title: Body mass index and survival in esophageal adenocarcinoma treated with chemoradiotherapy followed by esophagectomy.
abstract: BACKGROUND
  Body mass index (BMI) has been linked with inferior outcomes in gastrointestinal malignancies. The purpose of this study is to evaluate the effect of BMI on survival in patients with esophageal adenocarcinoma.
  
  
  METHODS
  Medical records were analyzed for patients who underwent esophagectomy after neoadjuvant chemoradiotherapy (nCRT) for adenocarcinoma from 2000 to the present. Patients were grouped into BMI ≤ 25, >25-30, >30-35, and BMI >35. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method. Multivariate analysis (MVA) was performed using Cox proportional hazard regression model.
  
  
  RESULTS
  We identified 303 patients for the analysis. The only difference in patient characteristics between groups was gender. We found no difference in OS and DFS associated with BMI (p=0.3297 for OS; p=0.5950 for DFS). There were no differences in postoperative complications or mortality between BMI groups. MVA revealed that higher stage and less than a complete response to nCRT were prognostic for worse OS and DFS, while age, gender, type of surgery, year of diagnosis, and BMI were not prognostic.
  
  
  CONCLUSIONS
  BMI was neither associated with surgical complications nor survival in patients with esophageal adenocarcinoma treated with nCRT. BMI should not be considered a contraindication to surgical resection after nCRT.
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL 33612, USA. Ravi.Shridhar@moffitt.org
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.forename: Thomas
authors.initials: T
authors.lastname: Hayman
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hoffe
authors.forename: Jill
authors.initials: J
authors.lastname: Weber
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Almhanna
authors.forename: Michael
authors.initials: M
authors.lastname: Chuong
authors.forename: Richard C
authors.initials: RC
authors.lastname: Karl
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Meredith
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015992:Body Mass Index; D059186:Chemoradiotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome