Subcutaneous Adiposity is an Independent Predictor of Mortality in Cancer Patients

Overview

Journal Br J Cancer

Specialty Oncology

Date 2017 Jun 8

PMID 28588319

Citations 94

Authors

Maryam Ebadi

Lisa Martin

Sunita Ghosh

Catherine J Field

Richard Lehner

Vickie E Baracos

Vera C Mazurak

Affiliations

Soon will be listed here.

Abstract

Background: Prognostic significance of adiposity, at the time of cancer diagnosis, on survival is not clear. Body mass index (kg m) does not provide an appropriate assessment of body composition; therefore, the concept of the 'obesity paradox' needs to be investigated based on the prognostic significance of fat and muscle. Independent prognostic significance of adipose tissue in predicting mortality, importance of visceral and subcutaneous adiposity in the presence and absence of sarcopenia on survival, was investigated.

Methods: Adiposity markers including total adipose index (TATI), visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI) were estimated for 1473 gastrointestinal and respiratory cancer patients and 273 metastatic renal cell carcinoma patients using computed tomography. Univariate and multivariate analysis to determine mortality hazard ratios (HR) were conducted using cox proportional hazard models.

Results: Low SATI (SATI <50.0 cm m in males and <42.0 cm m in females) independently associated with increased mortality (HR: 1.26; 95% CI: 1.11-1.43; P<0.001) and shorter survival (13.1 months; 95% CI, 11.4-14.7) compared to patients with high SATI (19.3 months; 95% CI, 17.6-21.0; P<0.001). In the presence of sarcopenia, the longest survival was observed in patients with high subcutaneous adiposity.

Conclusions: Subcutaneous adipose tissues appear to associate with reduction in mortality risk demonstrating the prognostic importance of fat distribution. The effect of sarcopenia on survival was more pronounced in patients with low subcutaneous adiposity.

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References

Kuk J, Lee S, Heymsfield S, Ross R . Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am J Clin Nutr. 2005; 81(6):1330-4. DOI: 10.1093/ajcn/81.6.1330. View

Kaneko G, Miyajima A, Yuge K, Yazawa S, Mizuno R, Kikuchi E . Visceral obesity is associated with better recurrence-free survival after curative surgery for Japanese patients with localized clear cell renal cell carcinoma. Jpn J Clin Oncol. 2014; 45(2):210-6. DOI: 10.1093/jjco/hyu193. View

Tran T, Yamamoto Y, Gesta S, Kahn C . Beneficial effects of subcutaneous fat transplantation on metabolism. Cell Metab. 2008; 7(5):410-20. PMC: 3204870. DOI: 10.1016/j.cmet.2008.04.004. View

Ogino S, Shima K, Baba Y, Nosho K, Irahara N, Kure S . Colorectal cancer expression of peroxisome proliferator-activated receptor gamma (PPARG, PPARgamma) is associated with good prognosis. Gastroenterology. 2009; 136(4):1242-50. PMC: 2663601. DOI: 10.1053/j.gastro.2008.12.048. View

Hakimi A, Furberg H, Zabor E, Jacobsen A, Schultz N, Ciriello G . An epidemiologic and genomic investigation into the obesity paradox in renal cell carcinoma. J Natl Cancer Inst. 2013; 105(24):1862-70. PMC: 3866155. DOI: 10.1093/jnci/djt310. View

Rickles A, Iannuzzi J, Mironov O, Deeb A, Sharma A, Fleming F . Visceral obesity and colorectal cancer: are we missing the boat with BMI?. J Gastrointest Surg. 2012; 17(1):133-43. DOI: 10.1007/s11605-012-2045-9. View

Doria-Rose V, Newcomb P, Morimoto L, Hampton J, Trentham-Dietz A . Body mass index and the risk of death following the diagnosis of colorectal cancer in postmenopausal women (United States). Cancer Causes Control. 2006; 17(1):63-70. DOI: 10.1007/s10552-005-0360-0. View

Martin L, Birdsell L, MacDonald N, Reiman T, Clandinin M, McCargar L . Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013; 31(12):1539-47. DOI: 10.1200/JCO.2012.45.2722. View

Lee H, Jeong B, Seo S, Jeon S, Lee H, Choi H . Prognostic significance of visceral obesity in patients with advanced renal cell carcinoma undergoing nephrectomy. Int J Urol. 2015; 22(5):455-61. DOI: 10.1111/iju.12716. View

10.

Miller K, Jones E, Yanovski J, Shankar R, Feuerstein I, Falloon J . Visceral abdominal-fat accumulation associated with use of indinavir. Lancet. 1998; 351(9106):871-5. DOI: 10.1016/S0140-6736(97)11518-5. View

11.

Mitsiopoulos N, Baumgartner R, Heymsfield S, Lyons W, Gallagher D, Ross R . Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol (1985). 1998; 85(1):115-22. DOI: 10.1152/jappl.1998.85.1.115. View

12.

Kasenda B, Bass A, Koeberle D, Pestalozzi B, Borner M, Herrmann R . Survival in overweight patients with advanced pancreatic carcinoma: a multicentre cohort study. BMC Cancer. 2014; 14:728. PMC: 4242603. DOI: 10.1186/1471-2407-14-728. View

13.

Porter S, Massaro J, Hoffmann U, Vasan R, ODonnel C, Fox C . Abdominal subcutaneous adipose tissue: a protective fat depot?. Diabetes Care. 2009; 32(6):1068-75. PMC: 2681034. DOI: 10.2337/dc08-2280. View

14.

Wajchenberg B . Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2001; 21(6):697-738. DOI: 10.1210/edrv.21.6.0415. View

15.

Mourtzakis M, Prado C, Lieffers J, Reiman T, McCargar L, Baracos V . A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008; 33(5):997-1006. DOI: 10.1139/H08-075. View

16.

Aubrey J, Esfandiari N, Baracos V, Buteau F, Frenette J, Putman C . Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol (Oxf). 2014; 210(3):489-97. PMC: 4309522. DOI: 10.1111/apha.12224. View

17.

Prado C, Gonzalez M, Heymsfield S . Body composition phenotypes and obesity paradox. Curr Opin Clin Nutr Metab Care. 2015; 18(6):535-51. DOI: 10.1097/MCO.0000000000000216. View

18.

Ebadi M, Mazurak V . Evidence and mechanisms of fat depletion in cancer. Nutrients. 2014; 6(11):5280-97. PMC: 4245589. DOI: 10.3390/nu6115280. View

19.

Antoun S, Bayar A, Ileana E, Laplanche A, Fizazi K, Palma M . High subcutaneous adipose tissue predicts the prognosis in metastatic castration-resistant prostate cancer patients in post chemotherapy setting. Eur J Cancer. 2015; 51(17):2570-7. DOI: 10.1016/j.ejca.2015.07.042. View

20.

Ibrahim M . Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev. 2009; 11(1):11-8. DOI: 10.1111/j.1467-789X.2009.00623.x. View