Kolorektal Kanser ve Abdominal Yağ Doku Dağılımı Arasındaki İlişki

Abstract

Amaç: Abdominal subkütan, viseral ve retroperitoneal yağ dokusu kalınlıkları ile obezite arasındaki ilişkiyi incelemek. Materyal ve Metod: Çalışmaya 62 kontrol ve 68 kolorektal kanser hastası dahil edildi. Hastaların ameliyat öncesi veya kolonoskopik muayenesinden önceki son 6 ay içinde çekilen abdominal bilgisayarlı tomografi tetkikleri değerlendirildi. Kolorektal kanser hastaları tümör lokalizasyonuna göre proksimal ve distal olarak iki gruba ayrıldı. Abdomenin subkütan, viseral ve retroperitoneal yağ doku kalınlıkları abdominal bilgisayarlı tomografi tetkikleri kullanılarak ölçüldü. Bulgular: Kolorektal kanser grubu ile kontrol grubu arasında vücut kitle indeksi, retroperitoneal ve viseral yağ doku kalınlığı ve cinsiyet açısından istatistiksel olarak anlamlı bir fark yoktu (sırasıyla p = 0.091; 0.246; 0.531; 0.190). Kolorektal kanser grubunun yaş ortalaması daha yüksekti (p <0.001). Kontrol grubunun ortalama subkütan yağ doku kalınlığı daha yüksekti (p = 0.045). Proksimal ve distal kolorektal kanser grubu arasında yaş, retroperitoneal, subkütan ve viseral yağ doku kalınlığı açısından istatistiksel olarak anlamlı bir fark yoktu (sırasıyla p = 0.734; 0.916; 0.800; 0.170). Distal kitle olan grubun ortalama vücut kitle indeksi daha yüksekti (p = 0.028). Distal kitle olan grupta erkeklerin oranı proksimal kitlesi olan gruba göre daha yüksekti (p = 0,024). Sonuç: Riskli popülasyonda kolorektal kanser teşhisi konmadan veya semptomlar gelişmeden önce abdomendeki yağ dokusunu ve dağılımını değerlendirmek, hangi hastaların daha detaylı izlenmesi gerektiğini gösterecek ve daha fazla kolorektal kanser vakasının oluşumunu önlemeye yardımcı olacaktır.

Keywords

• Bilgisayarlı tomografi
• kolorektal kanser
• viseral yağ dokusu
• abdominal subkutan yağ dokusu
• retroperitoneal yağ dokusu

The Relationship Between Colorectal Cancer and Abdominal Adipose Tissue Distribution

Abstract

Aim: To examine the relationship between obesity and the subcutaneous, visceral and retroperitoneal adipose tissue thicknesses of the abdomen. Materials and Methods: The study included 62 control and 68 colorectal cancer patients. Abdominal computed tomography of the patients, which were taken within the last 6 months before preoperative or colonoscopic examination were evaluated. Colorectal cancer patients were divided into two groups as proximal and distal according to tumor localization. Subcutaneous, visceral and retroperitoneal adipose tissue thicknesses of the abdomen were measured using abdominal computed tomography scans. Results: There was no statistically significant difference between the colorectal cancer group and the control group in terms of body mass index, retroperitoneal and visceral adipose tissue thickness and gender (p=0.091; 0.246; 0.531; 0.190,respectively). The mean age of the colorectal cancer group was higher (p<0.001). The mean subcutaneous adipose tissue thickness of the control group was higher (p=0.045). There was no statistically significant difference between the proximal and distal colorectal cancer group in terms of age, retroperitoneal, subcutaneous and visceral adipose tissue thickness (p=0.734; 0.916; 0.800; 0.170, respectively). The mean body mass index of the group with distal mass was higher (p=0.028). The proportion of males was higher in the group with distal mass than in the group with proximal mass (p=0.024). Conclusion: In the risky population evaluating the adipose tissue in the abdomen and its distribution before the colorectal cancer is diagnosed or the symptoms develop will indicate which patients should be followed up in more detail and help to prevent more cases of colorectal cancer.

Keywords

• computed tomography
• colorectal cancer
• visceral adipose tissue
• abdominal subcutaneous adipose tissue
• retroperitoneal adipose tissue

References

1. 1. Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019;14(2):89-103. doi:10.5114/pg.2018.81072
2. 2. Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. Lancet. 2014 Aug 30; 384(9945):755-65.
3. 3. Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer. Gut 2013;62:933–47.
4. 4. Frezza EE, Wachtel MS, Chiriva-Internati M. Influence of obesity on the risk of developing colon cancer. Gut 2006;55:285–91.
5. 5. Giovannucci E, Ascherio A, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med. 1995 Mar 1; 122(5):327-34.
6. 6. Larsson SC, Wolk A. Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies. Am J Clin Nutr. 2007 Sep; 86(3):556-65.
7. 7. Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol. 2012;85:1–10.
8. 8. Seo IK, Kim BJ, Kim B, et al. Abdominal fat distribution measured using computed tomography is associated with an increased risk of colorectal adenoma in men. Medicine (Baltimore). 2017 Sep;96(37):e8051.

9. 9. Fang H, Berg E, Cheng X, Shen W. How to best assess abdominal obesity. Curr Opin Clin Nutr Metab Care. 2018;21(5):360-365. doi:10.1097/MCO.0000000000000485
10. 10. Yamamoto S, Nakagawa T, Matsushita Y, et al. Visceral fat area and markers of insulin resistance in relation to colorectal neoplasia. Diabetes Care 2010;33:184–9.
11. 11. Oh TH, Byeon JS, Myung SJ, et al. Visceral obesity as a risk factor for colorectal neoplasm. J Gastroenterol Hepatol 2008;23:411–7.
12. 12. Lee JY, Lee HS, Lee DC, et al. Visceral fat accumulation is associated with colorectal cancer in postmenopausal women. PLoS One. 2014;9(11):e110587. Published 2014 Nov 17. doi:10.1371/journal.pone.0110587
13. 13. Mahamid A, Ashkenazi I, Shapira-Rootman M, et al. Impact of Increased Visceral Fat Measured by CT on Colon Adenocarcinoma Stage. Journal of Gastrointestinal Cancer, 2016;48(4), 347–352.
14. 14. Gradmark AMI, Rydh A, Renström F, et al. Computed tomography-based validation of abdominal adiposity measurements from ultrasonography, dual-energy X-ray absorptiometry and anthropometry. British Journal of Nutrition, 2010; 104(04), 582–588.
15. 15. Goldenberg L, Saliba W, Hayeq H, Hasadia R, Zeina AR. The impact of abdominal fat on abdominal aorta calcification measured on non-enhanced CT.Medicine (Baltimore). 2018 Dec;97(49):e13233.
16. 16. Hung CS, Lee JK, Yang CY, et al. Measurement of visceral fat: should we include retroperitoneal fat? PLoS One. 2014;9(11):e112355. Published 2014 Nov 17. doi:10.1371/journal.pone.0112355
17. 17. Ersöz F, Erbil Y, Sarı S, et al. Predictive value of retroperitoneal fat area measurement for detecting metabolic syndrome in patients undergoing adrenalectomy. World J Surg. 2011 May;35(5):986-94.
18. 18. Goh LY, Goh KL. Obesity: An epidemiological perspective from Asia and its relationship to gastrointestinal and liver cancers. J Gastroenterol Hepatol 2013;28:54-58.
19. 19. Ma Y, Yang Y, Wang F, et al. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PLoS One. 2013;8(1):e53916. doi: 10.1371/journal.pone.0053916. Epub 2013 Jan 17. PMID: 23349764; PMCID: PMC3547959.
20. 20. Shirdel M, Andersson F, Myte R, et al. Body composition measured by computed tomography is associated with colorectal cancer survival, also in early-stage disease. Acta Oncol. 2020 Mar 31:1-10.
21. 21. Wells JC, Treleaven P, Charoensiriwath S. Body shape by 3-D photonic scanning in Thai and UK adults: comparison of national sizing surveys. Int J Obes (Lond) 2012;36:148–54.
22. 22. Erarslan E, Turkay C, Koktener A, Koca C, Uz B, Bavbek N. Association of visceral fat accumulation and adiponectin levels with colorectal neoplasia. Dig Dis Sci. 2009 Apr;54(4):862-8. doi: 10.1007/s10620-008-0440-6. Epub 2008 Aug 21. PMID: 18716871.
23. 23. Akay S, Urkan M, Balyemez U, Erşen M, Taşar M. Is visceral obesity associated with colorectal cancer? The first volumetric study using all CT slices. Diagn Interv Radiol. 2019 Sep;25(5):338-345. doi: 10.5152/dir.2019.18350. PMID: 31287430; PMCID: PMC6727813.
24. 24. Rickles AS, Iannuzzi JC, Mironov O, et al. Visceral obesity and colorectal cancer: are we missing the boat with BMI? J Gastrointest Surg. 2013 Jan;17(1):133-43; discussion p.143. doi: 10.1007/s11605-012-2045-9. Epub 2012 Oct 23. PMID: 23090279.
25. 25. Yu H, Joh YG, Son GM, Kim HS, Jo HJ, Kim HY. Distribution and Impact of the Visceral Fat Area in Patients With Colorectal Cancer. Ann Coloproctol. 2016;32(1):20-26. doi:10.3393/ac.2016.32.1.20
26. 26. Im JP, Kim D, Chung SJ, et al. Visceral obesity as a risk factor for colorectal adenoma occurrence in surveillance colonoscopy. Gastrointest Endosc. 2018 Jul;88(1):119-127.e4. doi: 10.1016/j.gie.2018.02.040. Epub 2018 Mar 3. PMID: 29510147.
27. 27. Choe EK, Kim D, Kim HJ, Park KJ. Association of visceral obesity and early colorectal neoplasia. World J Gastroenterol 2013; 19:8349–8356.
28. 28. Leitner BP, Huang S, Brychta RJ, et al. Mapping of human brown adipose tissue in lean and obese young men. Proc Natl Acad Sci USA 2017; 114:8649–8654. [PubMed: 28739898]
29. 29. Song M, Hu FB, Spiegelman D, et al. Long-term status and change of body fat distribution, and risk of colorectal cancer: a prospective cohort study International Journal of Epidemiology, 2016, 871–883 doi: 10.1093/ije/dyv177
30. 30. Yang J, Du XL, Li ST, et al. Characteristics of Differently Located Colorectal Cancers Support Proximal and Distal Classification: A Population-Based Study of 57,847 Patients. PLoS One. 2016;11(12):e0167540. Published 2016 Dec 9. doi:10.1371/journal.pone.0167540