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@ARTICLE{Kohls:179919,
      author       = {M. Kohls and H. Freisling and H. Charvat and I.
                      Soerjomataram and V. Viallon and V. Davila-Batista and R.
                      Kaaks$^*$ and R. Turzanski-Fortner$^*$ and K. Aleksandrova
                      and M. B. Schulze and C. C. Dahm and H. Tilma Vistisen and
                      A. L. Rostgaard-Hansen and A. Tjønneland and C. Bonet and
                      M.-J. Sánchez and S. Colorado-Yohar and G. Masala and D.
                      Palli and V. Krogh and F. Ricceri and O. Rolandsson and S.
                      S. M. Lu and K. K. Tsilidis and E. Weiderpass and M. J.
                      Gunter and P. Ferrari and U. Berger and M. Arnold},
      title        = {{I}mpact of cumulative body mass index and cardiometabolic
                      diseases on survival among patients with colorectal and
                      breast cancer: a multi-centre cohort study.},
      journal      = {BMC cancer},
      volume       = {22},
      number       = {1},
      issn         = {1471-2407},
      address      = {Heidelberg},
      publisher    = {Springer},
      reportid     = {DKFZ-2022-00968},
      pages        = {546},
      year         = {2022},
      abstract     = {Body mass index (BMI) and cardiometabolic comorbidities
                      such as cardiovascular disease and type 2 diabetes have been
                      studied as negative prognostic factors in cancer survival,
                      but possible dependencies in the mechanisms underlying these
                      associations remain largely unexplored. We analysed these
                      associations in colorectal and breast cancer patients.Based
                      on repeated BMI assessments of cancer-free participants from
                      four European countries in the European Prospective
                      Investigation into Cancer and nutrition (EPIC) study,
                      individual BMI-trajectories reflecting predicted mean BMI
                      between ages 20 to 50 years were estimated using a growth
                      curve model. Participants with incident colorectal or breast
                      cancer after the age of 50 years were included in the
                      survival analysis to study the prognostic effect of mean BMI
                      and cardiometabolic diseases (CMD) prior to cancer. CMD were
                      defined as one or more chronic conditions among stroke,
                      myocardial infarction, and type 2 diabetes. Hazard ratios
                      (HRs) and confidence intervals (CIs) of mean BMI and CMD
                      were derived using multivariable-adjusted Cox proportional
                      hazard regression for mean BMI and CMD separately and both
                      exposures combined, in subgroups of localised and advanced
                      disease.In the total cohort of 159,045 participants, there
                      were 1,045 and 1,620 eligible patients of colorectal and
                      breast cancer. In colorectal cancer patients, a higher BMI
                      (by 1 kg/m2) was associated with a $6\%$ increase in risk of
                      death $(95\%$ CI of HR: 1.02-1.10). The HR for CMD was 1.25
                      $(95\%$ CI: 0.97-1.61). The associations for both exposures
                      were stronger in patients with localised colorectal cancer.
                      In breast cancer patients, a higher BMI was associated with
                      a $4\%$ increase in risk of death $(95\%$ CI: 1.00-1.08).
                      CMDs were associated with a $46\%$ increase in risk of death
                      $(95\%$ CI: 1.01-2.09). The estimates and CIs for BMI
                      remained similar after adjustment for CMD and vice versa.Our
                      results suggest that cumulative exposure to higher BMI
                      during early to mid-adulthood was associated with poorer
                      survival in patients with breast and colorectal cancer,
                      independent of CMD prior to cancer diagnosis. The
                      association between a CMD diagnosis prior to cancer and
                      survival in patients with breast and colorectal cancer was
                      independent of BMI.},
      keywords     = {Body mass index (Other) / Breast cancer (Other) /
                      Cardiovascular disease (Other) / Cohort study (Other) /
                      Colorectal cancer (Other) / Comorbidity (Other) / Cumulative
                      exposure (Other) / Diabetes (Other) / Survival (Other)},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:35568802},
      doi          = {10.1186/s12885-022-09589-y},
      url          = {https://inrepo02.dkfz.de/record/179919},
}