Abstract 644: Premorbid body weight and survival in high grade glioma
Authors: Siegel Erin M. , Thompson Reid C. , Nabors L. Burton , Olson Jeffrey J. , Madden Melissa H. , Browning James E. , Pan Edward , Egan Kathleen M. 
Published: August 2012

Abstract
Introduction: Greater adiposity has been linked to an increased risk and/or poorer survival in a variety of cancers. However, the relationship of body fat mass to glioma outcome is not well studied. In the present analysis, we examined whether premorbid body weight determined 1 to 5 years prior to diagnosis is associated with glioma patient survival. Methods: The analysis was based on 619 patients with high grade glioma (84% glioblastoma multiforme (GBM) and16% anaplastic astrocytoma (AA)) enrolled in a US-based multicenter case-control study between December 2004 and March 2011. In a structured interview, subjects provided information on height at age 21, weight at age 21 and weight 5 years prior to the study interview (1 year during the pilot study phase; N=95). Subjects were interviewed a median of 1.2 months following glioma diagnosis (interquartile range: 3 weeks to 2.5 months). A total of 408 deaths occurred, all glioma-related, 2 months to 4.8 years following diagnosis (median: 9.4 months). Proportional hazards regression was used to estimate Hazard Ratios (HR) and 95% Confidence Intervals (CIs) for glioma-related death according to categories of body mass index (BMI) (kg/m2) defining obesity (BMI &gt;=30; N=178), overweight (BMI 25-29.9; N=254), normal weight (BMI 18.5-24.9; N=179) and underweight (BMI &lt;18.5; N=8). All results were adjusted for age, gender and glioma subtype (GBM versus AA). Results: Patients with a premorbid BMI of 30 or greater had an elevated rate of glioma-related death when compared to patients with a normal BMI (HR=1.39; 95% CI: 1.07-1.82) whereas no significant excess mortality was observed in patients defined as overweight (HR=1.15; 95% CI: 0.89-1.49). Patients underweight 1-5 years prior to diagnosis had significantly poorer outcomes when compared to patients of normal weight (HR=2.43; 95% CI: 1.06-5.57), and weight loss of 10 pounds or greater between age 21 and 1-5 years prior to diagnosis (N=27) was significantly associated with a worse outcome (HR=1.92; 95% CI: 1.18-3.13) when compared to stable weight (within 10 pounds). All results were consistent in men and women, and were unchanged in analysis restricted to patients treated with the current standard of care including surgery, radiation and temozolomide (not shown). Conclusions: In this large well-characterized patient series, premorbid obesity was significantly associated with poorer survival following glioma diagnosis. Low body weight was also associated with a poorer outcome possibly reflecting effects of preclinical disease-associated changes on body weight. Findings for obesity support the hypothesis that elevated pre-diagnostic body weight is detrimental to glioma survival and suggest a role for insulin resistance, aberrant IGF signaling, and/or low-level chronic inflammation in the progression of high grade tumors.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 644. doi:1538-7445.AM2012-644