Objective: To investigate the predictive value of high body mass index (H-BMI) on the survival of patients with esophageal cancer (EC) after curative esophagectomy.
Methods: 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).
Results: 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).
Conclusions: 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.
目的：探讨食管癌患者术前高体重指数（high body mass index，H-BMI）对 食管癌根治性切除术后长期生存的影响及其预测价值。方法：通过系统、全 面的文献检索，收集已公开发表的有关食管癌患者术前H-BMI（包括超重和 肥胖）对术后生存期影响的所有临床研究，按累计定量分析的要求对检索到 的原始研究的质量进行评估，对符合条件的所有研究结果进行累计定量分 析，计算数据合并后的H-BMI 对正常BMI 的危险比（hazard ratio，HR）及 95% 置信区间（confidence interval，CI） ，并根据体重指数（body mass index，BMI）及食管癌亚型进行亚组分析，评价术前H-BMI 对食管癌患者根 治性切除术后生存期的影响。结果：共14 篇文献符合纳入标准，总样本量 4823 例。累计定量分析结果表明，H-BMI 改善了总体食管癌患者术后无疾病 生存率（ disease-free survival ， DFS ） 和总体生存率（ Overall survival ， OS），合并的HR 分别为0.83（95% CI: 0.75-0.90）和0.79（95% CI: 0.73- 0.85）；在亚组分析的超重患者中也得出了相似结果。根据肿瘤亚型进一步 分层分析发现，H-BMI 显著改善了食管腺癌患者术后OS，合并的HR 为0.81 （95% CI: 0.73-0.89），在超重和肥胖的亚组分析中也得出了相似的结果。然 而在食管鳞癌中，术前H-BMI 缩短了患者术后DFS，合并的HR 为2.26 （95% CI: 1.29-3.24）。结论：H-BMI 对食管鳞癌和食管腺癌患者术后长期生 存的影响完全不同。H-BMI 是食管癌总体、特别是食管腺癌术后生存预后较 佳的一个潜在性预测指标，而对食管鳞癌来说，H-BMI 则预示着较差的术后 生存。.