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

Abstract

<b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> Multivariate analysis showed that overweight and obese patients had a more favorable survival than normal weight and underweight patients (<i>p</i>=0.017). Patients with a low BMI and high BMI loss before therapy had worse OS than others (<i>p</i>=0.001). Subgroup analysis showed that patients with a high BMI were more likely to suffer hypertension (<i>p</i><0.001) and receive only surgery (<i>p</i><0.001), and they were less likely to be smokers (<i>p</i>=0.007) and anemic (<i>p</i><0.001). Conversely, patients with high BMI loss were more likely to be anemic (<i>p</i>=0.001), to have advanced pathological stage (<i>p</i>=0.012), and to receive chemotherapy and radiotherapy (<i>p</i>=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. <b>Conclusion:</b> 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.