"Obesity Paradox" as a new insight from long-term survivors in pancreatic cancer patients.

BACKGROUND

Obesity is traditionally associated with poor outcomes. However, the recently emerging concept of the "obesity paradox" suggests that obese cancer patients have better survival rates than non-obese patients. While this phenomenon has been confirmed in several cancers, its relevance to pancreatic cancer remains unclear. This retrospective study explores whether the obesity paradox applies to pancreatic cancer (PC) after pancreatectomy.

METHODS

A total of 404 PC patients who underwent surgery between 2004 and 2022 were studied. Patients were classified into the non-obese (BMI <25.0) (n = 313) and obese (BMI ≥25.0) (n = 91) groups. A subgroup analysis examined the impact of the visceral fat to subcutaneous fat ratio (VSR) on survival within the obese cohort.

RESULTS

Obese patients had a significantly better 5-year overall survival (p = 0.040) and cancer-specific survival (p = 0.047) than non-obese patients. Within the obese cohort, a lower VSR was associated with improved survival (p = 0.012), indicating the importance of fat distribution in outcomes.

CONCLUSION

Obesity is associated with improved survival in patients with PC, highlighting the potential benefits of a nuanced approach to manageing obese patients. Distribution of adipose tissue, particularly subcutaneous fat relative to visceral fat, further influences survival, suggesting that tailored treatment strategies may improve outcomes.