Prognostic value of body mass index for patients undergoing esophagectomy for esophageal squamous cell carcinoma.

OBJECTIVE The correlation between high body mass index and outcomes after esophagectomy has not been systematically addressed. Some studies have shown that patients with a high body mass index had better overall survival and disease-free survival compared with those with a normal/low body mass index, whereas others have shown that the body mass index was not of prognostic value. METHODS Ninety-nine patients with esophageal squamous cell carcinoma were retrospectively reviewed in this study. Patients' postoperative overall and disease-free survivals were compared between the two groups (body mass index <24.00 kg/m(2) and body mass index ≥24.00 kg/m(2)). RESULTS There were 66 patients in the low/normal body mass index group (body mass index <24.00 kg/m(2)) and 28 patients in the high body mass index group (body mass index ≥24.00 kg/m(2)). Although disease recurrence were more frequent in the high body mass index group vs. the low/normal body mass index group, there was no significant difference noted (60.7%, 40.9%, P = 0.078). The 3-year overall survival rates were 60.6% in the low/normal body mass index group and 57.1% in the high body mass index group (P = 0.392). The 3-year disease-free survival rates were higher in the low/normal body mass index group vs. the high body mass index group (56.1%, 39.3%, P = 0.048). On multivariate analysis, the number of lymph node metastases (hazard ratio: 1.192, 95% confidence interval: 1.076-1.320, P = 0.001) was recognized as an independent prognostic factor for overall survival. Both body weight loss (hazard ratio: 2.153, 95% confidence interval: 1.027-4.511, P = 0.042) and the number of lymph node metastases (hazard ratio: 1.669, 95% confidence interval: 1.297-2.146, P < 0.001) were significantly and independently associated with disease-free survival. CONCLUSIONS Our results suggest that high body mass index appears to shorten disease-free survival in esophageal squamous cell carcinoma patients and further studies are needed to detect the mechanism.