The influence of high body mass index on the prognosis of patients with esophageal cancer after surgery as primary therapy

Abstract

BACKGROUND: High body mass index (BMI), a prevalent condition in the United States, is associated with esophageal adenocarcinoma (EAC). Its influence on a patient's outcome remains unclear. In the current study, the authors examined the impact of BMI on survival and complications in patients with esophageal cancer (EC) who underwent surgery as their primary therapy. METHODS: The authors retrospectively reviewed 301 consecutive EC patients who underwent surgery but received no adjunctive therapy. Patients were segregated into 2 subgroups based on their baseline BMI: normal/low (<25 kg/m 2 ) and high ( 25 kg/m 2 ). RESULTS: Seventy-six (25%) patients had a BMI <25 kg/m 2 and 225 (75%) patients had a BMI 25 kg/m 2 . In the high BMI group, there were more men (P < .001), fewer upper ECs (P ¼ .021), a lower baseline clinical stage (P ¼ .006), and frequent EAC (P < .001). Postoperative morbidity was similar in both groups, with the exception of gastrointestinal complications (P ¼ .016). The 5-year overall survival (OS) rates were 44% in the normal/low BMI group and 60% in the high BMI group (P ¼ .017). The 5-year disease-free survival (DFS) rates were 41% in the normal/low BMI group and 60% in the high BMI group (P ¼ .005). On multivariable analysis, age, weight loss, peripheral vascular disease (PVD), and both clinical and pathological stage of disease were found to be independent prognosticators for OS. Older age (hazard ratio [HR]

Predictors of survival among patients diagnosed with adenocarcinoma of the esophagus and gastroesophageal junction

“…Similarly, a surgical series conducted in Canada reported better survival for obese patients (preoperative BMI C 30) who had undergone surgical resection for EAC [17]. In contrast, surgical series in Ireland [26] and Houston, USA [18] found that obesity (preoperative BMI C 30) did not independently influence survival for EAC. In univariate analyses, we found that obesity (BMI C 30 1 year prior to diagnosis) was associated with better survival for patients with EAC tumors.…”

“…Only two previous population-based studies have investigated whether lifestyle factors influence survival for EAC [12,16]. While one study reported a better prognosis for EAC in obese patients [12], there was no association in the other study [16], and it remains unclear whether the inverse association was confounded by tumor stage [17,18]. Other lifestyle factors, including smoking and alcohol, did not influence EAC survival [12,16].…”

Significant Variation of Resected Meso-esophageal Tissue Volume in Two-Stage Subtotal Esophagectomy Specimens: A Retrospective Morphometric Study

“…However, several recent studies in esophageal cancer patients all demonstrate that the total lymph node yield is not related to BMI. [31][32][33] These findings could potentially provide some indirect evidence that the meso-esophageal tissue volume also might not be related to the BMI.…”

The prognostic influence of body mass index, resting energy expenditure and fasting blood glucose on postoperative patients with esophageal cancer

“…High BMI in surgical patients is thought to be associated with increased comorbidities and postoperative complications, but the influence of high BMI on survival in patients undergoing esophagectomy is controversial. Hayashi found patients with high BMI showed better overall survival (OS) and disease-free survival (DFS) because of the early clinical diagnosis [5]. In contrast to this, Yoon pointed out that high BMI was independently associated with two-fold worsening of DFS, and OS after surgery for EAC [6].…”