<p>Prognostic significance of combined pretreatment body mass index (BMI) and BMI loss in patients with esophageal cancer</p>

Abstract

Background: Body mass index (BMI) has been associated with a risk of esophageal cancer. However, the influence of BMI and BMI loss on people with esophageal cancer that were treated with different therapies has not been described in China. Methods: In total, 615 consecutive patients that underwent esophagectomy and/or chemotherapy/radiotherapy were classified according to the Asian-specific BMI (kg/m 2 ) cutoff values. The impact of BMI and BMI loss on long-term overall survival (OS) was estimated using the Kaplan–Meier method and Cox proportional hazard models. Results: Multivariate analysis showed that overweight and obese patients had a more favorable survival than normal weight and underweight patients ( p =0.017). Patients with a low BMI and high BMI loss before therapy had worse OS than others ( p =0.001). Subgroup analysis showed that patients with a high BMI were more likely to suffer hypertension ( p <0.001) and receive only surgery ( p <0.001), and they were less likely to be smokers ( p =0.007) and anemic ( p <0.001). Conversely, patients with high BMI loss were more likely to be anemic ( p =0.001), to have advanced pathological stage ( p =0.012), and to receive chemotherapy and radiotherapy ( p =0.001). Moreover, the mortality rate was higher when patients had a high BMI loss. There is no survival benefit of higher BMI in the non-esophageal squamous cell carcinoma (ESCC) group. Conclusion: Pretreatment BMI was an independent prognostic factor for long-term survival in esophageal cancer patients treated with different treatments. The overall survival was increased in esophageal cancer patients with a high pretreatment BMI and no BMI loss. There is no survival benefit of higher BMI in the non-ESCC group.

Visceral Obesity, Metabolic Syndrome, and Esophageal Adenocarcinoma

“…Increased risk of dose-limiting toxicity may be due to reduced volume of distribution in lean body mass relative to calculated body surface area, with significant variation in the effective volume of distribution in obesity (145,146). In addition, patients with obesity often exhibit a greater number of baseline comorbidities, which may impact treatment tolerance (147,148). In some studies, patients with obesity were less likely to receive neoadjuvant therapy despite a similar stage at presentation (149).…”

“…Esophageal cancer surgery is associated with significant morbidity, and anastomotic leak, pneumonia, and atrial fibrillation are the most common major complications. Patients with VO and/or MetS may have greater respiratory and cardiac comorbidity, and T2DM, and reduced functional capacity, in particular with respect to pulmonary physiology (147,148). Baseline lung function testing predicts postoperative pulmonary complications among patients undergoing esophagectomy.…”

“…Despite differences in tolerance to preoperative (neoadjuvant) chemotherapy or chemoradiotherapy in esophageal cancer, limited data suggest that obesity is associated with similar response rates following neoadjuvant therapy (147,154). In comparative research using BMI as the measure of obesity, several studies demonstrate that increased BMI is associated with improved survival outcomes (148,154,155), with meta-analysis showing significantly (RR = 1.17 [95% CI: 1.03-1.32]) better survival among patients with obesity (26). Sarcopenic obesity however be associated with adverse survival outcomes among patients with esophageal cancer (156).…”

Factors Influencing Survival Time in Patients Treated for Oesophageal Cancer with Palliative Intent in South Africa

“…[29] BMI was shown to be an independent prognostic factor in patients with OSCC, irrespective of the treatment received but data from Africa is lacking. [11] This study underscores the signi cance of the negative impact of low BMI on prognosis in patients with OSCC in an African setting.…”

Perioperative Predictive Markers for Recurrence of Esophageal Cancer after Esophagectomy

“…Nutritional and immunological statuses are shown to be significant predictors of cancer progression and survival [8][9][10][11]. Preoperative nutritional and/or immunological factors, including BMI, albumin, prognostic nutritional index (PNI), and neutrophil-to-lymphocyte ratio (NLR), were evaluated with respect to progression in many types of cancer, including EC [12][13][14][15][16][17]. C-reactive protein (CRP) is an acute-phase serum protein and a well-established inflammatory marker; at high concentrations, it is associated with high mortality in solid tumors, including gastrointestinal malignancies [18].…”