Adiposity and cancer survival: a systematic review and meta-analysis

Purpose The increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies examining the relationship of visceral, subcutaneous, and overall adiposity to cancer survival. To summarize this emerging body of litera...

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Published inCancer causes & control Vol. 33; no. 10; pp. 1219 - 1246
Main Authors Cheng, En, Kirley, Jocelyn, Cespedes Feliciano, Elizabeth M., Caan, Bette J.
Format Journal Article
LanguageEnglish
Published Cham Springer International Publishing 01.10.2022
Springer Nature B.V
Subjects
Adipose tissue
Adiposity
Biomedical and Life Sciences
Biomedicine
Body fat
Breast cancer
Cancer Research
Carcinoma, Hepatocellular
Colorectal cancer
Colorectal carcinoma
Colorectal Neoplasms
Computed tomography
Epidemiology
Head and neck carcinoma
Hematology
Hepatocellular carcinoma
Humans
Kidney cancer
Kidney Neoplasms
Liver cancer
Liver Neoplasms
Lung cancer
Lung carcinoma
Male
Meta-analysis
Mortality
Obesity
Oncology
Pancreatic cancer
Pancreatic carcinoma
Prostate cancer
Public Health
Review Article
Survival
Systematic review
Waist–hip ratio
Adiposity
Computed tomography
Survival
Body composition
Cancer
Online AccessGet full text

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Abstract Purpose The increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies examining the relationship of visceral, subcutaneous, and overall adiposity to cancer survival. To summarize this emerging body of literature, we conducted a systematic review and meta-analysis of imaging-measured as well as anthropometric proxies for adipose tissue distribution and cancer survival across a wide range of cancer types. Methods Using keywords related to adiposity, cancer, and survival, we conducted a systematic search of the literature in PubMed and MEDLINE, Embase, and Web of Science Core Collection databases from database inception to 30 June 2021. We used a random-effect method to calculate pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) within each cancer type and tested for heterogeneity using Cochran’s Q test and the I 2 test. Results We included 203 records for this review, of which 128 records were utilized for quantitative analysis among 10 cancer types: breast, colorectal, gastroesophageal, head and neck, hepatocellular carcinoma, lung, ovarian, pancreatic, prostate, and renal cancer. We found that imaging-measured visceral, subcutaneous, and total adiposity were not significantly associated with increased risk of overall mortality, death from primary cancer, or cancer progression among patients diagnosed with these 10 cancer types; however, we found significant or high heterogeneity for many cancer types. For example, heterogeneity was similarly high when the pooled HRs (95% CI) for overall mortality associated with visceral adiposity were essentially null as in 1.03 (0.55, 1.92; I 2  = 58%) for breast, 0.99 (0.81, 1.21; I 2  = 71%) for colorectal, versus when they demonstrated a potential increased risk 1.17 (0.85, 1.60; I 2  = 78%) for hepatocellular carcinoma and 1.62 (0.90, 2.95; I 2  = 84%) for renal cancer. Conclusion Greater adiposity at diagnosis (directly measured by imaging) is not associated with worse survival among cancer survivors. However, heterogeneity and other potential limitations were noted across studies, suggesting differences in study design and adiposity measurement approaches, making interpretation of meta-analyses challenging. Future work to standardize imaging measurements and data analyses will strengthen research on the role of adiposity in cancer survival.
AbstractList The increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies examining the relationship of visceral, subcutaneous, and overall adiposity to cancer survival. To summarize this emerging body of literature, we conducted a systematic review and meta-analysis of imaging-measured as well as anthropometric proxies for adipose tissue distribution and cancer survival across a wide range of cancer types.PURPOSEThe increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies examining the relationship of visceral, subcutaneous, and overall adiposity to cancer survival. To summarize this emerging body of literature, we conducted a systematic review and meta-analysis of imaging-measured as well as anthropometric proxies for adipose tissue distribution and cancer survival across a wide range of cancer types.Using keywords related to adiposity, cancer, and survival, we conducted a systematic search of the literature in PubMed and MEDLINE, Embase, and Web of Science Core Collection databases from database inception to 30 June 2021. We used a random-effect method to calculate pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) within each cancer type and tested for heterogeneity using Cochran's Q test and the I2 test.METHODSUsing keywords related to adiposity, cancer, and survival, we conducted a systematic search of the literature in PubMed and MEDLINE, Embase, and Web of Science Core Collection databases from database inception to 30 June 2021. We used a random-effect method to calculate pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) within each cancer type and tested for heterogeneity using Cochran's Q test and the I2 test.We included 203 records for this review, of which 128 records were utilized for quantitative analysis among 10 cancer types: breast, colorectal, gastroesophageal, head and neck, hepatocellular carcinoma, lung, ovarian, pancreatic, prostate, and renal cancer. We found that imaging-measured visceral, subcutaneous, and total adiposity were not significantly associated with increased risk of overall mortality, death from primary cancer, or cancer progression among patients diagnosed with these 10 cancer types; however, we found significant or high heterogeneity for many cancer types. For example, heterogeneity was similarly high when the pooled HRs (95% CI) for overall mortality associated with visceral adiposity were essentially null as in 1.03 (0.55, 1.92; I2 = 58%) for breast, 0.99 (0.81, 1.21; I2 = 71%) for colorectal, versus when they demonstrated a potential increased risk 1.17 (0.85, 1.60; I2 = 78%) for hepatocellular carcinoma and 1.62 (0.90, 2.95; I2 = 84%) for renal cancer.RESULTSWe included 203 records for this review, of which 128 records were utilized for quantitative analysis among 10 cancer types: breast, colorectal, gastroesophageal, head and neck, hepatocellular carcinoma, lung, ovarian, pancreatic, prostate, and renal cancer. We found that imaging-measured visceral, subcutaneous, and total adiposity were not significantly associated with increased risk of overall mortality, death from primary cancer, or cancer progression among patients diagnosed with these 10 cancer types; however, we found significant or high heterogeneity for many cancer types. For example, heterogeneity was similarly high when the pooled HRs (95% CI) for overall mortality associated with visceral adiposity were essentially null as in 1.03 (0.55, 1.92; I2 = 58%) for breast, 0.99 (0.81, 1.21; I2 = 71%) for colorectal, versus when they demonstrated a potential increased risk 1.17 (0.85, 1.60; I2 = 78%) for hepatocellular carcinoma and 1.62 (0.90, 2.95; I2 = 84%) for renal cancer.Greater adiposity at diagnosis (directly measured by imaging) is not associated with worse survival among cancer survivors. However, heterogeneity and other potential limitations were noted across studies, suggesting differences in study design and adiposity measurement approaches, making interpretation of meta-analyses challenging. Future work to standardize imaging measurements and data analyses will strengthen research on the role of adiposity in cancer survival.CONCLUSIONGreater adiposity at diagnosis (directly measured by imaging) is not associated with worse survival among cancer survivors. However, heterogeneity and other potential limitations were noted across studies, suggesting differences in study design and adiposity measurement approaches, making interpretation of meta-analyses challenging. Future work to standardize imaging measurements and data analyses will strengthen research on the role of adiposity in cancer survival.
PurposeThe increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies examining the relationship of visceral, subcutaneous, and overall adiposity to cancer survival. To summarize this emerging body of literature, we conducted a systematic review and meta-analysis of imaging-measured as well as anthropometric proxies for adipose tissue distribution and cancer survival across a wide range of cancer types.MethodsUsing keywords related to adiposity, cancer, and survival, we conducted a systematic search of the literature in PubMed and MEDLINE, Embase, and Web of Science Core Collection databases from database inception to 30 June 2021. We used a random-effect method to calculate pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) within each cancer type and tested for heterogeneity using Cochran’s Q test and the I2 test.ResultsWe included 203 records for this review, of which 128 records were utilized for quantitative analysis among 10 cancer types: breast, colorectal, gastroesophageal, head and neck, hepatocellular carcinoma, lung, ovarian, pancreatic, prostate, and renal cancer. We found that imaging-measured visceral, subcutaneous, and total adiposity were not significantly associated with increased risk of overall mortality, death from primary cancer, or cancer progression among patients diagnosed with these 10 cancer types; however, we found significant or high heterogeneity for many cancer types. For example, heterogeneity was similarly high when the pooled HRs (95% CI) for overall mortality associated with visceral adiposity were essentially null as in 1.03 (0.55, 1.92; I2 = 58%) for breast, 0.99 (0.81, 1.21; I2 = 71%) for colorectal, versus when they demonstrated a potential increased risk 1.17 (0.85, 1.60; I2 = 78%) for hepatocellular carcinoma and 1.62 (0.90, 2.95; I2 = 84%) for renal cancer.ConclusionGreater adiposity at diagnosis (directly measured by imaging) is not associated with worse survival among cancer survivors. However, heterogeneity and other potential limitations were noted across studies, suggesting differences in study design and adiposity measurement approaches, making interpretation of meta-analyses challenging. Future work to standardize imaging measurements and data analyses will strengthen research on the role of adiposity in cancer survival.
The increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies examining the relationship of visceral, subcutaneous, and overall adiposity to cancer survival. To summarize this emerging body of literature, we conducted a systematic review and meta-analysis of imaging-measured as well as anthropometric proxies for adipose tissue distribution and cancer survival across a wide range of cancer types. Using keywords related to adiposity, cancer, and survival, we conducted a systematic search of the literature in PubMed and MEDLINE, Embase, and Web of Science Core Collection databases from database inception to 30 June 2021. We used a random-effect method to calculate pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) within each cancer type and tested for heterogeneity using Cochran's Q test and the I test. We included 203 records for this review, of which 128 records were utilized for quantitative analysis among 10 cancer types: breast, colorectal, gastroesophageal, head and neck, hepatocellular carcinoma, lung, ovarian, pancreatic, prostate, and renal cancer. We found that imaging-measured visceral, subcutaneous, and total adiposity were not significantly associated with increased risk of overall mortality, death from primary cancer, or cancer progression among patients diagnosed with these 10 cancer types; however, we found significant or high heterogeneity for many cancer types. For example, heterogeneity was similarly high when the pooled HRs (95% CI) for overall mortality associated with visceral adiposity were essentially null as in 1.03 (0.55, 1.92; I  = 58%) for breast, 0.99 (0.81, 1.21; I  = 71%) for colorectal, versus when they demonstrated a potential increased risk 1.17 (0.85, 1.60; I  = 78%) for hepatocellular carcinoma and 1.62 (0.90, 2.95; I  = 84%) for renal cancer. Greater adiposity at diagnosis (directly measured by imaging) is not associated with worse survival among cancer survivors. However, heterogeneity and other potential limitations were noted across studies, suggesting differences in study design and adiposity measurement approaches, making interpretation of meta-analyses challenging. Future work to standardize imaging measurements and data analyses will strengthen research on the role of adiposity in cancer survival.
Purpose The increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies examining the relationship of visceral, subcutaneous, and overall adiposity to cancer survival. To summarize this emerging body of literature, we conducted a systematic review and meta-analysis of imaging-measured as well as anthropometric proxies for adipose tissue distribution and cancer survival across a wide range of cancer types. Methods Using keywords related to adiposity, cancer, and survival, we conducted a systematic search of the literature in PubMed and MEDLINE, Embase, and Web of Science Core Collection databases from database inception to 30 June 2021. We used a random-effect method to calculate pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) within each cancer type and tested for heterogeneity using Cochran’s Q test and the I 2 test. Results We included 203 records for this review, of which 128 records were utilized for quantitative analysis among 10 cancer types: breast, colorectal, gastroesophageal, head and neck, hepatocellular carcinoma, lung, ovarian, pancreatic, prostate, and renal cancer. We found that imaging-measured visceral, subcutaneous, and total adiposity were not significantly associated with increased risk of overall mortality, death from primary cancer, or cancer progression among patients diagnosed with these 10 cancer types; however, we found significant or high heterogeneity for many cancer types. For example, heterogeneity was similarly high when the pooled HRs (95% CI) for overall mortality associated with visceral adiposity were essentially null as in 1.03 (0.55, 1.92; I 2  = 58%) for breast, 0.99 (0.81, 1.21; I 2  = 71%) for colorectal, versus when they demonstrated a potential increased risk 1.17 (0.85, 1.60; I 2  = 78%) for hepatocellular carcinoma and 1.62 (0.90, 2.95; I 2  = 84%) for renal cancer. Conclusion Greater adiposity at diagnosis (directly measured by imaging) is not associated with worse survival among cancer survivors. However, heterogeneity and other potential limitations were noted across studies, suggesting differences in study design and adiposity measurement approaches, making interpretation of meta-analyses challenging. Future work to standardize imaging measurements and data analyses will strengthen research on the role of adiposity in cancer survival.
Author Caan, Bette J.
Cheng, En
Cespedes Feliciano, Elizabeth M.
Kirley, Jocelyn
AuthorAffiliation 1 Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
AuthorAffiliation_xml – name: 1 Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
Author_xml – sequence: 1
  givenname: En
  surname: Cheng
  fullname: Cheng, En
  organization: Division of Research, Kaiser Permanente Northern California
– sequence: 2
  givenname: Jocelyn
  surname: Kirley
  fullname: Kirley, Jocelyn
  organization: Division of Research, Kaiser Permanente Northern California
– sequence: 3
  givenname: Elizabeth M.
  surname: Cespedes Feliciano
  fullname: Cespedes Feliciano, Elizabeth M.
  organization: Division of Research, Kaiser Permanente Northern California
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  givenname: Bette J.
  orcidid: 0000-0002-5803-310X
  surname: Caan
  fullname: Caan, Bette J.
  email: bette.caan@kp.org
  organization: Division of Research, Kaiser Permanente Northern California
BackLink https://www.ncbi.nlm.nih.gov/pubmed/35971021$$D View this record in MEDLINE/PubMed
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Issue 10
Keywords Waist–hip ratio
Adiposity
Computed tomography
Survival
Body composition
Cancer
Language English
License 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
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All authors contributed to the study conception and design. En Cheng, Jocelyn Kirley, and Elizabeth M. Cespedes Feliciano participated in the literature search and screening. En Cheng and Jocelyn Kirley performed study quality assessment. En Cheng conducted data analysis. En Cheng and Bette Caan drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final manuscript.
Author Contributions
Contributed equally
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PublicationSubtitle An International Journal of Studies of Cancer in Human Populations
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Snippet Purpose The increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in...
The increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies...
PurposeThe increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in...
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SubjectTerms Adipose tissue
Adiposity
Biomedical and Life Sciences
Biomedicine
Body fat
Breast cancer
Cancer Research
Carcinoma, Hepatocellular
Colorectal cancer
Colorectal carcinoma
Colorectal Neoplasms
Computed tomography
Epidemiology
Head and neck carcinoma
Hematology
Hepatocellular carcinoma
Humans
Kidney cancer
Kidney Neoplasms
Liver cancer
Liver Neoplasms
Lung cancer
Lung carcinoma
Male
Meta-analysis
Mortality
Obesity
Oncology
Pancreatic cancer
Pancreatic carcinoma
Prostate cancer
Public Health
Review Article
Survival
Systematic review
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Title Adiposity and cancer survival: a systematic review and meta-analysis
URI https://link.springer.com/article/10.1007/s10552-022-01613-7
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Volume 33
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