelli N, Carlin A et al (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596PubMedCrossRef
5.
Zurück zum Zitat Ostadi MA, Harnish JL, Stegienko S et al (2007) Factors affecting the number of LNs retrieved in colorectal cancer specimens. Surg Endosc 21:2142–2146PubMedCrossRef Ostadi MA, Harnish JL, Stegienko S et al (2007) Factors affecting the number of LNs retrieved in colorectal cancer specimens. Surg Endosc 21:2142–2146PubMedCrossRef
6.
Zurück zum Zitat Baxter NN, Virnig DJ, Rothenberger DA et al (2005) LN evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97:219–225PubMedCrossRef Baxter NN, Virnig DJ, Rothenberger DA et al (2005) LN evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97:219–225PubMedCrossRef
7.
Zurück zum Zitat Maurel J, Launoy G, Grosclaude P et al (1998) LN harvest reporting in patients with carcinoma of the large bowel. Cancer 82:1482–1486PubMedCrossRef Maurel J, Launoy G, Grosclaude P et al (1998) LN harvest reporting in patients with carcinoma of the large bowel. Cancer 82:1482–1486PubMedCrossRef
8.
Zurück zum Zitat Scott KWM, Grace RH (1989) Detection of LN metastases in colorectal carcinoma before and after fat clearance. Br J Surg 76:1165–1167PubMedCrossRef Scott KWM, Grace RH (1989) Detection of LN metastases in colorectal carcinoma before and after fat clearance. Br J Surg 76:1165–1167PubMedCrossRef
9.
Zurück zum Zitat Dhar DK, Kubota H, Tachibana M et al (2000) Body mass index determines the success of LN dissection and predicts the outcome of gastric carcinoma patients. Oncol 59:18–23CrossRef Dhar DK, Kubota H, Tachibana M et al (2000) Body mass index determines the success of LN dissection and predicts the outcome of gastric carcinoma patients. Oncol 59:18–23CrossRef
10.
Zurück zum Zitat Linebarger JH, Mathiason MA, Kallies KJ et al (2010) Does obesity impact LN retrieval in colon cancer surgery? Am J Surg 200:478–482PubMedCrossRef Linebarger JH, Mathiason MA, Kallies KJ et al (2010) Does obesity impact LN retrieval in colon cancer surgery? Am J Surg 200:478–482PubMedCrossRef
11.
Zurück zum Zitat Damadi AA, Julien L, Arrangoiz R et al (2008) Does obesity influence LN harvest among patients undergoing colectomy for colon cancer? Am Surg 74:1073–1077PubMed Damadi AA, Julien L, Arrangoiz R et al (2008) Does obesity influence LN harvest among patients undergoing colectomy for colon cancer? Am Surg 74:1073–1077PubMed
12.
Zurück zum Zitat Pimiento JM, Cristancho MA, Aboulhosn K et al (2006) Does body mass index affect LN retrieval in colon resection for cancer? J Clin Oncol 24:13571 Pimiento JM, Cristancho MA, Aboulhosn K et al (2006) Does body mass index affect LN retrieval in colon resection for cancer? J Clin Oncol 24:13571
13.
Zurück zum Zitat Shibakita M, Yoshimura H, Tachibana M et al (2010) Body mass index influences long term outcome in patients with colorectal cancer. Hepatogastroenterology 57:62–69PubMed Shibakita M, Yoshimura H, Tachibana M et al (2010) Body mass index influences long term outcome in patients with colorectal cancer. Hepatogastroenterology 57:62–69PubMed
14.
Zurück zum Zitat Görög D, Nagy P, Péter A et al (2003) Influence of obesity on LN recovery from rectal resection specimens. Pathol Oncol Res 9:180–183PubMedCrossRef Görög D, Nagy P, Péter A et al (2003) Influence of obesity on LN recovery from rectal resection specimens. Pathol Oncol Res 9:180–183PubMedCrossRef
15.
Zurück zum Zitat AJCC (2002) AJCC cancer staging manual, 6th edn. Springer, New York AJCC (2002) AJCC cancer staging manual, 6th edn. Springer, New York
17.
Zurück zum Zitat Larsson SC, Rutegard J, Bergkvist L et al (2006) Physical activity, obesity, and risk of colon and rectal cancer in a cohort of Swedish men. Eur J Cancer 42:2590–2597PubMedCrossRef Larsson SC, Rutegard J, Bergkvist L et al (2006) Physical activity, obesity, and risk of colon and rectal cancer in a cohort of Swedish men. Eur J Cancer 42:2590–2597PubMedCrossRef
18.
Zurück zum Zitat Pischon T, Lahmann PH, Boeing H et al (2006) Body size and risk of colon and rectal cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst 98:920–931PubMedCrossRef Pischon T, Lahmann PH, Boeing H et al (2006) Body size and risk of colon and rectal cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst 98:920–931PubMedCrossRef
19.
Zurück zum Zitat Calle EE, Rodriguez C, Walker-Thurmond K et al (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638PubMedCrossRef Calle EE, Rodriguez C, Walker-Thurmond K et al (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638PubMedCrossRef
20.
Zurück zum Zitat Murphy TK, Calle EE, Rodriguez C et al (2000) Body mass index and colon cancer mortality in a large prospective study. Am J Epidemiol 152:847–854PubMedCrossRef Murphy TK, Calle EE, Rodriguez C et al (2000) Body mass index and colon cancer mortality in a large prospective study. Am J Epidemiol 152:847–854PubMedCrossRef
21.
Zurück zum Zitat Matsuo K, Mizuoe T, Tanaka K et al (2011) Association between body mass index and the colorectal cancer risk in Japan: pooled analysis of population-based cohort studies in Japan. Ann Oncol 23(2):479–90PubMedCrossRef Matsuo K, Mizuoe T, Tanaka K et al (2011) Association between body mass index and the colorectal cancer risk in Japan: pooled analysis of population-based cohort studies in Japan. Ann Oncol 23(2):479–90PubMedCrossRef
22.
Zurück zum Zitat Ma J, Giovannucci E, Pollak M et al (2004) A prospective study of plasma C-peptide and colorectal cancer risk in men. J Natl Cancer Inst 96:546–553PubMedCrossRef Ma J, Giovannucci E, Pollak M et al (2004) A prospective study of plasma C-peptide and colorectal cancer risk in men. J Natl Cancer Inst 96:546–553PubMedCrossRef
23.
Zurück zum Zitat Giovannucci E (2007) Metabolic syndrome, hyperinsulinemia, and colon cancer: a review. Am J Clin Nutr 86:s836–s842PubMed Giovannucci E (2007) Metabolic syndrome, hyperinsulinemia, and colon cancer: a review. Am J Clin Nutr 86:s836–s842PubMed
24.
Zurück zum Zitat Wolpin BM, Meyerhardt JA, Chan AT et al (2009) Insulin, the insulin-like growth factor axis, and mortality in patients with nonmetastatic colorectal cancer. J Clin Oncol 27:176–185PubMedCrossRef Wolpin BM, Meyerhardt JA, Chan AT et al (2009) Insulin, the insulin-like growth factor axis, and mortality in patients with nonmetastatic colorectal cancer. J Clin Oncol 27:176–185PubMedCrossRef
25.
Zurück zum Zitat Meyerhardt JA, Niedzwiecki D, Hollis D et al (2008) Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from Cancer and Leukemia Group B 89803. J Clin Oncol 26:4109–4115PubMedCrossRef Meyerhardt JA, Niedzwiecki D, Hollis D et al (2008) Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from Cancer and Leukemia Group B 89803. J Clin Oncol 26:4109–4115PubMedCrossRef
26.
Zurück zum Zitat Sinicrope FA, Foster NR, Sargent DJ et al (2010) Obesity is an independent prognostic variable in colon cancer survivors. Clin Cancer Res 16:1884–1893PubMedCrossRef Sinicrope FA, Foster NR, Sargent DJ et al (2010) Obesity is an independent prognostic variable in colon cancer survivors. Clin Cancer Res 16:1884–1893PubMedCrossRef
27.
Zurück zum Zitat Lavie CJ, Milani RV, Ventura HO (2009) Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 53:1925–1932PubMedCrossRef Lavie CJ, Milani RV, Ventura HO (2009) Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 53:1925–1932PubMedCrossRef
28.
Zurück zum Zitat Horwich TB, Fonarow GC, Hamilton MA et al (2001) The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardio 38:789–795CrossRef Horwich TB, Fonarow GC, Hamilton MA et al (2001) The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardio 38:789–795CrossRef
29.
Zurück zum Zitat Stein PD, Matta F, Goldman J (2011) Obesity and pulmonary embolism: the mounting evidence of risk and mortality paradox. Thromb Res 128:518–523PubMedCrossRef Stein PD, Matta F, Goldman J (2011) Obesity and pulmonary embolism: the mounting evidence of risk and mortality paradox. Thromb Res 128:518–523PubMedCrossRef
30.
Zurück zum Zitat Flegal KM, Graubard BI, Williamson DF et al (2007) Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 298:2028–2037PubMedCrossRef Flegal KM, Graubard BI, Williamson DF et al (2007) Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 298:2028–2037PubMedCrossRef
31.
Zurück zum Zitat Orpana HM, Berthelot JM, Kaplan MS et al (2010) BMI and mortality: results from a national longitudinal study of Canadian adults. Obesity 18:214–218PubMedCrossRef Orpana HM, Berthelot JM, Kaplan MS et al (2010) BMI and mortality: results from a national longitudinal study of Canadian adults. Obesity 18:214–218PubMedCrossRef
32.
Zurück zum Zitat Kent AJ, Woolf D, McCue J et al (2010) The use of symptoms to predict colorectal cancer site. Can we reduce the pressure on our endoscopy services? Colorectal Dis 12:114–118PubMedCrossRef Kent AJ, Woolf D, McCue J et al (2010) The use of symptoms to predict colorectal cancer site. Can we reduce the pressure on our endoscopy services? Colorectal Dis 12:114–118PubMedCrossRef
33.
Zurück zum Zitat Healy LA, Ryan AM, Sutton E et al (2010) Impact of obesity on surgical and oncological outcomes in the management of colorectal cancer. Int J Colorectal Dis 25:1293–1299PubMedCrossRef Healy LA, Ryan AM, Sutton E et al (2010) Impact of obesity on surgical and oncological outcomes in the management of colorectal cancer. Int J Colorectal Dis 25:1293–1299PubMedCrossRef
34.
Zurück zum Zitat Le Voyer TE, Sigurdson ER, Hanlon AL et al (2003) Colon cancer survival is associated with increasing number of LNs analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21:2912–2919PubMedCrossRef Le Voyer TE, Sigurdson ER, Hanlon AL et al (2003) Colon cancer survival is associated with increasing number of LNs analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21:2912–2919PubMedCrossRef
35.
Zurück zum Zitat Prandi M, Lionetto R, Bini A et al (2002) Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg 235:458–463PubMedCrossRef Prandi M, Lionetto R, Bini A et al (2002) Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg 235:458–463PubMedCrossRef
36.
Zurück zum Zitat Kelder W, Inberg B, Schaapveld M et al (2009) Impact of the number of histologically examined LNs on prognosis in colon cancer: a population-based study in the Netherlands. Dis Colon Rectum 52:260–267PubMedCrossRef Kelder W, Inberg B, Schaapveld M et al (2009) Impact of the number of histologically examined LNs on prognosis in colon cancer: a population-based study in the Netherlands. Dis Colon Rectum 52:260–267PubMedCrossRef
37.
Zurück zum Zitat Sarli L, Bader G, Iusco D et al (2005) Number of LNs examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer 41:272–279PubMedCrossRef Sarli L, Bader G, Iusco D et al (2005) Number of LNs examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer 41:272–279PubMedCrossRef
38.
Zurück zum Zitat Bilimoria KY, Palis B, Stewart AK et al (2008) Impact of tumor location on nodal evaluation for colon cancer. Dis Colon Rectum 51:154–161PubMedCrossRef Bilimoria KY, Palis B, Stewart AK et al (2008) Impact of tumor location on nodal evaluation for colon cancer. Dis Colon Rectum 51:154–161PubMedCrossRef
39.
Zurück zum Zitat WHO (1995) Physical status: the use and interpretation of anthropometry. World Health Organization technical report series. WHO, Geneva, pp 1–47 WHO (1995) Physical status: the use and interpretation of anthropometry. World Health Organization technical report series. WHO, Geneva, pp 1–47
40.
Zurück zum Zitat Reese JA, Hall C, Bowles K et al (2009) Colorectal surgical specimen lymph node harvest: improvement of lymph node yield with a pathology assistant. J Gastrointest Surg 13:1459–1463PubMedCrossRef Reese JA, Hall C, Bowles K et al (2009) Colorectal surgical specimen lymph node harvest: improvement of lymph node yield with a pathology assistant. J Gastrointest Surg 13:1459–1463PubMedCrossRef
41.
Zurück zum Zitat Jakub JW, Russell G, Tillman CL et al (2009) Colon cancer and low lymph node count: who is to blame? Arch Surg 144:1115–1120PubMedCrossRef Jakub JW, Russell G, Tillman CL et al (2009) Colon cancer and low lymph node count: who is to blame? Arch Surg 144:1115–1120PubMedCrossRef
Metadaten
Titel
Does body mass index impact the number of LNs harvested and influence long-term survival rate in patients with stage III colon cancer?
verfasst von
Yi-Hung Kuo
Kam-Fai Lee
Chih-Chien Chin
Wen-Shih Huang
Chung-Hung Yeh
Jeng-Yi Wang
Publikationsdatum
01.12.2012
Verlag
Springer-Verlag
Erschienen in
International Journal of Colorectal Disease / Ausgabe 12/2012
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-012-1496-5

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