Visceral Adiposity is a Risk Factor for Poor Prognosis in Colorectal Cancer Patients Receiving Adjuvant Chemotherapy

Studies utilizing body mass index (BMI) have failed to show a consistent relationship between obesity and survival following treatment for colorectal cancer (CRC). Computerized tomography (CT) offers a reliable alternative approach to quantify body adiposity. We hypothesized that visceral obesity may negatively impact survival in CRC patients.

A retrospective review of CRC patients who received adjuvant chemotherapy at a single center during the period 2006–2009 identified from a prospectively maintained database. Visceral adiposity was determined by measuring visceral fat area (VFA) on preoperative staging CT. All patients were followed up to study completion or death.

Sixty-two CRC patients with a mean age of 63.2 years received adjuvant chemotherapy and had imaging available for analysis. Thirty-five patients (56.5 %) had node positive disease. Thirty-one patients (50 %) were classified viscerally obese based on staging CT. 85.4 % of the patients completed adjuvant chemotherapy and visceral obesity was not associated with increased toxicity or failure to complete treatment. After a median follow-up of 65.2 months, patients with visceral obesity had a significantly lower overall survival (OS) (54.8 % vs 87.1 %, p = 0.004) and disease-free survival (DFS) (48.4 vs 77.4 %, p = 0.007) compared with patients without visceral obesity. There was no relationship between BMI and survival. Multivariate analysis using Cox proportional hazards model showed that visceral obesity was independently associated with reduced OS (Hazard ratio = 7.0; 95 % CI 2.0–24.6; p = 0.002).

This study shows that visceral obesity increases the likelihood of a poor prognosis in CRC patients receiving adjuvant chemotherapy thus underlying the value of lifestyle interventions to minimize visceral obesity in this patient cohort.