| Objective:1 A number of clinical studies have confirmed that compared with normal body mass index,the incidence of colorectal cancer for obese patients was significantly higher.However,on the relationship between obesity and the prognosis of colorectal cancer is controversial.This paper aims to assess the relationship between body mass index and the prognosis in patients with colorectal cancer at diagnosis.2 Some patients of colorectal cancer with weight loss as the first symptom,some with stool properties change as the first symptom.With weight loss as the first symptom,the body mass index of patients was decreased compared to normal levels at diagnosis.This paper aims to explore the relationship between body mass index that decreased than normal levels at diagnosis and the prognosis in patients with colorectal cancer.Methods:1 The clinical data and follow-up data of clorectal cancer patients were collected from May 2011 to April 2014 at the Fourth Hospital of Hebei Medical University.The patients without surgery was diagnosed directly with colonoscopy biopsy, and the patients with surgery was diagnosed according to postoperative pathology. Among the patients,758 cases of colon cancer and 1066 cases of rectal cancer were recruited.According to the weight index of Chinese standards they were divided into 4 groups:the underweight group(<18.5kg/m2),normal weight group(18.5 ~ 23.9kg/m2), overweight group(24 ~ 27.9kg/m2) and obese group( ≥ 28kg/m2).Application SPSS16.0 statistical software for data analysis,the progression free survival and overall survival were observed,and survival curves were plotted using Kaplan-Meier method and the COX regression model was used for multivariate analysis.2 The clinical data and follow-up data were collected with detailed description of weight changes from the data collected above. Among the patients,330 cases of colon cancer and 419 cases of rectal cancer were recruited.Application SPSS16.0 statistical software for data analysis,the progression free survival and overall survival were observed,survival curves were plotted using Kaplan-Meier method and COX regression model was used for multivariate analysis.Results:1 The survival curves of colon cancer which was plotted with Kaplan-Meier(Fig.1,2),showed that body mass index was the prognostic factor in patients with colon cancer,and the patients with lower body mass index had a shorter progression-free survival(P<0.001) and overall survival(P<0.001).The COX regression multivariate analysis showed that(Fig.3,4),excluding the impact of confounding factors,body mass index was an independent prognostic factor for colon cancer,a lower body mass index is associated with a shorter progression-free survival(RR 0.783,95 % CI: 0.652-0.941, P=0.009) and overall survival(RR 0.791,95% CI: 0.658-0.951, P=0.013).The underweight group, overweight group and obese group were compared with normal weight group,showed that underweight group had a shorter progression free survival(Fig.5,P<0.001) and overall survival(Fig.6,P=0.001). A multivariate analysis was performed using COX regression model, excluding the impact of confounding factors, the results showed that body mass index of less than 18.5kg/m2 had a shorter progression free survival(Fig.7,RR 0.478, 95%CI:0.285-0.801, P=0.005) and overall survival(Fig.8,RR 0.499, 95%CI:0.298-0.837, P=0.008);but compared with normal weight group,the overweight group and obese group had no significant difference in progression free survival(P=0.845 and P=0.213) and overall survival(P=0.855 and P=0.280),but a higher body mass index had a trend of longer progression free survival and overall survival.2 The survival curves of rectal cancer which was plotted with Kaplan-Meier(Fig.9,10)showed that body mass index is also the prognostic factor in patients with rectal cancer,a lower body mass index in patients with a shorter overall survival(P=0.018),but the progression free survival(P=0.168) had no statistically significant difference.A multivariate analysis was performed using COX regression model showed that,excluding the impact of confounding factors,the body mass index was not an independent prognostic factor for overall survival with rectal cancer,but a higher body mass index had a trend of longer progression free survival and overall survival.The underweight group, overweight group and obese group were compared with normal weight group,showed that they had no significant difference in progression free survival(P=0.115 、 P=0.537 and P=0.244) and overall survival(P=0.113、P=0.497 and P=0.237),but a higher body mass index had a trend of longer progression free survival and overall survival.3 The survival curves of colon cancer which was plotted with Kaplan-Meier(Fig.11,12)showed that weight loss at diagnosis was the prognostic risk factor in patients with colon cancer,weight loss was associated witha shorter progression free survival(P=0.002)and overall survival(P=0.002).A multivariate analysis was performed using COX regression model showed that,excluding the impact of confounding factors,weight loss was not an independent prognostic factor for colon cancer.4 The survival curves ofrectal cancer which was plotted with Kaplan-Meier(Fig.13,14) showed that weight loss at diagnosis was the prognostic risk factor in patients for rectal cancer,weight loss was associated with a shorter overall survival(P=0.043),but had no statistically significant difference with progression free survival(P=0.075).A multivariate analysis was performed using COX regression model showed that,excluding the impact of confounding factors,weight loss was not an independent prognostic factor for rectal cancer.Conclusions:1 Body mass index was an independent prognostic factor for progression free survivaland overall survival for colon cancer.But for rectal cancer,single factor analysis showed that body mass index had a statistical difference with overall survival,but no statistical difference with progression free survival.COX multivariate analysis showed that body mass index was not an independent prognostic factor for overall survival for rectal cancer,but a higher body mass index had a trend of longer progression free survival and overall survival.2 Weight loss at diagnosis was not an independent prognostic factor for colon cancer,but weight loss was associated with a shorter progression free survival and overall survival.And also weight loss was not an independent prognostic factor for rectal cancer,it had no significant difference with progression free survival,but weight loss was associaed with a shorter overall survival. |
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