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Prognostic Significance of Combined Pretreatment Body Mass Index (BMI) and BMI Loss in Patients With Esophageal Cancer

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Prognostic Significance of Combined Pretreatment Body Mass Index (BMI) and BMI Loss in Patients With Esophageal Cancer

Wen-Shen Gu et al. Cancer Manag Res.

Abstract

Background: Body mass index (BMI) has been associated with a risk of esophageal cancer. However, the influence of BMI and BMI loss on people with esophageal cancer that were treated with different therapies has not been described in China. Methods: In total, 615 consecutive patients that underwent esophagectomy and/or chemotherapy/radiotherapy were classified according to the Asian-specific BMI (kg/m2) cutoff values. The impact of BMI and BMI loss on long-term overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional hazard models. Results: Multivariate analysis showed that overweight and obese patients had a more favorable survival than normal weight and underweight patients (p=0.017). Patients with a low BMI and high BMI loss before therapy had worse OS than others (p=0.001). Subgroup analysis showed that patients with a high BMI were more likely to suffer hypertension (p<0.001) and receive only surgery (p<0.001), and they were less likely to be smokers (p=0.007) and anemic (p<0.001). Conversely, patients with high BMI loss were more likely to be anemic (p=0.001), to have advanced pathological stage (p=0.012), and to receive chemotherapy and radiotherapy (p=0.001). Moreover, the mortality rate was higher when patients had a high BMI loss. There is no survival benefit of higher BMI in the non-esophageal squamous cell carcinoma (ESCC) group. Conclusion: Pretreatment BMI was an independent prognostic factor for long-term survival in esophageal cancer patients treated with different treatments. The overall survival was increased in esophageal cancer patients with a high pretreatment BMI and no BMI loss. There is no survival benefit of higher BMI in the non-ESCC group.

Keywords: BMI; BMI loss; esophageal cancer; long-term survival.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Prognostic significance of BMI in 615 esophageal cancer patients. The 10 year overall survival rate was calculated using the Kaplan-Meier method and analyzed with the log-rank test. The patients were categorized into a low BMI group, normal BMI group and a high BMI group, according to the Asian-specific BMI cutoff. A high BMI level was a favorable prognostic factor in whole esophageal cancer patients cohort.Abbreviation: BMI, body mass index.
Figure 2
Figure 2
Prognostic significance of BMI in ESCC and non-ESCC groups. The overall survival rate was calculated using the Kaplan-Meier method and analyzed with the log-rank test. The patients were categorized into either the ESCC group or the non-ESCC group. (A) The 10 year overall survival rate was different in these two groups. (B) A high BMI was a favorable prognostic factor in the ESCC group. (C) There were no statistically significant differences in the non-ESCC group. Abbreviations: BMI, body mass index; ESCC, esophageal squamous cell carcinoma.
Figure S1
Figure S1
Combining the prognostic significance of BMI and BMI loss. The overall survival rate was calculated using the Kaplan-Meier method and analyzed with the log-rank test. The patients were categorized into three groups: group 1 (no BMI loss), group 2 (BMI loss ≤2), and group 3 (BMI loss >2). (A) Patients with no BMI loss had a higher 10 year overall survival rate. (B) Patients with a high BMI and no BMI loss had a significantly higher survival probability than the other groups. (C) The mortality rate increased as BMI loss increased.

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