Pan Wenbiao, Sun Zhiyong, Xiang Yangwei, Fang Wentao
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Asia Pac J Clin Nutr. 2015;24(3):480-8. doi: 10.6133/apjcn.2015.24.3.05.
To investigate the predictive value of high body mass index (H-BMI) on the survival of patients with esophageal cancer (EC) after curative esophagectomy.
Studies were systematically identified to investigate the relationship between overweight and obese (H-BMI) and clinical outcomes in EC patients treated with curative esophagectomy. Measured clinical outcomes were disease-free survival (DFS) and overall survival (OS). The pooled hazard ratio (HR) with 95% confidence interval (CI) was estimated. Subgroup analyses were performed according to tumour type and body mass index (BMI).
Fourteen studies with 4823 cases were included in the final pooled quantitative analysis. In EC patients overall, H-BMI was associated with improved DFS (HR, 0.83; 95% CI: 0.75-0.90) and OS (HR, 0.79; 95 % CI: 0.73-0.85), as compared with normal BMI. The results were consistent with those who were overweight. Among patients with esophageal adenocarcinoma (EAC), a better prognosis, as reflected by OS, was observed with H-BMI (HR, 0.81; 95% CI: 0.73-0.89). The same results were also observed in EAC patients who were obese and overweight. In contrast, among patients with esophageal squamous cell carcinoma (ESCC), H-BMI was associated with a worse prognosis, as reflected by DFS (HR, 2.26; 95% CI: 1.29-3.24).
H-BMI has distinctly different impacts on the postoperative survival of EAC and ESCC patients. H-BMI is a potential predictor for better prognosis in EC patients overall, and particularly in EAC patients, treated with curative esophagectomy. However, in ESCC patients, H-BMI is a potential predictor for a worse prognosis of postoperative survival.
探讨高体重指数（H-BMI）对食管癌（EC）患者根治性食管切除术后生存的预测价值。
系统检索相关研究，以调查超重和肥胖（H-BMI）与接受根治性食管切除术的EC患者临床结局之间的关系。测量的临床结局为无病生存期（DFS）和总生存期（OS）。估计合并风险比（HR）及95%置信区间（CI）。根据肿瘤类型和体重指数（BMI）进行亚组分析。
最终纳入14项研究，共4823例患者进行合并定量分析。总体而言，与正常BMI相比，EC患者中H-BMI与DFS改善（HR，0.83；95%CI：0.75-0.90）和OS改善（HR，0.79；95%CI：0.73-0.85）相关。超重患者的结果与之相符。在食管腺癌（EAC）患者中，H-BMI患者的OS显示出较好的预后（HR，0.81；95%CI：0.73-0.89）。肥胖和超重的EAC患者也观察到相同结果。相反，在食管鳞状细胞癌（ESCC）患者中，H-BMI与DFS反映的较差预后相关（HR，2.26；95%CI：1.29-3.24）。
H-BMI对EAC和ESCC患者术后生存有明显不同的影响。H-BMI是接受根治性食管切除术的总体EC患者，尤其是EAC患者预后较好的潜在预测指标。然而，在ESCC患者中，H-BMI是术后生存预后较差的潜在预测指标。
