Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma

doi:10.3748/wjg.v26.i8.839

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Feb 28, 2020; 26(8): 839-849
Published online Feb 28, 2020. doi: 10.3748/wjg.v26.i8.839

Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma

Han-Lu Zhang, Yu-Shang Yang, Jia-Nan Duan, Qi-Xin Shang, Song-Lin He, Yi-Min Gu, Wei-Peng Hu, Wen-Ping Wang, Yang Hu, Yun Wang, Yong Yuan, Long-Qi Chen

Han-Lu Zhang, Yu-Shang Yang, Qi-Xin Shang, Yi-Min Gu, Wei-Peng Hu, Wen-Ping Wang, Yang Hu, Yun Wang, Yong Yuan, Long-Qi Chen, Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China

Jia-Nan Duan, Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China

Song-Lin He, Department of Thoracic and Cardiovascular Surgery, the Second People's Hospital of Chengdu, Chengdu 610017, Sichuan Province, China

Author contributions: Zhang HL and Yang YS wrote the manuscript and made the data analysis; Zhang HL, Yuan Y, Chen LQ and Wang Y revised the manuscript; Duan JN, Shang QX, He SL and Gu YM made the data collection and performed the follow-up; Wang WP and Hu Y provided clinical advice; Yuan Y, Chen LQ and Wang Y made the conception and design of the study.

Supported by National Natural Science Foundation of China, No. 81970481; Sichuan Science and Technology Program, No. 2018HH0150; Chengdu Science and Technology Bureau; No. 2017GH00072.

Institutional review board statement: The study protocol was approved by West China Hospital of Sichuan University Biomedical Research Ethics Committee.

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.

Data sharing statement: No additional data are available.

Corresponding author: Yong Yuan, MD, PhD, Associate Professor, Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China. dy818@sina.com

Received: October 9, 2019
Peer-review started: October 9, 2019
First decision: December 23, 2019
Revised: January 13, 2020
Accepted: January 24, 2020
Article in press: January 24, 2020
Published online: February 28, 2020
Processing time: 141 Days and 13.2 Hours

Abstract

BACKGROUND

The impact of body mass index (BMI) on survival in patients with esophageal squamous cell carcinoma (ESCC) undergoing surgery remains unclear. Therefore, a definition of clinically significant BMI in patients with ESCC is needed.

AIM

To explore the impact of preoperative weight loss (PWL)-adjusted BMI on overall survival (OS) in patients undergoing surgery for ESCC.

METHODS

This retrospective study consisted of 1545 patients who underwent curative resection for ESCC at West China Hospital of Sichuan University between August 2005 and December 2011. The relationship between PWL-adjusted BMI and OS was examined, and a multivariate analysis was performed and adjusted for age, sex, TNM stage and adjuvant therapy.

RESULTS

Trends of poor survival were observed for patients with increasing PWL and decreasing BMI. Patients with BMI ≥ 20.0 kg/m² and PWL < 8.8% were classified into Group 1 with the longest median OS (45.3 mo). Patients with BMI < 20.0 kg/m² and PWL < 8.8% were classified into Group 2 with a median OS of 29.5 mo. Patients with BMI ≥ 20.0 kg/m² and PWL ≥ 8.8% (HR = 1.9, 95%CI: 1.5-2.5), and patients with BMI < 20.0 kg/m² and PWL ≥ 8.8% (HR = 2.0, 95%CI: 1.6-2.6), were combined into Group 3 with a median OS of 20.1 mo. Patients in the three groups were associated with significantly different OS (P < 0.05). In multivariate analysis, PWL-adjusted BMI, TNM stage and adjuvant therapy were identified as independent prognostic factors.

CONCLUSION

PWL-adjusted BMI has an independent prognostic impact on OS in patients with ESCC undergoing surgery. BMI might be an indicator for patients with PWL < 8.8% rather than ≥ 8.8%.

Keywords: Esophageal neoplasms; Body mass index; Body weight change; Survival; Surgery; Nutrition status

Core tip: The aim of this study was to explore the impact of preoperative weight loss (PWL)-adjusted body mass index (BMI) on overall survival for patients undergoing surgery for esophageal squamous cell carcinoma. Patients with BMI ≥ 20.0 kg/m² and PWL < 8.8% were classified into Group 1. Patients with BMI < 20.0 kg/m² and PWL < 8.8% were classified into Group 2. Patients with PWL ≥ 8.8% were classified into Group 3. Patients in the three groups were associated with significantly different overall survival. This result indicates that PWL-adjusted BMI has prognostic value for patients undergoing surgery for esophageal squamous cell carcinoma.