Impact of cumulative body mass index and cardiometabolic diseases on survival among patients with colorectal and breast cancer: a multi‑centre cohort study
Metadatos
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BMC
Materia
Body mass index Breast cancer Colorectal cancer Cardiovascular disease Diabetes Comorbidity Cumulative exposure Survival Cohort study
Fecha
2022-05-14Referencia bibliográfica
Kohls, M... [et al.]. Impact of cumulative body mass index and cardiometabolic diseases on survival among patients with colorectal and breast cancer: a multi-centre cohort study. BMC Cancer 22, 546 (2022). [https://doi.org/10.1186/s12885-022-09589-y]
Patrocinador
European Commission European Commission Joint Research Centre; International Agency for Research on Cancer; Danish Cancer Society; Deutsche Krebshilfe; Helmholtz Association; Federal Ministry of Education & Research (BMBF); Deutsche Krebshilfe Deutsches Krebsforschungszentrum; Federal Ministry of Education & Research (BMBF); Fondazione AIRC per la ricerca sul cancro; Instituto de Salud Carlos III PI13/00061 PI13/01162; Regional Governments of Andalucia, Asturias; Basque Government Murcia and Navarra Catalan Institute of Oncology (Spain); Wereld Kanker Onderzoek Fonds (WKOF); World Cancer Research Fund International grant programme IIG_2016_1636; World Cancer Research Fund (WCRF UK), World Cancer Research Fund International grant programme IIG_2019_1978; Institut National du Cancer (INCA) France 2020-087Resumen
Background: Body mass index (BMI) and cardiometabolic comorbidities such as cardiovascular disease and type
2 diabetes have been studied as negative prognostic factors in cancer survival, but possible dependencies in the
mechanisms underlying these associations remain largely unexplored. We analysed these associations in colorectal
and breast cancer patients.
Methods: Based on repeated BMI assessments of cancer-free participants from four European countries in the European
Prospective Investigation into Cancer and nutrition (EPIC) study, individual BMI-trajectories reflecting predicted
mean BMI between ages 20 to 50 years were estimated using a growth curve model. Participants with incident colorectal
or breast cancer after the age of 50 years were included in the survival analysis to study the prognostic effect of
mean BMI and cardiometabolic diseases (CMD) prior to cancer. CMD were defined as one or more chronic conditions
among stroke, myocardial infarction, and type 2 diabetes. Hazard ratios (HRs) and confidence intervals (CIs) of mean
BMI and CMD were derived using multivariable-adjusted Cox proportional hazard regression for mean BMI and CMD
separately and both exposures combined, in subgroups of localised and advanced disease. Results: In the total cohort of 159,045 participants, there were 1,045 and 1,620 eligible patients of colorectal and
breast cancer. In colorectal cancer patients, a higher BMI (by 1 kg/m2) was associated with a 6% increase in risk of
death (95% CI of HR: 1.02–1.10). The HR for CMD was 1.25 (95% CI: 0.97–1.61). The associations for both exposures
were stronger in patients with localised colorectal cancer. In breast cancer patients, a higher BMI was associated with
a 4% increase in risk of death (95% CI: 1.00–1.08). CMDs were associated with a 46% increase in risk of death (95% CI:
1.01–2.09). The estimates and CIs for BMI remained similar after adjustment for CMD and vice versa.
Conclusions: Our results suggest that cumulative exposure to higher BMI during early to mid-adulthood was associated
with poorer survival in patients with breast and colorectal cancer, independent of CMD prior to cancer diagnosis.
The association between a CMD diagnosis prior to cancer and survival in patients with breast and colorectal cancer
was independent of BMI.