title: Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy.
abstract: BACKGROUND
  Although obesity is an established risk factor for developing colon cancer, its prognostic impact and relation to patient sex in colon cancer survivors remains unclear.
  
  
  METHODS
  The authors examined the prognostic and predictive impact of the body mass index (BMI) in patients with stage II and III colon carcinoma (N = 25,291) within the Adjuvant Colon Cancer Endpoints (ACCENT) database. BMI was measured at enrollment in randomized trials of 5-fluorouracil-based adjuvant chemotherapy. Association of BMI with the time to recurrence (TTR), disease-free survival (DFS), and overall survival (OS) were determined using Cox regression models. Statistical tests were 2-sided.
  
  
  RESULTS
  During a median follow-up of 7.8 years, obese and underweight patients had significantly poorer survival compared with overweight and normal-weight patients. In a multivariable analysis, the adverse prognostic impact of BMI was observed among men but not among women (Pinteraction = .0129). Men with class 2 and 3 obesity (BMI ≥ 35.0 kg/m(2) ) had a statistically significant reduction in DFS (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.01-1.33; P = .0297) compared with normal-weight patients. Underweight patients had a significantly shorter TTR and reduced DFS (HR, 1.18; 95% CI, 1.09-1.28; P < .0001) that was more significant among men (HR, 1.31; 95% CI, 1.15-1.50; P < .0001) than among women (HR, 1.11; 95% CI, 1.01-1.23; P = .0362; Pinteraction = .0340). BMI was not predictive of a benefit from adjuvant treatment.
  
  
  CONCLUSIONS
  Obesity and underweight status were associated independently with inferior outcomes in patients with colon cancer who received treatment in adjuvant chemotherapy trials.
authors: Division of Oncology, Mayo Clinic and North Central Cancer Treatment Group, Rochester, Minnesota, USA. sinicrope.frank@mayo.edu
authors: Frank A
authors: FA
authors: Sinicrope
authors: Nathan R
authors: NR
authors: Foster
authors: Greg
authors: G
authors: Yothers
authors: Al
authors: A
authors: Benson
authors: Jean Francois
authors: JF
authors: Seitz
authors: Roberto
authors: R
authors: Labianca
authors: Richard M
authors: RM
authors: Goldberg
authors: Aimery
authors: A
authors: Degramont
authors: Michael J
authors: MJ
authors: O'Connell
authors: Daniel J
authors: DJ
authors: Sargent
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015992:Body Mass Index; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009656:North America / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis; D013851:Thinness / Q000453:epidemiology
chemical_list: D005472:Fluorouracil