title: The correlation between high body mass index and survival in patients with esophageal cancer after curative esophagectomy: evidence from retrospective studies.
abstract: OBJECTIVE
  To investigate the predictive value of high body mass index (H-BMI) on the survival of patients with esophageal cancer (EC) after curative esophagectomy.
  
  
  METHODS
  Studies were systematically identified to investigate the relationship between overweight and obese (H-BMI) and clinical outcomes in EC patients treated with curative esophagectomy. Measured clinical outcomes were disease-free survival (DFS) and overall survival (OS). The pooled hazard ratio (HR) with 95% confidence interval (CI) was estimated. Subgroup analyses were performed according to tumour type and body mass index (BMI).
  
  
  RESULTS
  Fourteen studies with 4823 cases were included in the final pooled quantitative analysis. In EC patients overall, H-BMI was associated with improved DFS (HR, 0.83; 95% CI: 0.75-0.90) and OS (HR, 0.79; 95 % CI: 0.73-0.85), as compared with normal BMI. The results were consistent with those who were overweight. Among patients with esophageal adenocarcinoma (EAC), a better prognosis, as reflected by OS, was observed with H-BMI (HR, 0.81; 95% CI: 0.73-0.89). The same results were also observed in EAC patients who were obese and overweight. In contrast, among patients with esophageal squamous cell carcinoma (ESCC), H-BMI was associated with a worse prognosis, as reflected by DFS (HR, 2.26; 95% CI: 1.29-3.24).
  
  
  CONCLUSIONS
  H-BMI has distinctly different impacts on the postoperative survival of EAC and ESCC patients. H-BMI is a potential predictor for better prognosis in EC patients overall, and particularly in EAC patients, treated with curative esophagectomy. However, in ESCC patients, H-BMI is a potential predictor for a worse prognosis of postoperative survival.
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.|Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
authors.forename: Wenbiao
authors.initials: W
authors.lastname: Pan
authors.affiliation: Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
authors.forename: Yangwei
authors.initials: Y
authors.lastname: Xiang
authors.affiliation: Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China. Email: vwtfang@hotmail.com.
authors.forename: Wentao
authors.initials: W
authors.lastname: Fang
mesh_terms: D015992:Body Mass Index; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies