Body mass index is prognostic in metastatic colorectal cancer: Pooled analysis of patients from first-line clinical trials in the ARCAD database

Lindsay A. Renfro, Fotios Loupakis, Richard A. Adams, Matthew T. Seymour, Volker Heinemann, Hans Joachim Schmoll, Jean Yves Douillard, Herbert Hurwitz, Charles S. Fuchs, Eduardo Diaz-Rubio, Rainer Porschen, Christophe Tournigand, Benoist Chibaudel, Alfredo Falcone, Niall C. Tebbutt, Cornelis J.A. Punt, J. Randolph Hecht, Carsten Bokemeyer, Eric Van Cutsem, Richard M. GoldbergLeonard B. Saltz, Aimery De Gramont, Daniel J. Sargent, Heinz Josef Lenz

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


Purpose. In recent retrospective analyses of early-stage colorectal cancer (CRC), low and high body mass index (BMI) scores were associated with worsened outcomes. Whether BMI is a prognostic or predictive factor in metastatic CRC (mCRC) is unclear. Patients and Methods. Individual data from 21,149 patients enrolled onto 25 first-line mCRC trials during 1997 to 2012 were pooled. We assessed both prognostic and predictive effects of BMI on overall survival and progression-free survival, and we accounted for patient and tumor characteristics and therapy type (targeted v nontargeted). Results. BMI was prognostic for overall survival (P < .001) and progression-free survival (P < .001), with an L-shaped pattern. That is, risk of progression and/or death was greatest for low BMI; risk decreased as BMI increased to approximately 28 kg/m2, and then it plateaued. Relative to obese patients, patients with a BMI of 18.5 kg/m2 had a 27% increased risk of having a PFS event (95% CI, 20% to 34%) and a 50% increased risk of death (95% CI, 43%to 56%). Low BMI was associated with poorer survival for men than women (interaction P < .001). BMI was not predictive of treatment effect. Conclusion. Low BMI is associated with an increased risk of progression and death among the patients enrolled on the mCRC trials, with no increased risk for elevated BMI, in contrast to the adjuvant setting. Possible explanations include negative effects related to cancer cachexia in patients with low BMI, increased drug delivery or selection bias in patients with high BMI, and potential for an interaction between BMI and molecular signaling pathways.

Original languageEnglish (US)
Pages (from-to)144-150
Number of pages7
JournalJournal of Clinical Oncology
Issue number2
StatePublished - Jan 10 2016

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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