TUMOR MICROENVIRONMENT AND BODY MASS INDEX: CORRELATION WITH THE PROGRESSION OF GASTRIC CANCER

Abstract

Summary. Obesity increases the risk of developing malignant tumors contributes to the worsening of the progression of the disease. Today, the relationship between the course of gastric cancer (GC) and obesity is considered to have been proven, however the epidemiological data pertaining to this relationship is marked by contradictions and uncertainties. The identification of tumor microenvironment factors that are associated with obesity (taking into account the age and gender of patients) will allow to group patients in accordance to the risk of adverse progression of the disease. Aim: to determine the levels of the metastasis of regional and distant cancer as well as the survival of patients with GC depending on their body mass index (BMI), taking into account their age and gender; to analyze the correlation of these indicators to the aggressiveness of the tumor microenvironment, which was determined by us previously by grouping patients with GC by BMI, age and sex. Object and methods: the clinico-pathological indicators and the overall 3-year survival of 246 patients (171 men, 75 women) with primary esophageal cancer were studied using clinical, oncological and statistical methods. Results: it was found that there was no significant statistical difference (p > 0.05) between the frequency of the metastasis of distant cancer in the groups of patients, regardless of weight, sex and age. Patients with normal weight had a 1.4 times significantly higher (p = 0.012) frequency of regional cancer metastasis than patients with excess weight. Significantly highest survival rates were observed in middle-aged men of normal weight, elderly women of normal weight, and middle-aged women who were overweight/obese, there was no significant statistical difference (p > 0.05) between the frequency of distant cancer metastasis in the groups of patients regardless of weight, sex and age. Patients with normal weight had a 1.4 times significantly higher (p = 0.012) frequency of regional cancer metastasis than patients with excess weight. The highest survival rates were observed in middle-aged men of normal weight, elderly women of normal weight, and middle-aged women who were overweight/obese and the lowest in overweight/ obese middle-aged men and overweight/obese elderly women. It was determined that in cases of patients who were overweight, survival is correlated with the nature of aggressiveness of the tumor as it relates to the age and gender of the patients with GC (a high frequency of pro-tumor factors of the GC microenvironment is associated with low survival (direct negative correlation; k = –0.93)), as it relates to patients with normal weight — no correlation (direct positive correlation; correlation coefficient = 0.98). Conclusions: the study of tumor microenvironment factors that are associated with obesity, taking into account patients’ age and gender, will allow to group patients with GC according to the risk of adverse progression of the disease at the stage of initial tumor detection, and in a technically accessible and economical way, to improve the determination of a prognosis and the efficiency of anticancer therapy.