The Impact of Body Mass Index on Complication and Survival in Resected Oesophageal Cancer: a Clinical-based Cohort and Meta-analysis

Overview

Journal Br J Cancer

Specialty Oncology

Date 2013 Nov 9

PMID 24201750

Citations 71

Authors

S S Zhang

H Yang

K J Luo

Q Y Huang

J Y Chen

F Yang

X L Cai

X Xie

Q W Liu

A E Bella

R G Hu

J Wen

Y Hu

J H Fu

Affiliations

Soon will be listed here.

Abstract

Background: Body mass index (BMI) has been associated with the risk of oesophageal cancer. But the influence of BMI on postoperative complication and prognosis has always been controversial.

Methods: In total, 2031 consecutive patients who underwent oesophagectomy between 1998 and 2008 were classified according to Asian-specific BMI (kg m(-2)) cutoff values. The impact of BMI on overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional hazard models. We performed a meta-analysis to examine the association of BMI with OS and postoperative complication.

Results: Patients with higher BMI had more postoperative complication (P=0.002), such as anastomotic leakage (P=0.016) and cardiovascular diseases (P<0.001), but less incidence of chylous leakage (P=0.010). Logistic regression analysis showed that BMI (P=0.005) was a confounding factor associated with postoperative complication. Multivariate analysis showed that overweight and obese patients had a more favourable survival than normal weight patients (HR (hazard ratio) = 0.80, 95% CI (confidence interval): 0.70-0.92, P=0.001). Subgroup analysis showed that the association with higher BMI and increased OS was observed in patients with oesophageal squamous cell carcinoma (ESCC) (P<0.001), oesophageal adenocarcinoma (EA) (P=0.034), never-smoking (P=0.035), ever-smoking (P=0.035), never alcohol consumption (P=0.005), weight loss (P=0.003) and advanced pathological stage (P<0.001). The meta-analysis further corroborated that higher BMI was associated with increased complication of anastomotic leakage (RR (risk ratio)=1.04, 95% CI: 1.02-1.06, P=0.001), wound infection (RR=1.03, 95% CI: 1.00-1.05, P=0.031) and cardiovascular diseases (RR=1.02, 95% CI: 1.00-1.05, P=0.039), but decreased incidence of chylous leakage (RR=0.98, 95% CI: 0.96-0.99, P<0.001). In addition, high BMI could significantly improved OS (HR=0.78, 95% CI: 0.71-0.85, P<0.001).

Conclusion: Preoperative BMI was an independent prognostic factor for survival, and strongly associated with postoperative complications in oesophageal cancer.

Citing Articles

The adipokines in oral cancer pathogenesis and its potential as a new therapeutic approach.

Wang X, Wang J, Zhao X, Zhang J, Zhang Y Naunyn Schmiedebergs Arch Pharmacol. 2025; .

PMID: 40056203 DOI: 10.1007/s00210-025-03939-w.

Low L3 skeletal muscle index and endometrial cancer: a statistic pooling analysis.

Aru N, Yang C, Chen Y, Liu J BMC Cancer. 2025; 25(1):43.

PMID: 39780132 PMC: 11716173. DOI: 10.1186/s12885-025-13430-7.

Underweight as a Risk Factor for Major Intra-abdominal Malignancy Surgeries.

Lim J, Ke Y, Hwang N Cureus. 2024; 16(10):e71835.

PMID: 39559639 PMC: 11570910. DOI: 10.7759/cureus.71835.

Effect of body mass index on post-treatment oral function in patients with oral cancer: a cross-sectional study.

Shimamura Y, Matsuda Y, Takeda M, Morioka R, Kotani T, Kanno T Sci Rep. 2024; 14(1):21869.

PMID: 39300157 PMC: 11413172. DOI: 10.1038/s41598-024-67246-9.

The Anatomy of the Thoracic Duct and Cisterna Chyli: A Meta-Analysis with Surgical Implications.

Plutecki D, Bonczar M, Wilk J, Necka S, Joniec M, Elsaftawy A J Clin Med. 2024; 13(15).

PMID: 39124550 PMC: 11313251. DOI: 10.3390/jcm13154285.

References

Melis M, Weber J, McLoughlin J, Siegel E, Hoffe S, Shridhar R . An elevated body mass index does not reduce survival after esophagectomy for cancer. Ann Surg Oncol. 2010; 18(3):824-31. PMC: 4623586. DOI: 10.1245/s10434-010-1336-1. View

Morgan M, Lewis W, Hopper A, Escofet X, Harvard T, Brewster A . Prognostic significance of body mass indices for patients undergoing esophagectomy for cancer. Dis Esophagus. 2007; 20(1):29-35. DOI: 10.1111/j.1442-2050.2007.00637.x. View

Yoon H, Lewis M, Shi Q, Khan M, Cassivi S, Diasio R . Prognostic impact of body mass index stratified by smoking status in patients with esophageal adenocarcinoma. J Clin Oncol. 2011; 29(34):4561-7. PMC: 3236656. DOI: 10.1200/JCO.2011.37.1260. View

Scipione C, Chang A, Pickens A, Lau C, Orringer M . Transhiatal esophagectomy in the profoundly obese: implications and experience. Ann Thorac Surg. 2007; 84(2):376-82. DOI: 10.1016/j.athoracsur.2006.11.070. View

Choi Y, Park B, Jeong B, Seo S, Jeon S, Choi H . Body mass index and survival in patients with renal cell carcinoma: a clinical-based cohort and meta-analysis. Int J Cancer. 2012; 132(3):625-34. DOI: 10.1002/ijc.27639. View

Turati F, Tramacere I, La Vecchia C, Negri E . A meta-analysis of body mass index and esophageal and gastric cardia adenocarcinoma. Ann Oncol. 2012; 24(3):609-17. DOI: 10.1093/annonc/mds244. View

Mullen J, Davenport D, Hutter M, Hosokawa P, Henderson W, Khuri S . Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol. 2008; 15(8):2164-72. DOI: 10.1245/s10434-008-9990-2. View

Morgan T, Tang D, Stratton K, Barocas D, Anderson C, Gregg J . Preoperative nutritional status is an important predictor of survival in patients undergoing surgery for renal cell carcinoma. Eur Urol. 2011; 59(6):923-8. PMC: 3085569. DOI: 10.1016/j.eururo.2011.01.034. View

Liu J, Hu Y, Xie X, Fu J . Subcarinal node metastasis in thoracic esophageal squamous cell carcinoma. Ann Thorac Surg. 2011; 93(2):423-7. DOI: 10.1016/j.athoracsur.2011.10.011. View

10.

Holscher A, Bollschweiler E, Schneider P, Siewert J . Prognosis of early esophageal cancer. Comparison between adeno- and squamous cell carcinoma. Cancer. 1995; 76(2):178-86. DOI: 10.1002/1097-0142(19950715)76:2<178::aid-cncr2820760204>3.0.co;2-d. View

11.

Trivers K, De Roos A, Gammon M, Vaughan T, Risch H, Olshan A . Demographic and lifestyle predictors of survival in patients with esophageal or gastric cancers. Clin Gastroenterol Hepatol. 2005; 3(3):225-30. DOI: 10.1016/s1542-3565(04)00613-5. View

12.

van Hagen P, Hulshof M, van Lanschot J, Steyerberg E, van Berge Henegouwen M, Wijnhoven B . Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012; 366(22):2074-84. DOI: 10.1056/NEJMoa1112088. View

13.

Thrift A, Nagle C, Fahey P, Russell A, Smithers B, Watson D . The influence of prediagnostic demographic and lifestyle factors on esophageal squamous cell carcinoma survival. Int J Cancer. 2012; 131(5):E759-68. DOI: 10.1002/ijc.27420. View

14.

Skipworth J, Foster J, Raptis D, Hughes F . The effect of preoperative weight loss and body mass index on postoperative outcome in patients with esophagogastric carcinoma. Dis Esophagus. 2009; 22(7):559-63. DOI: 10.1111/j.1442-2050.2009.00939.x. View

15.

Blom R, Lagarde S, Klinkenbijl J, Busch O, van Berge Henegouwen M . A high body mass index in esophageal cancer patients does not influence postoperative outcome or long-term survival. Ann Surg Oncol. 2011; 19(3):766-71. PMC: 3278623. DOI: 10.1245/s10434-011-2103-7. View

16.

Kubo A, Corley D . Body mass index and adenocarcinomas of the esophagus or gastric cardia: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2006; 15(5):872-8. DOI: 10.1158/1055-9965.EPI-05-0860. View

17.

Oh S, Yoon Y, Shin S . Effects of excess weight on cancer incidences depending on cancer sites and histologic findings among men: Korea National Health Insurance Corporation Study. J Clin Oncol. 2005; 23(21):4742-54. DOI: 10.1200/JCO.2005.11.726. View

18.

Tierney J, Stewart L, Ghersi D, Burdett S, Sydes M . Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007; 8:16. PMC: 1920534. DOI: 10.1186/1745-6215-8-16. View

19.

Healy L, Ryan A, Gopinath B, Rowley S, Byrne P, Reynolds J . Impact of obesity on outcomes in the management of localized adenocarcinoma of the esophagus and esophagogastric junction. J Thorac Cardiovasc Surg. 2007; 134(5):1284-91. DOI: 10.1016/j.jtcvs.2007.06.037. View

20.

Dindo D, Muller M, Weber M, Clavien P . Obesity in general elective surgery. Lancet. 2003; 361(9374):2032-5. DOI: 10.1016/S0140-6736(03)13640-9. View