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Visceral fat area is an independent predictive biomarker of outcome after first-line bevacizumab-based treatment in metastatic colorectal cancer
  1. Boris Guiu1,2,3,
  2. Jean Michel Petit3,4,
  3. Franck Bonnetain5,6,
  4. Sylvain Ladoire4,7,
  5. Séverine Guiu4,7,
  6. Jean-Pierre Cercueil2,
  7. Denis Krausé2,
  8. Patrick Hillon8,
  9. Christophe Borg9,
  10. Bruno Chauffert4,7,
  11. François Ghiringhelli4,7
  1. 1Department of Radiology, Georges-Francois Leclerc Cancer Cente, Dijon, France
  2. 2Department of Radiology, Le Bocage University Hospital, Dijon, France
  3. 3Department of Endocrinology, Diabetology and Metabolic Diseases, Le Bocage University Hospital, Dijon, France
  4. 4AVENIR INSERM U866 Unit, School of Medicine, Dijon, France
  5. 5Biostatistics Unit, Georges-Francois Leclerc Cancer Center, Dijon, France
  6. 6EA 4184, School of Medicine, Dijon, France
  7. 7Department of Oncology, Georges-Francois Leclerc Cancer Centre, Dijon, France
  8. 8Department of Hepatology, Le Bocage University Hospital, Dijon, France
  9. 9Department of Oncology, University Hospital, Besançon, France
  1. Correspondence to Dr François Ghiringhelli, Georges-Francois Leclerc Cancer Centre, INSERM Avenir 866, 1 rue du Professeur Marion, Dijon 21000, France; fghiringhelli{at}


Background Adipose tissue releases angiogenic factors that may promote tumour growth.

Objective To determine whether body mass index (BMI), subcutaneous fat area (SFA) and visceral fat area (VFA) are associated with outcomes in patients given first-line bevacizumab-based treatment for metastatic colorectal cancer (MCC).

Patients CT was used to measure SFA and VFA in 120 patients with MCC who received bevacizumab-based treatment (bevacizumab group, n=80) or chemotherapy alone (chemotherapy group, n=40) as first-line treatment. Associations linking BMI, SFA and VFA to tumour response, time-to-progression (TTP) and overall survival (OS) were evaluated.

Results In the bevacizumab group, median follow-up lasted for 24 months (3–70). BMI, SFA and VFA values above the median (ie, high BMI, high VFA and high SFA) were significantly associated with absence of a response. TTP was shorter in patients with high BMI (9 vs 12 months; p=0.01) or high VFA (9 vs 14 months; p=0.0008). High VFA was associated with shorter OS (p=0.0493). By multivariate analysis, high VFA was independently associated with response, TTP and OS (HR=7.18, p=0.008, HR=5.79, p=0.005 and HR=2.88, p=0.027, respectively). In the chemotherapy group, median follow-up lasted for 30 months (4–84). BMI, SFA and VFA were not associated with response, TTP or OS. In the whole population, interaction between VFA and bevacizumab administration was significant for response (OR=3.31, p=0.005) and TTP (HR=1.64, p=0.022), thereby confirming the results.

Conclusion This study provides the first evidence that high VFA independently predicts a poorer outcome in patients given first-line bevacizumab-based treatment for MCC. However, this predictive biomarker needs to be validated in a different dataset.

  • Colorectal cancer
  • bevacizumab
  • visceral fat
  • computed tomography
  • SFA
  • subcutaneous fat area
  • VFA
  • visceral fat area
  • CT
  • computed tomography
  • PS
  • performance status
  • CRC
  • colorectal cancer
  • CR
  • complete response
  • PR
  • partial response
  • SD
  • stable disease
  • TTP
  • time to progression
  • ROC
  • receiver-operating characteristic
  • area under the ROC curve

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  • Funding ARC (Association Recherche Cancer), 9 rue Guy Moquet, 94800 Villejuif, France Ligue Nationale contre le Cancer, Comité de Côte d'Or, 38B rue Tivoli, 21000 Dijon, France.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Comité de Protection des Personnes (CPP) Est I - Pr B. Blettery.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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