Matthew G Davey, Noel E Donlon, Mark Donnelly, Eanna J Ryan, Odhran K Ryan, Ian S Reynolds, William P Joyce
{"title":"评估肥胖悖论对直肠癌手术治疗患者生存结果的影响——系统回顾和荟萃分析","authors":"Matthew G Davey, Noel E Donlon, Mark Donnelly, Eanna J Ryan, Odhran K Ryan, Ian S Reynolds, William P Joyce","doi":"10.1007/s00384-025-04957-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Obesity is a well-established risk factor for rectal cancer development. The association between obesity and survival outcomes in those undergoing resection for rectal cancer remains unclear. The objective of this study was to perform a systematic review and meta-analysis evaluating the association between obesity and overall (OS) and disease-free (DFS) in patients undergoing surgery for rectal cancer with curative intent.</p><p><strong>Methods: </strong>A systematic review was performed as per PRISMA guidelines. Descriptive statistics (Fisher's exact test (†)) were used. Meta-analyses were performed using Mantel-Haenszel and generic inverse variance methods using RevMan version 5.4.</p><p><strong>Results: </strong>Twenty-three studies with 22,520 patients were included (mean follow-up: 59.7 months). Overall, 18.5% of patients were living with obesity (4174/22,520). Obesity was associated with poorer DFS [60.5% (2289/3783) vs. 62.4% (9576/15,335), P = 0.029, †]; however, a non-significant difference was observed at meta-analysis [hazard ratio (HR): 1.12, 95% confidence interval (95% CI) 0.90-1.40, P = 0.320, heterogeneity (I<sup>2</sup>) = 77%]. Obesity was associated with enhanced OS [67.8% (2500/3687) vs. 59.8% (9048/15,125), P < 0.001, †], results which were replicated at meta-analysis [HR 1.24, 95% CI 1.03-1.50, P = 0.020, I<sup>2</sup> = 59%]. Using time-to-effect modelling, a non-significant difference in DFS [HR 0.93, 95% CI 0.69-1.24, P = 0.600, I<sup>2</sup> = 57%] and OS [HR 1.00, 95% CI 0.73-1.37, P = 1.000, I<sup>2</sup> = 69%] was observed at meta-analysis.</p><p><strong>Conclusion: </strong>Once diagnosed and being treated with curative intent for rectal cancer, patients living with obesity exhibit similar survival outcomes as those living without obesity. This study refutes hypotheses that an 'obesity paradox' is protective for survival in patients with rectal cancer. Given the current obesity epidemic, this concept may warrant incorporation into preoperative counselling.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"180"},"PeriodicalIF":2.3000,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361308/pdf/","citationCount":"0","resultStr":"{\"title\":\"Evaluating the influence of the obesity paradox on survival outcomes in patients being treated surgically for rectal cancer-a systematic review and meta-analysis.\",\"authors\":\"Matthew G Davey, Noel E Donlon, Mark Donnelly, Eanna J Ryan, Odhran K Ryan, Ian S Reynolds, William P Joyce\",\"doi\":\"10.1007/s00384-025-04957-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Obesity is a well-established risk factor for rectal cancer development. The association between obesity and survival outcomes in those undergoing resection for rectal cancer remains unclear. The objective of this study was to perform a systematic review and meta-analysis evaluating the association between obesity and overall (OS) and disease-free (DFS) in patients undergoing surgery for rectal cancer with curative intent.</p><p><strong>Methods: </strong>A systematic review was performed as per PRISMA guidelines. Descriptive statistics (Fisher's exact test (†)) were used. Meta-analyses were performed using Mantel-Haenszel and generic inverse variance methods using RevMan version 5.4.</p><p><strong>Results: </strong>Twenty-three studies with 22,520 patients were included (mean follow-up: 59.7 months). Overall, 18.5% of patients were living with obesity (4174/22,520). Obesity was associated with poorer DFS [60.5% (2289/3783) vs. 62.4% (9576/15,335), P = 0.029, †]; however, a non-significant difference was observed at meta-analysis [hazard ratio (HR): 1.12, 95% confidence interval (95% CI) 0.90-1.40, P = 0.320, heterogeneity (I<sup>2</sup>) = 77%]. Obesity was associated with enhanced OS [67.8% (2500/3687) vs. 59.8% (9048/15,125), P < 0.001, †], results which were replicated at meta-analysis [HR 1.24, 95% CI 1.03-1.50, P = 0.020, I<sup>2</sup> = 59%]. Using time-to-effect modelling, a non-significant difference in DFS [HR 0.93, 95% CI 0.69-1.24, P = 0.600, I<sup>2</sup> = 57%] and OS [HR 1.00, 95% CI 0.73-1.37, P = 1.000, I<sup>2</sup> = 69%] was observed at meta-analysis.</p><p><strong>Conclusion: </strong>Once diagnosed and being treated with curative intent for rectal cancer, patients living with obesity exhibit similar survival outcomes as those living without obesity. This study refutes hypotheses that an 'obesity paradox' is protective for survival in patients with rectal cancer. Given the current obesity epidemic, this concept may warrant incorporation into preoperative counselling.</p>\",\"PeriodicalId\":13789,\"journal\":{\"name\":\"International Journal of Colorectal Disease\",\"volume\":\"40 1\",\"pages\":\"180\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-08-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361308/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Colorectal Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00384-025-04957-z\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Colorectal Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00384-025-04957-z","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：肥胖是直肠癌发展的一个公认的危险因素。在直肠癌切除术患者中，肥胖与生存结果之间的关系尚不清楚。本研究的目的是进行一项系统回顾和荟萃分析，评估有治愈意图的直肠癌手术患者的肥胖与总体（OS）和无病（DFS）之间的关系。方法：按照PRISMA指南进行系统评价。使用描述性统计（Fisher's exact test（†））。meta分析采用Mantel-Haenszel和通用逆方差法，采用RevMan version 5.4进行。结果：纳入23项研究，22,520例患者（平均随访时间：59.7个月）。总体而言，18.5%的患者患有肥胖症（4174/ 22520）。肥胖与较差的DFS相关[60.5%（2289/3783）比62.4% (9576/ 15335),P = 0.029，†]；然而，在荟萃分析中观察到无显著差异[风险比（HR）： 1.12, 95%可信区间（95% CI） 0.90-1.40, P = 0.320，异质性(I2) = 77%]。肥胖与OS增强相关[67.8%（2500/3687）比59.8% (9048/15,125),P 2 = 59%]。采用时间效应模型，在meta分析中观察到DFS [HR 0.93, 95% CI 0.69-1.24, P = 0.600, I2 = 57%]和OS [HR 1.00, 95% CI 0.73-1.37, P = 1.000, I2 = 69%]无显著差异。结论：一旦确诊并以治愈为目的治疗直肠癌，肥胖患者与非肥胖患者表现出相似的生存结果。这项研究驳斥了“肥胖悖论”对直肠癌患者生存有保护作用的假设。鉴于目前肥胖的流行，这一概念可能需要纳入术前咨询。
Evaluating the influence of the obesity paradox on survival outcomes in patients being treated surgically for rectal cancer-a systematic review and meta-analysis.
Background: Obesity is a well-established risk factor for rectal cancer development. The association between obesity and survival outcomes in those undergoing resection for rectal cancer remains unclear. The objective of this study was to perform a systematic review and meta-analysis evaluating the association between obesity and overall (OS) and disease-free (DFS) in patients undergoing surgery for rectal cancer with curative intent.
Methods: A systematic review was performed as per PRISMA guidelines. Descriptive statistics (Fisher's exact test (†)) were used. Meta-analyses were performed using Mantel-Haenszel and generic inverse variance methods using RevMan version 5.4.
Results: Twenty-three studies with 22,520 patients were included (mean follow-up: 59.7 months). Overall, 18.5% of patients were living with obesity (4174/22,520). Obesity was associated with poorer DFS [60.5% (2289/3783) vs. 62.4% (9576/15,335), P = 0.029, †]; however, a non-significant difference was observed at meta-analysis [hazard ratio (HR): 1.12, 95% confidence interval (95% CI) 0.90-1.40, P = 0.320, heterogeneity (I2) = 77%]. Obesity was associated with enhanced OS [67.8% (2500/3687) vs. 59.8% (9048/15,125), P < 0.001, †], results which were replicated at meta-analysis [HR 1.24, 95% CI 1.03-1.50, P = 0.020, I2 = 59%]. Using time-to-effect modelling, a non-significant difference in DFS [HR 0.93, 95% CI 0.69-1.24, P = 0.600, I2 = 57%] and OS [HR 1.00, 95% CI 0.73-1.37, P = 1.000, I2 = 69%] was observed at meta-analysis.
Conclusion: Once diagnosed and being treated with curative intent for rectal cancer, patients living with obesity exhibit similar survival outcomes as those living without obesity. This study refutes hypotheses that an 'obesity paradox' is protective for survival in patients with rectal cancer. Given the current obesity epidemic, this concept may warrant incorporation into preoperative counselling.
期刊介绍：
The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies.
The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
