Objective — to determine the impact of the degree and pattern of deposition of fatty tissue and its metabolic activity on the course of colorectal cancer (CRC). Material and methods. This investigation enrolled 291 patients with CRC without late metastasis at their initial visit, who had received radical treatment at the Russian Scientific Center of Roentgenoradiology, Ministry of Health of the Russian Federation, in 1996 to 2014. The results of special treatment and long-term follow-up were available for all patients. The study group patients were divided according to body mass index (BMI). The pattern of fat deposition was determined in 75% of the patients who were divided into central and peripheral fat deposition groups. Fatty tissue hormones (leptin, resistin, and adiponectin) and insulin were investigated in 47 patients. The course of CRC was examined in the formed groups and subgroups according to the indicators chosen. Results. The analysis revealed a higher progression rate of CRC in the presence of increased BMI and a significant rise in the frequency of its progression in central and peripheral fat distribution (26.1 and 3.5%, respectively). Assessment of the course of CRC established that at the leptin level of above 30 ng/ml, the prognosis of CRC became significantly worse — its progression occurred in 44.4% of the cases whereas at the leptin level of below 30 ng/ml it was only in 3.5% (p<0.007). Conclusion. The determination of BMI, the pattern of fat disposition, and the serum levels of leptin in patients with CRC can be used as a prognostic factor. The patients with central fat deposition and a serum leptin level of over 30 ng/mg before initiation of special treatment should be included into a group at high risk for CRC progression.