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BMI-ARDI relationships were similar (TE \u22121.08% [\u22121.44, \u22120.72]), but ARDI-OS relationships were inverted (HR 1.05 [1.01, 1.09]). BMI showed no association with grade 3+ toxicity (OR 1.01 (0.91, 1.14)). However, toxicity was associated with worse OS (TE HR 1.37 [1.17, 1.61]), which attenuated on adjusting for ACRD (DE HR 1.20 [1.02, 1.41]), suggesting partial mediation via a significant toxicity-ACRD relationship (\u221210.37% [\u221211.77, \u22128.97]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study establishes possible adverse indirect effects of obesity on CRC survival, through treatment-selection, supporting full BSA-based ACT dosing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41416-026-03472-4","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T15:19:42Z","timestamp":1781018382000},"page":"773-783","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Body mass index, adjuvant chemotherapy, toxicity, and survival in non-metastatic colorectal cancer: an individual participant data meta-analysis (OCTOPUS)"],"prefix":"10.1038","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1243-7253","authenticated-orcid":false,"given":"Corinna G. 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RR receives royalties from Wiley from the sale of his IPD meta-analysis textbook; consultancy fee from the BMJ for statistical reviews. RGJ has received honoraria from Servier. All other authors have no conflicts of interest.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Ethics approval was not required for this study. Ethics approval for the individual trials included was obtained by the individual trials, and anonymised individual participant data was shared according to data transfer agreements with the trial centres. Patient informed consent was also obtained by the individual trials for trial participation, and was not directly required for this study. No informed consent was required in relation to imaging, as no patient imaging is included within the study. All methods were performed in accordance with PRISMA guidelines.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Ethics"}}]}}