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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
Lower than average weight and preoperative weight loss (PWL) are common for patients with esophageal squamous cell carcinoma (ESCC). To our knowledge, these are also thought to be important prognostic factors in many cancers. However, various levels of body mass index (BMI) and PWL are used to define clinically-significant BMI and PWL.
Research motivation
Definitions of clinically-significant BMI and PWL in patients with ESCC are unclear.
Research objectives
The aim of this study was to explore whether BMI and PWL are valuable predictors to risk-stratify esophageal squamous cell cancer patients prior to surgery.
Research methods
We retrospectively analyzed the data of 1545 ESCCs who underwent curative surgical resection. To define the prognostic significance of PWL and BMI, patients were divided into three groups: Patients with BMI ≥ 20.0 kg/m2 and PWL < 8.8% (Group 1), patients with BMI < 20.0 kg/m2 and PWL < 8.8% (Group 2), and patients with PWL ≥ 8.8% (Group 3). Then, a multivariate analysis was performed and adjusted for age, sex, TNM stage and adjuvant therapy.
Research results
Trends of poor survival were observed for patients with increasing PWL and decreasing BMI. Patients in Group 1 had the longest median overall survival (OS) with 45.3 mo, patients in Group 2 had a median OS of 29.5 mo, and patients in Group 3 had the worst median OS with 20.1 mo. When PWL was < 8.8%, patients with high BMI had a significantly better prognosis than patients with low BMI. When PWL was higher than 8.8%, no significant difference was observed between patients with low BMI and patients with high BMI.
Research conclusions
Both PWL and BMI are prognostic factors for patients with ESCC.
Research perspectives
Both BMI and PWL are simple and objective nutritional parameters that are easily available to physicians, and may be valuable predictors to risk-stratify patients prior to surgery.
