title: High-BMI at diagnosis is associated with inferior survival in patients with osteosarcoma: a report from the Children's Oncology Group.
abstract: BACKGROUND
  Body mass index (BMI), at diagnosis has been associated with lower survival and increased toxicity in cancer patients. We analyzed the effect of BMI at diagnosis on therapy related toxicities and outcome in pediatric osteosarcoma patients treated on Children's Oncology Group (COG) trial INT0133.
  
  
  METHODS
  All patients enrolled on COG-INT0133 with height, weight and toxicity information were eligible. BMI was expressed as age and gender specific percentiles using height and weight at diagnosis. Patients were classified into high, normal and low BMI groups. Logistic regression models were used to analyze toxicities; Kaplan-Meier curves were created to assess event free (EFS) and overall survival (OAS).
  
  
  RESULTS
  Seven hundred and ten patients met eligibility criteria. BMI distribution was: 447 normal BMI, 74 low BMI, and 189 high BMI. Renal toxicity was higher in the high BMI group (OR = 2.7, 95% CI 1.2-6.4, P = = 0.01) only during one of the courses of therapy. Compared to the normal BMI group, patients with high BMI had significantly worse OAS at 5 years compared to those with normal BMI, 69.7% versus 80.5% (HR = 1.6, 95% CI 1.1-2.2, P = 0.005) and a trend towards worse event-free survival at 3 years 66.2% versus 75.5% (HR = 1.3 95% CI 0.9-1.8, P = 0.05). There was no difference in EFS or OAS in patients with low BMI compared to patients with normal BMI.
  
  
  CONCLUSIONS
  High BMI at diagnosis is associated with worse OAS in patients with osteosarcoma. No clinically significant differences in toxicity were observed in the various BMI groups.
authors: Mayo Clinic, Rochester, Minnesota.
authors: Sadaf
authors: S
authors: Altaf
authors: Felicity
authors: F
authors: Enders
authors: Elysia
authors: E
authors: Jeavons
authors: Mark
authors: M
authors: Krailo
authors: Donald A
authors: DA
authors: Barkauskas
authors: Paul
authors: P
authors: Meyers
authors: Carola
authors: C
authors: Arndt
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015992:Body Mass Index; D001859:Bone Neoplasms / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009765:Obesity / Q000150:complications* / Q000401:mortality; D019637:Orthopedic Procedures; D012516:Osteosarcoma / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult
keywords: chemotherapy; obesity; osteosarcoma; survival