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Joint Presence of Metabolic Syndrome and Obesity Seems to Be Associated With Poorer Survival in Early-Stage Colorectal Cancer

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Key Points

  • The co-presence of metabolic syndrome and obesity was associated with poorer overall survival in patients with early-stage colorectal cancer.
  • Nonsignificant increases in risk were observed for other groups vs nonobese patients without metabolic syndrome.

In a study in Kaiser Permanante patients reported in the Journal of Clinical Oncology, Cespedes Feliciano et al found that the joint presence of obesity and metabolic syndrome in those with early-stage colorectal cancer was associated with poorer overall and colorectal cancer–specific survival.

The study included 2,446 patients diagnosed with stage I to III disease from 2006 to 2011. Metabolic syndrome at diagnosis was defined as three or more of the following: fasting glucose level > 100 mg/dL or diabetes; elevated blood pressure (systolic ≥ 130 mm Hg, diastolic ≥ 85 mm Hg, or on antihypertensive medication); HDL (high-density lipoprotein) cholesterol level < 40 mg/dL in men or < 50 mg/dL in women; triglyceride level ≥ 150 mg/dL or on antilipid medication; and highest sex-specific quartile of visceral fat by computed tomography scan. Obesity was defined as a body mass index ≥ 30 kg/m2.

Associations With Survival

Patients had a mean age of 64 years. Over a median follow-up of 6 years, 601 patients died, 325 due to colorectal cancer. In analysis adjusting for demographic, tumor, and treatment factors and muscle mass at diagnosis, compared with nonobese patients without metabolic syndrome (n = 1,225), hazard ratios (HRs) for overall survival were 1.45 (95% confidence interval [CI] = 1.12–1.82) for obese patients with metabolic syndrome (n = 480), 1.09 (95% CI = 0.83–1.44) for nonobese patients with metabolic syndrome (n = 417), and 1.00 (95% CI = 0.80–1.26) for obese patients without metabolic syndrome (n = 324). Compared with nonobesity and no syndrome, hazard ratios for colorectal cancer–specific survival were 1.49 (95% CI = 1.09–2.02) for obese/with syndrome, 1.12 (95% CI = 0.82–1.52) for nonobese/with syndrome, and 1.20 (95% CI = 0.83–1.73) for obese/without syndrome. Mortality risk increased with the increasing number of metabolic syndrome components independent of obesity.

The investigators concluded: “Patients with early-stage [colorectal cancer] with obesity and [metabolic syndrome] have worse survival, overall and [colorectal cancer] related.”

The study was supported by the National Cancer Institute.

Elizabeth M. Cespedes Feliciano, ScD, of Kaiser Permanente Northern California, Oakland, California, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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