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 Ejaz; Timothy M Pawlik

doi:10.1016/j.ejso.2019.03.004

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

Eur J Surg Oncol. 2019 Jun;45(6):1084-1091. doi: 10.1016/j.ejso.2019.03.004. Epub 2019 Mar 7.

Authors

Katiuscha Merath¹, Rittal Mehta¹, J Madison Hyer¹, Fabio Bagante², Kota Sahara³, Sorin Alexandrescu⁴, Hugo P Marques⁵, Luca Aldrighetti⁶, Shishir K Maithel⁷, Carlo Pulitano⁸, Matthew J Weiss⁹, Todd W Bauer¹⁰, Feng Shen¹¹, George A Poultsides¹², Olivier Soubrane¹³, Guillaume Martel¹⁴, B Groot Koerkamp¹⁵, Alfredo Guglielmi¹⁶, Endo Itaru¹⁷, Aslam Ejaz¹, Timothy M Pawlik¹⁸

Affiliations

¹ The Ohio State University Wexner Medical Center, Columbus, OH, USA.
² The Ohio State University Wexner Medical Center, Columbus, OH, USA; University of Verona, Verona, Italy.
³ The Ohio State University Wexner Medical Center, Columbus, OH, USA; Yokohama City University, Yokohama, Japan.
⁴ Fundeni Clinical Institute, Bucharest, Romania.
⁵ Curry Cabral Hospital, Lisbon, Portugal.
⁶ Ospedale San Raffaele, Milan, Italy.
⁷ Emory University, Atlanta, GA, USA.
⁸ University of Sydney, Sydney, Australia.
⁹ Johns Hopkins Hospital, Baltimore, MD, USA.
¹⁰ University of Virginia, Charlottesville, VA, USA.
¹¹ Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
¹² Stanford University, Stanford, CA, USA.
¹³ Beaujon Hospital, Clichy, France.
¹⁴ University of Ottawa, Canada.
¹⁵ Erasmus University Medical Center, Rotterdam, Netherlands.
¹⁶ University of Verona, Verona, Italy.
¹⁷ Yokohama City University, Yokohama, Japan.
¹⁸ The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: tim.pawlik@osumc.edu.

PMID: 30871884
DOI: 10.1016/j.ejso.2019.03.004

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.

Keywords: BMI; Intrahepatic cholangiocarcinoma; Obesity; Prognosis; Recurrence.

Publication types

Multicenter Study

MeSH terms

Bile Duct Neoplasms / diagnosis
Bile Duct Neoplasms / surgery*
Bile Ducts, Intrahepatic*
Body Mass Index*
Canada / epidemiology
China / epidemiology
Cholangiocarcinoma / diagnosis
Cholangiocarcinoma / surgery*
Disease-Free Survival
Europe / epidemiology
Female
Follow-Up Studies
Hepatectomy / methods*
Humans
Incidence
Japan / epidemiology
Male
Neoplasm Recurrence, Local / epidemiology*
Neoplasm Recurrence, Local / etiology
Prognosis
Retrospective Studies
Risk Factors
Survival Rate / trends
United States / epidemiology