TY - JOUR

T1 - Impact of cumulative body mass index and cardiometabolic diseases on survival among patients with colorectal and breast cancer

T2 - a multi-centre cohort study

AU - Kohls, Mirjam

AU - Freisling, Heinz

AU - Charvat, Hadrien

AU - Soerjomataram, Isabelle

AU - Viallon, Vivian

AU - Davila-Batista, Veronica

AU - Kaaks, Rudolf

AU - Turzanski-Fortner, Renée

AU - Aleksandrova, Krasimira

AU - Schulze, Matthias B

AU - Dahm, Christina C

AU - Tilma Vistisen, Helene

AU - Rostgaard-Hansen, Agnetha Linn

AU - Tjønneland, Anne

AU - Bonet, Catalina

AU - Sánchez, Maria-Jose

AU - Colorado-Yohar, Sandra

AU - Masala, Giovanna

AU - Palli, Domenico

AU - Krogh, Vittorio

AU - Ricceri, Fulvio

AU - Rolandsson, Olov

AU - Lu, Sai San Moon

AU - Tsilidis, Konstantinos K

AU - Weiderpass, Elisabete

AU - Gunter, Marc J

AU - Ferrari, Pietro

AU - Berger, Ursula

AU - Arnold, Melina

N1 - © 2022. The Author(s).

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

KW - Adult

KW - Body Mass Index

KW - Breast Neoplasms/complications

KW - Cardiovascular Diseases/epidemiology

KW - Cohort Studies

KW - Colorectal Neoplasms

KW - Diabetes Mellitus, Type 2/complications

KW - Female

KW - Humans

KW - Middle Aged

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Risk Factors

KW - Young Adult

U2 - 10.1186/s12885-022-09589-y

DO - 10.1186/s12885-022-09589-y

M3 - Journal article

C2 - 35568802

VL - 22

JO - B M C Cancer

JF - B M C Cancer

SN - 1471-2407

IS - 1

M1 - 546

ER -