The impact of body mass index on complication and survival in resected oesophageal cancer: a clinical-based cohort and meta-analysis

被引：133

作者：

Zhang, S. S. ^{[1
,2
,3
]}

Yang, H. ^{[1
,2
,3
]}

Luo, K. J. ^{[1
,2
,3
]}

Huang, Q. Y. ^{[1
,2
,3
]}

Chen, J. Y. ^{[1
,2
,3
]}

Yang, F. ^{[1
,2
,3
]}

Cai, X. L. ^{[4
]}

Xie, X. ^{[1
,2
,3
]}

Liu, Q. W. ^{[1
,2
,3
]}

Bella, A. E. ^{[1
,2
,3
]}

Hu, R. G. ^{[1
,2
,3
]}

Wen, J. ^{[1
,2
,3
]}

Hu, Y. ^{[1
,2
,3
]}

Fu, J. H. ^{[1
,2
,3
]}

机构：

[1] Sun Yat Sen Univ, Ctr Canc, State Key Lab Oncol South China, Collaborat Innovat Ctr Canc Med, Guangzhou 510275, Guangdong, Peoples R China

[2] Guangdong Esophageal Canc Res Inst, Guangzhou, Guangdong, Peoples R China

[3] Sun Yat Sen Univ, Ctr Canc, Dept Thorac Oncol, Guangzhou 510275, Guangdong, Peoples R China

[4] Southern Med Univ, Dept Oncol, Nanfang Hosp, Guangzhou, Guangdong, Peoples R China

来源：

BRITISH JOURNAL OF CANCER | 2013年 / 109卷 / 11期

关键词：

body mass index; oesophageal cancer; meta-analysis; postoperative complication; survival; SURGICAL RESECTION; CELL CARCINOMA; OBESITY; PROGNOSIS; ADENOCARCINOMA; OUTCOMES; WEIGHT; TERM; MEN;

D O I：

10.1038/bjc.2013.666

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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.

引用

页码：2894 / 2903

页数：10

共 37 条

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