7, 8 Obesity is a major risk factor for CRC. 5, 6 During the past 40 years, the prevalence of obesity in the United States has more than doubled, accounting for 42.4% of the population in 2018. The World Health Organization defines obesity as a body mass index (BMI calculated as weight in kilograms divided by height in meters squared) of 30 or greater. 1 - 3 Modifiable factors for CRC include tobacco exposure, alcohol consumption, poor diet, and obesity these are major contributors to the increased incidence and mortality. Similarly, mortality rates have increased by 1.3% annually in those younger than 50 years. 1 However, the incidence in those aged between 50 to 64 years has been increasing by 1% annually, and that among patients younger than 50 years has been increasing by 2% annually. The incidence among those older than 65 years has been steadily declining. Approximately 52 980 people in the United States will die from CRC in 2021. The association could reflect a systemic condition (ie, obesity) locally influencing aggressive growth (ie, high TB) in colon cancer.Ĭolorectal cancer (CRC) remains the second most common cause of cancer deaths in the United States. Additionally, patients with a higher TB grade had worse overall survival (intermediate vs low TB: hazard ratio, 2.20 95% CI, 1.11-4.35 log-rank P = .02 high vs low TB: hazard ratio, 2.67 95% CI, 1.45-4.90 log-rank P < .001).Ĭonclusions and Relevance In this cohort study, a novel association between high TB grade and obesity was found. Multivariable analysis adjusting for clinical and histological factors demonstrated that higher TB grade was associated with obesity (odds ratio, 4.25 95% CI, 1.95-9.26), higher PDC grade (grade 2 vs 1: OR, 9.14 95% CI, 3.49-23.93 grade 3 vs 1: OR, 5.10 95% CI, 2.30-11.27), increased infiltrative tumor border (OR, 1.03 95% CI, 1.01-1.04), cecal location (OR, 2.55 95% CI, 1.09-5.97), and higher stage (eg, stage III vs stage I for high-grade or intermediate-grade vs low-grade TB: OR, 2.91 95% CI, 1.00-8.49). A total of 57 specimens (28.5%) were from stage I tumors 74 (37.0%), stage II and 69 (34.5%), stage III. The median (interquartile range) age of patients was 62 (55-72) years, 102 (51.0%) were women, and the mean (SD) BMI was 28.5 (8.4).
Results A total of 200 specimens were reviewed. Secondary outcomes include the association of TB with clinical features (ie, age, race, sex, TNM stage, tumor location) and pathological features (ie, poorly differentiated tumor clusters, Klintrup-Mäkinen inflammatory score, desmoplasia, infiltrative tumor border, tumor necrosis, and tumor-to-stroma ratio). The primary outcome was the association of TB with obesity (defined as body mass index of 30 or greater). Main Outcomes and Measures TB was defined as 1 to 4 malignant cells at the invasive edge of the tumor, independently assessed by 2 academic pathologists. Specimens came from 200 patients with stage I to III colon cancer patients with stage 0, stage IV, or incomplete data were excluded.
Objective To evaluate the association of TB with obesity and other prognostic factors in colon cancer.ĭesign, Setting, and Participants This cohort study involved a histological review of colon cancer specimens obtained during 7 years (January 2008 to December 2015) at the University of Kentucky Medical Center data analysis was conducted from February 2020 to January 2021.
Tumor budding (TB) is an important prognostic factor for CRC, but its association with obesity is unknown. Importance Obesity is associated with increased risk of colorectal cancer (CRC) and a more aggressive disease course. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.