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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2024; 16(2): 331-342
Published online Feb 15, 2024. doi: 10.4251/wjgo.v16.i2.331
Tumour response following preoperative chemotherapy is affected by body mass index in patients with colorectal liver metastases
Hua-Chuan Song, Hang-Cheng Zhou, Ping Gu, Bing Bao, Quan Sun, Tian-Ming Mei, Wei Cui, Kang Yao, Huan-Zhang Yao, Shen-Yu Zhang, Yong-Shuai Wang, Rui-Peng Song, Ji-Zhou Wang
Hua-Chuan Song, Huan-Zhang Yao, Ji-Zhou Wang, Department of General Surgery, Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, Anhui Province, China
Hua-Chuan Song, Shen-Yu Zhang, Yong-Shuai Wang, Rui-Peng Song, Ji-Zhou Wang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Hang-Cheng Zhou, Ping Gu, Department of Pathology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Bing Bao, Department of Gastrointestinal Surgery, Tongcheng People’s Hospital, Tongcheng 231400, Anhui Province, China
Quan Sun, Tian-Ming Mei, Department of Gastrointestinal Surgery, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
Wei Cui, Kang Yao, Department of General Surgery, Xuancheng People’s Hospital, Xuancheng 242000, Anhui Province, China
Co-first authors: Hua-Chuan Song and Hang-Cheng Zhou.
Author contributions: Song HC and Zhou HC contributed equally to this work; Song HC, Zhou HC, Song RP, and Wang JZ designed the research study; Song HC, Bao B, Sun Q, Mei TM, Yao K, Cui W, and Yao HZ performed the research and collected the data; Zhou HC and Gu P assessed the pathological section; Song HC, Zhang SY, and Wang YS analysed and interpreted data; Song HC and Zhou HC wrote the manuscript; Song RP and Wang JZ revised and proofed the manuscript; and all authors have read and approve the final manuscript.
Supported by National Natural Science Foundation of China, No. 82170618.
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of University of Science and Technology of China Institutional Review Board (Approval No. 2023KY-323).
Clinical trial registration statement: This study is registered at Medical Research Registration and Filing Information System of China (
www.medicalresearch.org.cn), Filing number is MR 34 23 043810.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data and materials are available from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ji-Zhou Wang, PhD, Chief, Professor, Department of General Surgery, Provincial Hospital Affiliated to Anhui Medical University, No. 218 Jixi Road, Shushan District, Hefei 230001, Anhui Province, China. wangjoe@ustc.edu.cn
Received: October 17, 2023
Peer-review started: October 17, 2023
First decision: November 16, 2023
Revised: December 5, 2023
Accepted: December 25, 2023
Article in press: December 25, 2023
Published online: February 15, 2024
BACKGROUND
Colorectal cancer is the third most prevalent malignancy globally and ranks second in cancer-related mortality, with the liver being the primary organ of metastasis. Preoperative chemotherapy is widely recommended for initially or potentially resectable colorectal liver metastases (CRLMs). Tumour pathological response serves as the most important and intuitive indicator for assessing the efficacy of chemotherapy. However, the postoperative pathological results reveal that a considerable number of patients exhibit a poor response to preoperative chemotherapy. Body mass index (BMI) is one of the factors affecting the tumorigenesis and progression of colorectal cancer as well as prognosis after various antitumour therapies. Several studies have indicated that overweight and obese patients with metastatic colorectal cancer experience worse prognoses than those with normal weight, particularly when receiving first-line chemotherapy regimens in combination with bevacizumab.
AIM
To explore the predictive value of BMI regarding the pathologic response following preoperative chemotherapy for CRLMs.
METHODS
A retrospective analysis was performed in 126 consecutive patients with CRLM who underwent hepatectomy following preoperative chemotherapy at four different hospitals from October 2019 to July 2023. Univariate and multivariate logistic regression models were applied to analyse potential predictors of tumour pathological response. The Kaplan-Meier method with log rank test was used to compare progression-free survival (PFS) between patients with high and low BMI. BMI < 24.0 kg/m2 was defined as low BMI, and tumour regression grade 1-2 was defined as complete tumour response.
RESULTS
Low BMI was observed in 74 (58.7%) patients and complete tumour response was found in 27 (21.4%) patients. The rate of complete tumour response was significantly higher in patients with low BMI (29.7% vs 9.6%, P = 0.007). Multivariate analysis revealed that low BMI [odds ratio (OR) = 4.56, 95% confidence interval (CI): 1.42-14.63, P = 0.011], targeted therapy with bevacizumab (OR = 3.02, 95%CI: 1.10-8.33, P = 0.033), preoperative carcinoembryonic antigen level < 10 ng/mL (OR = 3.84, 95%CI: 1.19-12.44, P = 0.025) and severe sinusoidal dilatation (OR = 0.17, 95%CI: 0.03-0.90, P = 0.037) were independent predictive factors for complete tumour response. The low BMI group exhibited a significantly longer median PFS than the high BMI group (10.7 mo vs 4.7 mo, P = 0.011).
CONCLUSION
In CRLM patients receiving preoperative chemotherapy, a low BMI may be associated with better tumour response and longer PFS.
Core Tip: Increasing evidence suggests that body mass index (BMI) is a significantly underestimated predictor in the diagnosis and treatment of colorectal cancer. However, few literatures have evaluated the relationship between BMI and tumour response to chemotherapy in colorectal liver metastases (CRLMs). In this study, we found that a low BMI was associated with an improved tumour response to preoperative chemotherapy. This finding may provide a novel perspective for the individualized treatment of CRLMs.
