{"id":"https://openalex.org/W7213904321","doi":"https://doi.org/10.64898/2026.09.19.26363465","title":"Weighing the Odds: Body Mass Index and Recurrence-Free Survival in Early-Onset Colorectal Cancer","display_name":"Weighing the Odds: Body Mass Index and Recurrence-Free Survival in Early-Onset Colorectal Cancer","publication_year":2026,"publication_date":"2026-09-21","ids":{"openalex":"https://openalex.org/W7213904321","doi":"https://doi.org/10.64898/2026.09.19.26363465"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.19.26363465","doi":"https://doi.org/10.64898/2026.09.19.26363465","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.19.26363465","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/21/2026.09.19.26363465.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/21/2026.09.19.26363465.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5152335160","display_name":"Erik Delryd","orcid":"https://orcid.org/0009-0000-4860-2690","observed_orcids":["https://orcid.org/0009-0000-4860-2690"]},"institutions":[{"id":"https://openalex.org/I881427289","display_name":"University of Gothenburg","ror":"https://ror.org/01tm6cn81","country_code":"SE","type":"education","lineage":["https://openalex.org/I881427289"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Erik Delryd","raw_affiliation_strings":["Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 412 96 Gothenburg, Sweden"],"raw_orcid":"https://orcid.org/0009-0000-4860-2690","affiliations":[{"raw_affiliation_string":"Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 412 96 Gothenburg, Sweden","institution_ids":["https://openalex.org/I881427289"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5124502043","display_name":"Andy Tran","orcid":"https://orcid.org/0000-0002-8370-9749","observed_orcids":["https://orcid.org/0000-0002-8370-9749"]},"institutions":[{"id":"https://openalex.org/I126307644","display_name":"University of Iowa","ror":"https://ror.org/036jqmy94","country_code":"US","type":"education","lineage":["https://openalex.org/I126307644"]},{"id":"https://openalex.org/I4210142782","display_name":"University of Iowa Health Care","ror":"https://ror.org/0431j1t39","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I126307644","https://openalex.org/I4210142782"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Andy Tran","raw_affiliation_strings":["Department of Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA"],"raw_orcid":"https://orcid.org/0000-0002-8370-9749","affiliations":[{"raw_affiliation_string":"Department of Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA","institution_ids":["https://openalex.org/I126307644","https://openalex.org/I4210142782"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5059806276","display_name":"Elinor Bexe Lindskog","orcid":"https://orcid.org/0000-0003-1466-1486","observed_orcids":["https://orcid.org/0000-0003-1466-1486"]},"institutions":[{"id":"https://openalex.org/I2801112325","display_name":"Sahlgrenska University Hospital","ror":"https://ror.org/04vgqjj36","country_code":"SE","type":"healthcare","lineage":["https://openalex.org/I2801112325"]},{"id":"https://openalex.org/I4210095705","display_name":"Region V\u00e4stra G\u00f6taland","ror":"https://ror.org/00a4x6777","country_code":"SE","type":"government","lineage":["https://openalex.org/I4210095705"]},{"id":"https://openalex.org/I881427289","display_name":"University of Gothenburg","ror":"https://ror.org/01tm6cn81","country_code":"SE","type":"education","lineage":["https://openalex.org/I881427289"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Elinor Bexe Lindskog","raw_affiliation_strings":["Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 412 96 Gothenburg, Sweden","Department of Surgery, Sahlgrenska University Hospital, Region V\u00e4stra G\u00f6taland, 413 45 Gothenburg, Sweden"],"raw_orcid":"https://orcid.org/0000-0003-1466-1486","affiliations":[{"raw_affiliation_string":"Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 412 96 Gothenburg, Sweden","institution_ids":["https://openalex.org/I881427289"]},{"raw_affiliation_string":"Department of Surgery, Sahlgrenska University Hospital, Region V\u00e4stra G\u00f6taland, 413 45 Gothenburg, Sweden","institution_ids":["https://openalex.org/I2801112325","https://openalex.org/I4210095705"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5041778425","display_name":"David Ljungman","orcid":"https://orcid.org/0000-0003-0419-1118","observed_orcids":["https://orcid.org/0000-0003-0419-1118"]},"institutions":[{"id":"https://openalex.org/I2801112325","display_name":"Sahlgrenska University Hospital","ror":"https://ror.org/04vgqjj36","country_code":"SE","type":"healthcare","lineage":["https://openalex.org/I2801112325"]},{"id":"https://openalex.org/I4210095705","display_name":"Region V\u00e4stra G\u00f6taland","ror":"https://ror.org/00a4x6777","country_code":"SE","type":"government","lineage":["https://openalex.org/I4210095705"]},{"id":"https://openalex.org/I881427289","display_name":"University of Gothenburg","ror":"https://ror.org/01tm6cn81","country_code":"SE","type":"education","lineage":["https://openalex.org/I881427289"]}],"countries":["SE"],"is_corresponding":true,"raw_author_name":"David Ljungman","raw_affiliation_strings":["Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 412 96 Gothenburg, Sweden","Department of Surgery, Sahlgrenska University Hospital, Region V\u00e4stra G\u00f6taland, 413 45 Gothenburg, Sweden"],"raw_orcid":"https://orcid.org/0000-0003-0419-1118","affiliations":[{"raw_affiliation_string":"Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 412 96 Gothenburg, Sweden","institution_ids":["https://openalex.org/I881427289"]},{"raw_affiliation_string":"Department of Surgery, Sahlgrenska University Hospital, Region V\u00e4stra G\u00f6taland, 413 45 Gothenburg, Sweden","institution_ids":["https://openalex.org/I2801112325","https://openalex.org/I4210095705"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":5,"corresponding_author_ids":["https://openalex.org/A5041778425"],"corresponding_institution_ids":["https://openalex.org/I2801112325","https://openalex.org/I4210095705","https://openalex.org/I881427289"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12103","display_name":"Cancer Risks and Factors","score":0.9003999829292297,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12103","display_name":"Cancer Risks and Factors","score":0.9003999829292297,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10335","display_name":"Colorectal Cancer Surgical Treatments","score":0.03999999910593033,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10010","display_name":"Obesity, Physical Activity, Diet","score":0.012600000016391277,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/early-onset-colorectal-cancer","display_name":"early-onset colorectal cancer","score":0.9990000128746033},{"id":"https://openalex.org/keywords/body-mass-index","display_name":"body mass index","score":0.9380000233650208},{"id":"https://openalex.org/keywords/obesity-paradox","display_name":"obesity paradox","score":0.9900000095367432},{"id":"https://openalex.org/keywords/recurrence-free-survival","display_name":"recurrence-free survival","score":0.9819999933242798},{"id":"https://openalex.org/keywords/colorectal-adenocarcinoma","display_name":"colorectal adenocarcinoma","score":0.8619999885559082},{"id":"https://openalex.org/keywords/body-composition","display_name":"body composition","score":0.6930000185966492},{"id":"https://openalex.org/keywords/tumor-biology","display_name":"tumor biology","score":0.5989999771118164}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8730000257492065},{"id":"https://openalex.org/C2780221984","wikidata":"https://www.wikidata.org/wiki/Q131191","display_name":"Body mass index","level":2,"score":0.8276000022888184},{"id":"https://openalex.org/C526805850","wikidata":"https://www.wikidata.org/wiki/Q188874","display_name":"Colorectal cancer","level":3,"score":0.7928000092506409},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.6757000088691711},{"id":"https://openalex.org/C2780586474","wikidata":"https://www.wikidata.org/wiki/Q332428","display_name":"Overweight","level":3,"score":0.6725999712944031},{"id":"https://openalex.org/C50382708","wikidata":"https://www.wikidata.org/wiki/Q223218","display_name":"Proportional hazards model","level":2,"score":0.6175000071525574},{"id":"https://openalex.org/C143998085","wikidata":"https://www.wikidata.org/wiki/Q162555","display_name":"Oncology","level":1,"score":0.5898000001907349},{"id":"https://openalex.org/C511355011","wikidata":"https://www.wikidata.org/wiki/Q12174","display_name":"Obesity","level":2,"score":0.5335999727249146},{"id":"https://openalex.org/C207103383","wikidata":"https://www.wikidata.org/wiki/Q3930246","display_name":"Hazard ratio","level":3,"score":0.44999998807907104},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.4422000050544739},{"id":"https://openalex.org/C2781121325","wikidata":"https://www.wikidata.org/wiki/Q1146902","display_name":"Underweight","level":4,"score":0.42899999022483826},{"id":"https://openalex.org/C2781182431","wikidata":"https://www.wikidata.org/wiki/Q356033","display_name":"Adenocarcinoma","level":3,"score":0.40700000524520874},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.38609999418258667},{"id":"https://openalex.org/C2777501473","wikidata":"https://www.wikidata.org/wiki/Q1796666","display_name":"Body surface area","level":2,"score":0.3822999894618988},{"id":"https://openalex.org/C10515644","wikidata":"https://www.wikidata.org/wiki/Q543310","display_name":"Survival analysis","level":2,"score":0.36559998989105225},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.35429999232292175},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.35350000858306885},{"id":"https://openalex.org/C146357865","wikidata":"https://www.wikidata.org/wiki/Q1123245","display_name":"Stage (stratigraphy)","level":2,"score":0.32030001282691956},{"id":"https://openalex.org/C2778527826","wikidata":"https://www.wikidata.org/wiki/Q1787017","display_name":"Cancer registry","level":3,"score":0.2538999915122986},{"id":"https://openalex.org/C152877465","wikidata":"https://www.wikidata.org/wiki/Q208042","display_name":"Regression analysis","level":2,"score":0.25110000371932983}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.19.26363465","doi":"https://doi.org/10.64898/2026.09.19.26363465","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.19.26363465","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/21/2026.09.19.26363465.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.19.26363465","doi":"https://doi.org/10.64898/2026.09.19.26363465","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.19.26363465","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/21/2026.09.19.26363465.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"score":1.0,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7213904321.pdf","grobid_xml":"https://content.openalex.org/works/W7213904321.grobid-xml"},"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W4206444608","https://openalex.org/W4400380142","https://openalex.org/W4416535624","https://openalex.org/W7125918383","https://openalex.org/W3185917911","https://openalex.org/W2952283061","https://openalex.org/W7214340473","https://openalex.org/W2003255413","https://openalex.org/W4401893806","https://openalex.org/W4224066401"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Early-Onset":[2],"Colorectal":[3],"Cancer":[4],"(EOCRC,":[5],"<":[6],"50":[7,72],"years)":[8],"is":[9,33],"rising":[10],"sharply":[11],"in":[12,35,43,61,204,208,223],"many":[13],"parts":[14],"of":[15,50,105,252],"the":[16,48,103,154,179,192,211],"world.":[17],"The":[18],"\u201cobesity":[19,212],"paradox\u201d,":[20],"where":[21],"overweight":[22],"correlates":[23],"with":[24,86,133,145,153,174,202],"better":[25],"outcome":[26],"despite":[27],"obesity":[28],"being":[29],"a":[30,125,150,188],"risk":[31],"factor,":[32],"established":[34],"colorectal":[36,68,88],"cancer":[37,69],"(CRC)":[38],"overall":[39],"but":[40,206],"remains":[41],"ambiguous":[42],"EOCRC.":[44,218],"Aim":[45],"To":[46],"investigate":[47],"association":[49,152],"Body":[51],"Mass":[52],"Index":[53],"(BMI)":[54],"at":[55,79,157,162],"diagnosis":[56],"and":[57,63,94,114,128,160,165,178,228,233],"recurrence-free":[58],"survival":[59],"(RFS)":[60],"EOCRC":[62,92,205,232],"compare":[64],"it":[65],"to":[66,107,121,217,239],"average-onset":[67],"(AOCRC,":[70],"\u2265":[71],"years).":[73],"Methods":[74],"A":[75],"retrospective":[76],"cohort":[77],"study":[78],"Sahlgrenska":[80],"University":[81],"Hospital":[82],"included":[83],"1,459":[84],"patients":[85],"curative-intent":[87],"adenocarcinoma":[89],"surgery":[90],"comprising":[91],"(n=159)":[93],"AOCRC":[95,168,209,234],"(n=1,300)":[96],"cohorts.":[97],"Cox":[98],"proportional":[99],"hazards":[100],"models":[101],"assessed":[102,132],"relation":[104],"BMI":[106,123,141,158,163,170,198],"RFS,":[108],"adjusted":[109],"for":[110],"tumour":[111,226],"stage,":[112],"location,":[113],"differentiation.":[115],"Restricted":[116],"cubic":[117],"splines":[118],"were":[119],"used":[120],"model":[122,129],"as":[124,247,249],"continuous":[126,140,169],"variable,":[127],"fit":[130],"was":[131,142,171,182,199],"likelihood-ratio":[134],"tests":[135],"(LRT).":[136],"Results":[137],"In":[138,167],"EOCRC,":[139],"significantly":[143,200],"associated":[144,173,201],"RFS":[146,175,203],"(LRT":[147,176,194],"p=0.02),":[148],"displaying":[149],"U-shaped":[151],"lowest":[155],"hazard":[156],"27":[159],"highest":[161],"<20":[164],">30.":[166],"not":[172,207],"p=0.15)":[177],"spline":[180],"curve":[181],"flat.":[183],"An":[184],"interaction":[185],"analysis":[186],"showed":[187],"significant":[189],"difference":[190],"between":[191,231],"cohorts":[193],"p=0.046).":[195],"Conclusion":[196],"Continuous":[197],"suggesting":[210],"paradox\u201d":[213],"may":[214,220,236],"be":[215,237],"specific":[216],"This":[219],"reflect":[221],"differences":[222],"body":[224,253],"composition,":[225],"biology":[227],"systemic":[229],"metabolism":[230],"or":[235],"due":[238],"methodological":[240],"biases.":[241],"Future":[242],"research":[243],"should":[244],"incorporate":[245],"biomarkers,":[246],"well":[248],"refined":[250],"measures":[251],"composition.":[254]},"counts_by_year":[],"updated_date":"2026-11-08T12:12:28.789561","created_date":"2026-09-22T00:00:00"}