Prognostic significance of body mass indices for patients undergoing esophagectomy for cancer

• Published in: Diseases of the esophagus Vol. 20; no. 1; pp. 29 - 35
• Main Authors: Morgan, M. A., Lewis, W. G., Hopper, A. N., Escofet, X., Harvard, T. J., Brewster, A. E., Crosby, T. D. L., Roberts, S. A., Clark, G. W. B.
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01-02-2007
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Aged; Aged, 80 and over; Body Mass Index; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Case-Control Studies; Combined Modality Therapy; esophageal cancer; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagectomy; Female; Follow-Up Studies; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Multivariate Analysis; Prognosis; surgery; Survival Analysis
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1111/j.1442-2050.2007.00637.x

The aim of this study was to determine the role of body mass index (BMI) in a Western population on outcomes after esophagectomy for cancer. Two hundred and fifteen consecutive patients undergoing esophagectomy for esophageal cancer of any cell type were studied prospectively. Patients with BMIs > 25 kg/m were classified as overweight and compared with control patients with BMIs below these reference values. Ninety‐seven patients (45%) had low or normal BMIs, 86 patients (40%) were overweight, and a further 32 (15%) were obese. High BMIs were associated with a higher incidence of adenocarcinoma versus squamous cell carcinoma (83%vs. 14%, P = 0.041). Operative morbidity and mortality were 53% and 3% in overweight patients compared with 49% (P = 0.489) and 8% (P = 0.123) in control patients. Cumulative survival at 5 years was 27% for overweight patients compared with 38% for control patients (P = 0.6896). In a multivariate analysis, age (hazard ratio [HR] 1.492, 95% CI 1.143–1.948, P = 0.003), T‐stage (HR 1.459, 95% CI 1.028–2.071, P = 0.034), N‐stage (HR 1.815, 95% CI 1.039–3.172, P = 0.036) and the number of lymph node metastases (HR 1.008, 95% CI 1.023–1.158, P = 0.008), were significantly and independently associated with durations of survival. High BMIs were not associated with increased operative risk, and long‐term outcomes were similar after R0 esophagectomy.