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Obesity linked to node-positive pancreatic cancer
Lower rates of survival observed for obese patients.
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After surgical resection for pancreatic cancer, reduced survival rate and node-positive pancreatic cancer were observed in patients with BMI >35, according a recent retrospective study.
The study included 285 patients who underwent pancreatic resection for pancreatic adenocarcinoma from Jan. 1, 1999. to Oct. 31, 2006. Patients were separated into five groups by BMI: <23, 23 to 25, 26 to 29, 30 to 35, and >35.
The results of prior epidemiologic studies indicated that BMI >35 was associated with an RR of 2.61 for death from pancreatic cancer, according to the researchers.
“Our findings extend these observations to those patients who undergo surgery to treat pancreatic cancer and suggest that obesity is a host factor affecting tumor biology independent of the difficulties involved in delivering oncologic care in obese patients,” they wrote.
BMI >35 a risk factor
When compared with the BMI <23 group, tumor size increased (P=.04) and the number of patients with positive lymph nodes increased for the BMI >35 group (P<.001).
When the researchers used generalized estimating equations, after adjustment for preoperative treatment the risk for positive lymph nodes was approximately twofold in the BMI >35 group compared with patients with BMI ≤35 (P=.002). After adjustment using logistic regression analysis, the BMI >35 group had an approximate 12-fold risk for positive lymph nodes (P=.02).
In the BMI >35 group, the median recurrence time was 8.5 months (95% CI, 5.2-11.3). There was cancer recurrence in 95% of these patients compared with all other groups (61%; P=.005). Compared with patients with BMI ≤35, the BMI >35 group was at an approximate twofold risk for cancer recurrence (P=.005).
The lowest median survival rate was observed in the BMI >35 group (13.2 months; 95% CI, 10.9-18.1) vs. the group with BMI <23 (27.4 months; 95% CI, 20.0-45.5). Patients with BMI >35 had a nearly twofold risk for death after pancreatectomy when compared with patients with BMI ≤35 (P=.02).
There was a 53% death rate during a median of 16 months’ follow-up, according to the researchers. The median survival rate was 27.4 months for patients with BMI <23 vs. patients with BMI >35 (13.2 months). The BMI >35 group had a 75% mortality rate at final follow-up compared with those in the BMI ≤35 group (52%).
“Future investigations should include a search for systemic or tumor biomarkers in this group of patients that could provide additional insight,” the researchers wrote.
Fleming JB. Arch Surg. 2009;144:216-221.