Impact of Body Mass Index on the Outcome and Overall Survival of Patients with Esophageal Squamous Cell Cancer after Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUOYue-kui ¹ , WANGCheng ² , MENGYu-qi ² , GUOQuan-wei ² ,  ZHANGJian-hua ²

1. The Second Medical College, Lanzhou University, Lanzhou 730030, P. R. China;
2. Department of Thoracic Surgery, The Second Hospital, Lanzhou University, Lanzhou 730030, P. R. China;

Corresponding author：

ZHANGJian-hua, Email: 972659434@qq.com

Keywords：

Esophageal squamous cell cancer; Body mass index; Complication; Surgery; Prognosis

DOI：

10.7507/1007-4848.20160110

Video：

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Objectives To evaluate the effect of preoperative body mass index (BMI) on the perioperative and long-term results in esophageal squamous cell cancer patients. Method We retrospectively analyzed the clinical data of 503 patients with esophageal cancer between January 2001 and December 2009. There were 268 males and 235 females with the median age of 57 years ranging from 32-88 years. The associations between preoperative BMI and clinic patholo-gical characteristics were assessed by using the χ² or Fisher's exact test. Survival analysis was performed by Kaplan-Meier curves with log-rank tests. Results The 1-year, 3-year, 5-year, and 10-year overall survival rate for the entire cohort of patients was 64.0%, 49.0%, 43.0%, and 41.0% respectively. The occurance rates of weight loss, lymph node metastases, and poorly differentiated tumorigenesis represented statistically higher in patients with BMI≤18.5 kg/m² than those in the patients with BMI>18.5 kg/m² (P=0.026, P=0.006, P=0.048). For the cohort, the Kaplan-Meier survival analysis showed a significant trend toward a decreased survival in esophageal cancer patients with underweight (P=0.001). No statistical difference in overall complication, anastomotic leakage, and pulmonary complication rate was detected among the different BMI classes(P=0.162, P=0.590, P=0.376). Univariate and multivariate analysis showed that the drinking status, pathological stage, and underweight were the independent prognostic factors. Conclusions After esophagectomy, BMI is not associated with the incidence of postoperative complications in patients. Patients with underweight are usually diagnosed with advanced stage, therefore tend to have poorer survivals than those with normal or over-weight.

Citation： LUOYue-kui, WANGCheng, MENGYu-qi, GUOQuan-wei, ZHANGJian-hua. Impact of Body Mass Index on the Outcome and Overall Survival of Patients with Esophageal Squamous Cell Cancer after Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(5): 467-471. doi: 10.7507/1007-4848.20160110 Copy

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3.	Refaely Y, Krasna MJ. Multimodality therapy for esophageal cancer. Surg Clin North Ame, 2002, 82(4):729-746.
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6.	Viklund P, Lindblad M, Lu M, et al. Risk factors for complications after esophageal cancer resection:A prospective population-based study in sweden. Ann Surg, 2006, 243(2):204-211.
7.	Grotenhuis BA, Wijnhoven BP, Hotte GJ, et al. Prognostic value of body mass index on short-term and long-term outcome after resection of esophageal cancer. World J Surg, 2010, 34(11):2621-2627.
8.	Oh SJ, Hyung WJ, Li C, et al. Effect of being overweight on postoper-ative morbidity and long-term surgical outcomes in proximal gastric carcinoma. J Gastroenterol Hepatol, 2009, 24(3):475-479.
9.	Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. New Eng J Med, 2003, 348(17):1625-1638.
10.	Yoon HH, Lewis MA, Shi Q, et al. Prognostic impact of body mass index stratified by smoking status in patients with esophageal adenocarcinoma. J clin Oncol, 2011, 29(34):4561-4567.
11.	Melis M, Weber JM, McLoughlin JM, et al. An elevated body mass index does not reduce survival after esophagectomy for cancer. Ann Surg Oncol, 2011, 18(3):824-831.
12.	Blom RL, Lagarde SM, Klinkenbijl JH, et al. A high body mass index in esophageal cancer patients does not influence postoperative outcome or long-term survival. Ann Surgical Oncol, 2012, 19(3):766-771.
13.	Hayashi Y, Correa AM, Hofstetter WL, et al. The influence of high body mass index on the prognosis of patients with esophageal cancer after surgery as primary therapy. Cancer, 2010, 116(24):5619-5627.
14.	Scarpa M, Cagol M, Bettini S, et al. Overweight patients operated on for cancer of the esophagus survive longer than normal-weight patients. J Gastrointest Surg, 2013, 17(2):218-227.
15.	Hayashi Y, Correa AM, Hofstetter WL, et al. Patients with high body mass index tend to have lower stage of esophageal carcinoma at diagnosis. Dis Esoph, 2012, 25(7):614-622.
16.	Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC Cancer Staging Manual:esophagus and esophagogastric junction. Ann Surg Oncol, 2010, 17(7):1721-1734.
17.	龙梦云, 韦诗友, 黄芊, 等. 两种食管上提径路对食管癌患者术后并发症影响的系统评价和Meta分析. 中国胸心血管外科临床杂志, 2015, 22(2):91-99.
18.	Ramos Chaves M, Boleo-Tome C, Monteiro-Grillo I, et al. The diversity of nutritional status in cancer:new insights. Oncologist, 2010, 15(5):523-530.
19.	Di Fiore F, Lecleire S, Pop D, et al. Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol, 2007, 102(11):2557-2563.
20.	RK Chandra. Impact of nutritional status and nutrient supplements on immune responses and incidence of infection in older indivi-duals. Ageing Res Rev, 2004, 3:91-104.
21.	Miller KR, Bozeman MC. Nutrition therapy issues in esophageal cancer. Curr Gastroenterol Rep, 2012, 14:356-366.
22.	刘勇恩, 寇瑛莉. 食管癌术后肺部并发症发生的原因及防治进展. 中国胸心血管外科临床杂志, 2008, 15(2):138-142.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2):87-108.
2. Ke L. Mortality and incidence trends from esophagus cancer in selected geographic areas of china circa 1970-1990. Int J Cancer, 2002, 102(3):271-274.
3. Refaely Y, Krasna MJ. Multimodality therapy for esophageal cancer. Surg Clin North Ame, 2002, 82(4):729-746.
4. Enzinger PC, Mayer RJ. Esophageal cancer. New Eng J Med, 2003, 349(23):2241-2252.
5. Wu PC, Posner MC. The role of surgery in the management of esophageal cancer. Lancet Oncol, 2003, 4(8):481-488.
6. Viklund P, Lindblad M, Lu M, et al. Risk factors for complications after esophageal cancer resection:A prospective population-based study in sweden. Ann Surg, 2006, 243(2):204-211.
7. Grotenhuis BA, Wijnhoven BP, Hotte GJ, et al. Prognostic value of body mass index on short-term and long-term outcome after resection of esophageal cancer. World J Surg, 2010, 34(11):2621-2627.
8. Oh SJ, Hyung WJ, Li C, et al. Effect of being overweight on postoper-ative morbidity and long-term surgical outcomes in proximal gastric carcinoma. J Gastroenterol Hepatol, 2009, 24(3):475-479.
9. Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. New Eng J Med, 2003, 348(17):1625-1638.
10. Yoon HH, Lewis MA, Shi Q, et al. Prognostic impact of body mass index stratified by smoking status in patients with esophageal adenocarcinoma. J clin Oncol, 2011, 29(34):4561-4567.
11. Melis M, Weber JM, McLoughlin JM, et al. An elevated body mass index does not reduce survival after esophagectomy for cancer. Ann Surg Oncol, 2011, 18(3):824-831.
12. Blom RL, Lagarde SM, Klinkenbijl JH, et al. A high body mass index in esophageal cancer patients does not influence postoperative outcome or long-term survival. Ann Surgical Oncol, 2012, 19(3):766-771.
13. Hayashi Y, Correa AM, Hofstetter WL, et al. The influence of high body mass index on the prognosis of patients with esophageal cancer after surgery as primary therapy. Cancer, 2010, 116(24):5619-5627.
14. Scarpa M, Cagol M, Bettini S, et al. Overweight patients operated on for cancer of the esophagus survive longer than normal-weight patients. J Gastrointest Surg, 2013, 17(2):218-227.
15. Hayashi Y, Correa AM, Hofstetter WL, et al. Patients with high body mass index tend to have lower stage of esophageal carcinoma at diagnosis. Dis Esoph, 2012, 25(7):614-622.
16. Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC Cancer Staging Manual:esophagus and esophagogastric junction. Ann Surg Oncol, 2010, 17(7):1721-1734.
17. 龙梦云, 韦诗友, 黄芊, 等. 两种食管上提径路对食管癌患者术后并发症影响的系统评价和Meta分析. 中国胸心血管外科临床杂志, 2015, 22(2):91-99.
18. Ramos Chaves M, Boleo-Tome C, Monteiro-Grillo I, et al. The diversity of nutritional status in cancer:new insights. Oncologist, 2010, 15(5):523-530.
19. Di Fiore F, Lecleire S, Pop D, et al. Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol, 2007, 102(11):2557-2563.
20. RK Chandra. Impact of nutritional status and nutrient supplements on immune responses and incidence of infection in older indivi-duals. Ageing Res Rev, 2004, 3:91-104.
21. Miller KR, Bozeman MC. Nutrition therapy issues in esophageal cancer. Curr Gastroenterol Rep, 2012, 14:356-366.
22. 刘勇恩, 寇瑛莉. 食管癌术后肺部并发症发生的原因及防治进展. 中国胸心血管外科临床杂志, 2008, 15(2):138-142.

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Impact of Body Mass Index on the Outcome and Overall Survival of Patients with Esophageal Squamous Cell Cancer after Surgery

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