Impact of body mass index on tumor recurrence among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma- a multi-institutional international analysis

Katiuscha Merath, Rittal Mehta, J. Madison Hyer, Fabio Bagante, Kota Sahara, Sorin Alexandrescu, Hugo P. Marques, Luca Aldrighetti, Shishir K. Maithel, Carlo Pulitano, Matthew J. Weiss, Todd W. Bauer, Feng Shen, George A. Poultsides, Olivier Soubrane, Guillaume Martel, B. Groot Koerkamp, Alfredo Guglielmi, Endo Itaru, Aslam EjazTimothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: The association between body mass index (BMI) and long-term outcomes of patients with ICC has not been well defined. We sought to define the presentation and oncologic outcomes of patients with ICC undergoing curative-intent resection, according to their BMI category. Methods: Patients who underwent resection of ICC were identified in a multi-institutional database. Patients were categorized as normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0–29.9 kg/m2) and obese (BMI≥30 kg/m2) according to the World Health Organization (WHO) definition. Impact of clinico-pathological factors on recurrence-free survival (RFS) was assessed using Cox proportional hazards model among patients in the three BMI categories. Results: Among a total of 790 patients undergoing curative-intent resection of ICC in the analytic cohort, 399 (50.5%) had normal weight, 274 (34.7%) were overweight and 117 (14.8%) were obese. Caucasian patients were more likely to be obese (66.7%, n = 78) and overweight (47.1%, n = 129) compared with Asian (obese: 18.8%, n = 22; overweight: 46%, n = 126) and other races (obese: 14.5%, n = 17; overweight: 6.9%, n = 19)(p < 0.001). There were no differences in the presence of cirrhosis (10.9%, vs. 12.8%, vs. 12.9%), preoperative jaundice (8.6% vs. 9.5% vs. 12.0%), or levels of CA 19–9 (75, IQR 24.6–280 vs. 50.9, IQR 17.9–232 vs. 43, IQR 16.9–192.7) among the BMI groups (all p > 0.05). On multivariable analysis, increased BMI was an independent risk factor for tumor recurrence (OR 1.16, 95% CI 1.02–1.32, for every 5 unit increase). Conclusion: Increasing BMI was associated with incremental increases in the risk of recurrence following curative-intent resection of ICC. Future studies should aim to achieve a better understanding of BMI-related factors relative to prognosis of patients with ICC.

Original languageEnglish (US)
Pages (from-to)1084-1091
Number of pages8
JournalEuropean Journal of Surgical Oncology
Volume45
Issue number6
DOIs
StatePublished - Jun 2019

Keywords

  • BMI
  • Intrahepatic cholangiocarcinoma
  • Obesity
  • Prognosis
  • Recurrence

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Merath, K., Mehta, R., Hyer, J. M., Bagante, F., Sahara, K., Alexandrescu, S., Marques, H. P., Aldrighetti, L., Maithel, S. K., Pulitano, C., Weiss, M. J., Bauer, T. W., Shen, F., Poultsides, G. A., Soubrane, O., Martel, G., Koerkamp, B. G., Guglielmi, A., Itaru, E., ... Pawlik, T. M. (2019). Impact of body mass index on tumor recurrence among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma- a multi-institutional international analysis. European Journal of Surgical Oncology, 45(6), 1084-1091. https://doi.org/10.1016/j.ejso.2019.03.004