title: Patients with high body mass index tend to have lower stage of esophageal carcinoma at diagnosis.
abstract: High body mass index (H-BMI; ≥25 kg/m(2) ) is common in US adults. In a small cohort of esophageal cancer (EC) patients treated with surgery, H-BMI and diagnosis of early stage EC appeared associated. We evaluated a much larger cohort of EC patients. From a prospectively maintained database, we analyzed 925 EC patients who had surgery with or without adjunctive therapy. Various statistical methods were used. Among 925 patients, 69% had H-BMI, and 31% had normal body mass index (<25 kg/m(2) ; N-BMI). H-BMI was associated with men (P<0.001), Caucasians (P=0.064; trend), lower esophageal localization (P<0.001), adenocarcinoma histology (P<0.001), low baseline cT-stage (P=0.003), low baseline overall clinical stage (P=0.003), coronary artery disease (P=0.036), and diabetes (P<0.001). N-BMI was associated with weight loss (P<0.001), alcohol abuse (P=0.056; trend), ever/current smoking (P=0.014), and baseline cN+ (P=0.018). H-BMI patients with cT1 tumors (n=110) had significantly higher rates of gastresophageal reflux disease symptoms (P<0.001), gastresophageal reflux disease history (P<0.001), and Barrett's esophagus history (P<0.001) compared with H-BMI patients with cT2 tumors (n=114). Median survival of N-BMI patients was 36.66 months compared with 53.20 months for H-BMI patients (P=0.005). In multivariate analysis, older age (P<0.001), squamous histology (P=0.002), smoking (P=0.040), weight loss (P=0.002), high baseline stage (P<0.001), high number of ypN+ (P=0.005), high surgical stage (P<0.001), and American Society of Anesthesia scores, three out of four (P<0.001) were independent prognosticators for poor overall survival. We were able to perform propensity-based analysis of surgical complications between H-BMI and N-BMI patients. A comparison of fully matched 376 patients (188 with H-BMI and 188 with N-BMI) found no significant differences in the rate of complications between the two groups. This larger data set confirms that a fraction of H-BMI patients with antecedent history is diagnosed with early baseline EC. Upon validation of our data in an independent cohort, refinements in surveillance of symptomatic H-BMI patients are warranted and could be implemented. Our data also suggest that H-BMI patients do not experience higher rate of surgical complications compared with N-BMI patients.
authors.affiliation: Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Hayashi
authors.forename: A M
authors.initials: AM
authors.lastname: Correa
authors.forename: W L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: A A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: R J
authors.initials: RJ
authors.lastname: Mehran
authors.forename: D C
authors.initials: DC
authors.lastname: Rice
authors.forename: A
authors.initials: A
authors.lastname: Suzuki
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: M S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: J
authors.initials: J
authors.lastname: Welsh
authors.forename: S H
authors.initials: SH
authors.lastname: Lin
authors.forename: D M
authors.initials: DM
authors.lastname: Maru
authors.forename: S G
authors.initials: SG
authors.lastname: Swisher
authors.forename: J A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications*; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors