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Prognostic significance of combined pretreatment body mass index (BMI) and BMI loss in patients with esophageal cancer

Authors Gu WS, Fang WZ, Liu CY, Pan KY, Ding R, Li XH, Duan CH

Received 11 December 2018

Accepted for publication 28 February 2019

Published 10 April 2019 Volume 2019:11 Pages 3029—3041


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Beicheng Sun

Wen-Shen Gu,1,2,* Wei-Zhen Fang,1,2,* Chun-Yue Liu,1,2 Kun-Yi Pan,1,2 Rui Ding,1,2 Xiao-Hui Li,3 Chao-Hui Duan1,2

1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People’s Republic of China; 2Department of Laboratory Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou 510120, People’s Republic of China; 3Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People’s Republic of China

*These authors contributed equally to this work 
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

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