High body mass index patients have lower stages of esophageal carcinoma at diagnosis

Patients with high body mass index tend to have lower stage of esophageal carcinoma at diagnosis, reports the latest issue of the Diseases of the Esophagus.

High body mass index is common in US adults.

In a small cohort of esophageal cancer patients treated with surgery, high-BMI and diagnosis of early stage esophageal cancer appeared associated.

Dr Jaffer Ajani and colleagues from Texas, USA evaluated a much larger cohort of esophageal cancer patients.

From a prospectively maintained database, the team analyzed 925 esophageal cancer patients who had surgery with or without adjunctive therapy.

Various statistical methods were used.

High-BMI patients do not experience higher rate of surgical complications

Diseases of the Esophagus

Among 925 patients, 69% had high-BMI, and 31% had normal body mass index.

High-BMI was associated with men, Caucasians, lower esophageal localization, adenocarcinoma histology, low baseline cT-stage, low baseline overall clinical stage, coronary artery disease, and diabetes.

The researchers found that normal-BMI was associated with weight loss, alcohol abuse, ever/current smoking, and baseline cN+.

High-BMI patients with cT1 tumors had significantly higher rates of gastresophageal reflux disease symptoms, gastresophageal reflux disease history, and Barrett's esophagus history compared with H-BMI patients with cT2 tumors.

The team noted that the median survival of normal-BMI patients was 37 months compared with 53 months for high-BMI patients.

The researchers found that older age, squamous histology, smoking, weight loss, high baseline stage, high number of ypN+, high surgical stage, and American Society of Anesthesia scores, 3 out of 4 were independent prognosticators for poor overall survival.

The researchers were able to perform propensity-based analysis of surgical complications between high-BMI and normal-BMI patients.

A comparison of fully matched 376 patients found no significant differences in the rate of complications between the 2 groups.

The team confirmed that a fraction of high-BMI patients with antecedent history is diagnosed with early baseline esophageal cancer.

Dr Ajani's team concludes, "Upon validation of our data in an independent cohort, refinements in surveillance of symptomatic high-BMI patients are warranted and could be implemented."

"Our data also suggest that high-BMI patients do not experience higher rate of surgical complications compared with normal-BMI patients."