title: Early adulthood body mass index, cumulative smoking, and esophageal adenocarcinoma survival.
abstract: Smoking and obesity are esophageal adenocarcinoma (EAC) risk factors. However, the same risk factors may also affect biological aggressiveness and cancer outcomes. Our study evaluated the combined effects of early-adulthood obesity and cumulative smoking on the EAC survival.
  
  
  
  In two EAC cohorts, Toronto (TO; N=235) and Boston (BO; N=329), associations between early adulthood body mass index (EA-BMI), BMI at 1year prior to diagnosis (BMI-1), and smoking with overall survival (OS) were assessed using Cox proportional hazard models, adjusted for relevant covariates.
  
  
  
  Both cohorts were predominantly Caucasian (89%), male (88%), ever-smokers (73%) with locally advanced/metastatic EAC (78%), and good ECOG performance status (90%); median packyears was 34; median EA-BMI, 24; median BMI-1, 25. No relationships with survival were found with BMI-1. For smoking and EA-BMI, TO, BO, and combined TO-BO analyses showed similar associations: smoking conferred worse OS in the combined TO-BO cohort, with adjusted hazard ratios (aHR) of 1.22 (95%CI: 1.15-1.43;p<0.0001) for each 20 pack-year increase. Likewise, EA-BMI ≥25 was associated with worse OS (EA-BMI of 25-<30, aHR=1.84,95%CI: 1.37-2.48; and EA-BMI>30, aHR=2.78, 95%CI: 1.94-3.99). Risk of death was also increased in remotely underweight patients with EA-BMI<18.5 (aHR=2.03,95%CI: 1.27-3.24), when compared to normal-EA-BMI (18≤EA-BMI<25).
  
  
  
  Two key modifiable behaviors, elevated BMI in early adulthood and heavy cumulative smoking history are independently associated with increased mortality risk in two North American cohorts of EAC patients.
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Spreafico
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Coate
authors.affiliation: Harvard School of Public Health, Boston, MA, USA.
authors.forename: Rihong
authors.initials: R
authors.lastname: Zhai
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Zheng-Fei
authors.initials: ZF
authors.lastname: Chen
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Devalben
authors.initials: D
authors.lastname: Patel
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Brandon
authors.initials: B
authors.lastname: Tse
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: M Catherine
authors.initials: MC
authors.lastname: Brown
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Heist
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Lorin
authors.initials: L
authors.lastname: Dodbiba
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Teichman
authors.affiliation: Dana Farber Cancer Institute-Partners Cancer Care, Harvard University, Boston, MA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kulke
authors.affiliation: Harvard School of Public Health, Boston, MA, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Su
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Lawson
authors.initials: L
authors.lastname: Eng
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Knox
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wong
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada.
authors.forename: Gail E
authors.initials: GE
authors.lastname: Darling
authors.affiliation: Harvard School of Public Health, Boston, MA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
authors.affiliation: Princess Margaret Cancer Centre-Ontario Cancer Institute, UHN, University of Toronto, Toronto, Canada. Electronic address: Geoffrey.liu@uhn.ca.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Liu
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004938:Esophageal Neoplasms / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate; D055815:Young Adult
keywords: Body mass index; Esophageal adenocarcinoma; Overall survival; Smoking