The influence of high body mass index on the prognosis of patients with esophageal cancer after surgery as primary therapy.
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 = .021), a lower baseline clinical stage (P = .006), and frequent EAC (P < .001). Postoperative morbidity was similar in both groups, with the exception of gastrointestinal complications (P = .016). The 5-year overall survival (OS) rates were 44% in the normal/low BMI group and 60% in the high BMI group (P = .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 = .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], 1.029; 95% confidence interval [95% CI], 1.009-1.049 [P = .004]), weight loss (HR, 1.525; 95% CI, 1.034-2.248 [P = .033]), and PVD (HR, 2.325; 95% CI, 1.039-5.204 [P = .040]) were found to be associated with poor OS.


CONCLUSIONS
High BMI is common in EC patients and the better OS/DFS noted in patients with a high BMI is because of the diagnosis of a low baseline clinical stage. Confirmation of these findings is warranted.
Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Yuki
Y
Hayashi
Arlene M
AM
Correa
Wayne L
WL
Hofstetter
Ara A
AA
Vaporciyan
David C
DC
Rice
Garrett L
GL
Walsh
Reza J
RJ
Mehran
Jeffrey H
JH
Lee
Manoop S
MS
Bhutani
Alexander
A
Dekovich
Stephen G
SG
Swisher
Jaffer A
JA
Ajani
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000368:Aged; D015992:Body Mass Index; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate