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Impact of Body Mass Index on Outcomes and Treatment-Related Toxicity in Patients With Stage II and III Rectal Cancer: Findings From Intergroup Trial 0114

From the Department of Medical Oncology, Dana-Farber Cancer Institute; Department of Radiation Oncology, Massachusetts General Hospital; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill; Cancer and Leukemia Group B Statistical Center, Durham, NC; Baylor-Sammons Cancer Center, Dallas, TX; Allegheny Cancer Center, Allegheny General Hospital, Pittsburgh, PA; St Vincent's Clinical Cancer Center, New York, NY; Division of Hematology-Oncology, Northwestern University, Chicago, IL; and Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada

Address reprint requests to Jeffrey A. Meyerhardt, MD, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115; e-mail: jmeyerhardt{at}partners.org

PURPOSE: To study the relationship between body mass index (BMI) and rates of sphincter-preserving operations, overall survival, cancer recurrence, and treatment-related toxicities in patients with rectal cancer.

PATIENTS AND METHODS: We evaluated a nested cohort of 1,688 patients with stage II and III rectal cancer participating in a randomized trial of postoperative fluorouracil-based chemotherapy and radiation therapy.

RESULTS: Obese patients were more likely to undergo an abdominoperineal resection (APR) than normal-weight patients (odds ratio, 1.77; 95% CI, 1.27 to 2.46). When analyzed by sex, increasing adiposity in men was a strong predictor of having an APR (P < .0001). Obese men with rectal cancer were also more likely than normal-weight men to have a local recurrence (hazard ratio [HR], 1.61; 95% CI, 1.00 to 2.59). In contrast, obesity was not predictive of cancer recurrence in women, nor was BMI predictive of overall mortality in either men or women. Underweight patients had an increased risk of death (HR, 1.43; 95% CI, 1.08 to 1.89) compared with normal-weight patients but no increase in cancer recurrences. Among all study participants, obese patients had a significantly lower rate of grade 3 to 4 leukopenia, neutropenia, and stomatitis and a lower rate of any grade 3 or worse toxicity when compared with normal-weight individuals.

CONCLUSION: Increasing BMI in male patients with rectal cancer is associated with a decreased likelihood of sphincter preservation and a higher chance of local recurrence. For both men and women, overweight and obese patients experience less toxicity associated with adjuvant chemoradiotherapy, suggesting that actual body weight dosing of fluorouracil for obese patients is justified.

J.A.M. is supported in part by a K07 award from the National Cancer Institute (1K07CA097992-01A1) and an American Society of Clinical Oncology career development award. Other support provided by grants from the National Cancer Institute (CA31946) to the Cancer and Leukemia Group B.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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