Evaluating the role of BMI in survival and complications in older esophageal squamous cell carcinoma following esophagectomy

We aimed to estimate the optimal gestational weight gain (GWG) in Tibetan women and to evaluate the appropriateness of the Institute of Medicine (IOM) GWG recommendations for Tibetan women. We analyzed data from 1474 Tibetan women from a cross-sectional study conducted in 2019. According to the three different body mass index (BMI) classification criteria (WHO BMI categories, WHO Asian BMI categories, Chinese BMI categories), we estimated the association of GWG with pregnancy outcomes (neonate birthweight and mode of delivery) using a polynomial regression model, and the optimal GWG in each BMI group was calculated. The risk of adverse outcomes showed a U-shaped curve with increasing GWG. The optimal GWG of Tibetan women based on the WHO BMI categories was 17.2 kg (range, 13.3 to 20.9 kg) for underweight, 9.3 kg (5.8 to 12.9 kg) for normal weight, and 5.2 kg (1.3 to 9.1 kg) for overweight. Underweight Tibetan mothers may gain more gestational weight than recommend by the IOM guidelines. However, normal weight Tibetan mothers are likely to benefit from gaining less weight than that recommended by the IOM. The GWG recommendations based on the IOM guidelines might not be appropriate for Tibetan women, and ethnicity-specific recommendations for GWG should be properly addressed.

Background Oesophageal squamous cell carcinoma (OSCC) is a prevalent cancer in the elderly, with surgical resection as a primary treatment. This study investigates the impact of Body Mass Index (BMI) on postoperative outcomes in elderly OSCC patients who underwent esophagectomy. Methods We conducted a retrospective cohort study using data from the Sichuan Cancer Hospital & Institute, focusing on patients aged 70 and older diagnosed with thoracic OSCC who underwent esophagectomy between May 2016 and August 2021. Patients were categorized into underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), and overweight/obese (≥25 kg/m2) groups based on BMI. Primary outcomes were overall survival (OS) and disease-free survival (DFS), while secondary outcomes included postoperative complication rates, assessed using the Clavien-Dindo classification. Results The study included 469 patients, with a median follow-up of 47.5 months. The median OS for normal, high, and low BMI groups was 50.7, 36.9, and 33.5 months, respectively, with no significant differences in OS among the groups. DFS also showed no significant differences. Complication rates were higher in the low BMI group, including pulmonary infections, hydrothorax, and chylous fistula. Conclusion BMI did not significantly affect OS or DFS among elderly OSCC patients post-esophagectomy, though low BMI was associated with higher complication rates.

Background Acute kidney injury (AKI) is a common clinical syndrome carrying high morbidity and mortality. Body mass index (BMI) is a common health indicator, and a high BMI value-obesity has been shown to be associated with the outcomes of several diseases. However, the relationship between different BMI categories and mortality in all critically ill patients with AKI is unclear and needs further investigation. Therefore, we evaluated the ability of BMI to predict the severity and all-cause mortality of AKI in critically ill patients. Methods We extracted clinical data from the MIMIC-III v1.4 database. All adult patients with AKI were initially screened. The baseline data extracted within 24 hours after ICU admission were presented according to WHO BMI categories. Logistic regression models and the Cox proportional hazards models were, respectively, constructed to assess the relationship between BMI and the severity and all-cause mortality of AKI. The generalized additive model (GAM) was used to identify nonlinear relationships as BMI was a continuous variable. The subgroup analyses were performed to further analyze the stability of the association between BMI category and 365-day all-cause mortality of AKI. Result A total of 15,174 patients were extracted and were divided into four groups according to BMI. Obese patients were more likely to be young and male. In the fully adjusted logistic regression model, we found that overweight and obesity were significant predictors of AKI stage III (OR, 95 CI: 1.17, 1.05–1.30; 1.32, 1.18–1.47). In the fully adjusted Cox proportional hazards model, overweight and obesity were associated with significantly lower 30-day, 90-day, and 365-day all-cause mortality. The corresponding adjusted HRs (95 CIs) for overweight patients were 0.87 (0.77, 0.99), 0.84 (0.76, 0.93), and 0.80 (0.74, 0.88), and for obese patients, they were 0.87 (0.77, 0.98), 0.79 (0.71, 0.88), and 0.73 (0.66, 0.80), respectively. The subgroup analyses further presented a stable relationship between BMI category and 365-day all-cause mortality. Conclusions BMI was independently associated with the severity and all-cause mortality of AKI in critical illness. Overweight and obesity were associated with increased risk of AKI stage III; however, they were predictive of a relatively lower mortality risk in these patients.

Objective This study aims to quantify bias in self-reported height and weight, assess its impact on body mass index (BMI)-based obesity classification, and identify clinical and demographic predictors of misreporting in a specialist outpatient population. Design Cross-sectional observational study comparing self-reported and measured anthropometric data, with multivariable regression analyses to investigate factors associated with discrepancies in height, weight, and BMI. Methods A total of 408 adult outpatients were enrolled in a tertiary-level outpatient endocrinology and obesity clinic in Italy. Self-reported height and weight were recorded immediately before standardized measurements. Body mass index was calculated from both data sources. Differences were expressed as Δ height, Δ weight, and Δ BMI. Agreement in WHO BMI categories was evaluated, and sensitivity/specificity for detecting obesity (BMI ≥30 kg/m²) was calculated using measured BMI as reference. Multivariable linear models included sex, age, menopausal status (in women), measured BMI, and waist circumference. Results Mean (95% confidence intervals) misreporting was +3.13 cm (+2.90 to +3.36) for height, −0.97 kg (−1.29 to −0.65) for weight, and −1.63 kg/m² (−1.80 to −1.47) for BMI. WHO BMI-category misclassification occurred in 20.0% of participants, primarily due to under-classification (19.4%). Sensitivity and specificity for detecting obesity based on self-report were 0.72 and 1.00, respectively. Age predicted height over-reporting; age and measured BMI predicted both weight under-reporting and BMI underestimation. Conclusions Self-reported anthropometric data systematically underestimate BMI and result in substantial misclassification of obesity. Given the clinical and policy implications of BMI-based criteria for obesity treatment access, objective measurement should be prioritized in all relevant settings.

Background: The association between obesity and prognosis in HER2-positive early breast cancer remains unclear, with limited data available. This study aimed to determine the impact of body mass index (BMI) at baseline and weight change after 2 years on outcomes of patients with HER2-positive early breast cancer. Methods: ALTTO was a randomized phase III trial in patients with HER2-positive early breast cancer. BMI was collected at randomization and 2 years after. WHO BMI categories were used: underweight, <18.5 kg/m2; normal weight, 18.5 to <25 kg/m2; overweight, ≥25 to <30 kg/m2; and obese ≥30 kg/m2. A weight change from baseline of ≥5.0% and ≤5.0% was categorized as weight gain and weight loss. The impact of BMI at randomization and of weight change on disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) were investigated with multivariate analyses, adjusting for baseline patients and tumor characteristics. Results: A total of 8,381 patients were included: 187 (2.2%), 3,797 (45.3%), 2,690 (32.1%), and 1,707 (20.4%) were underweight, normal weight, overweight, and obese at baseline, respectively. Compared with normal weight, being obese at randomization was associated with a significantly worse DDFS (adjusted hazard ratio [aHR], 1.25; 95% CI, 1.04–1.50) and OS (aHR, 1.27; 95% CI, 1.01–1.60), but no significant difference in DFS (aHR, 1.14; 95% CI, 0.97–1.32). Weight loss ≥5.0% at 2 years after randomization was associated with significantly poorer DFS (aHR, 1.34; 95% CI, 1.05–1.71), DDFS (aHR, 1.46; 95% CI, 1.07–1.98), and OS (aHR, 1.83; 95% CI, 1.18–2.84). Hormone receptor and menopausal status but not anti-HER2 treatment type influenced outcomes. Toxicities were more frequent in obese patients. Conclusions: In patients with HER2-positive early breast cancer, obesity at baseline is a poor prognostic factor. Weight loss during treatment and follow-up negatively impacts clinical outcomes. Dietary counseling should be part of survivorship care programs.

BackgroundHypertension in pregnancy is an important cause of pregnancy complications for both mother and baby in about 8% of pregnancies. Epidemiological reviews have reported an association between pre-eclampsia and maternal...

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. 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)). 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. 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.

AB0307 No Correlation between Body Mass Index and Clinical Response To Infliximab: Post-Hoc Analysis of Planetra

The role of postoperative chemotherapy (POCT) in pathologic T3N0M0 thoracic esophageal squamous cell carcinoma (TESCC) has not been well addressed. The purpose of this study was to investigate the impact of postoperative adjuvant chemotherapy on survival, recurrence, and toxicities in pathologic T3N0M0 TESCC. This study included 582 patients with pT3N0M0 TESCC who were treated at Sichuan Cancer Hospital from January 2009 to December 2017. The patients were divided into two groups: surgery plus postoperative chemotherapy group (S + POCT), and surgery group (S group). Propensity score matching was used to create patient groups that were balanced across several covariates (n = 236 in each group). Outcome measures included overall survival (OS) and disease-free survival (DFS). After PSM, both groups have balance factors. S + POCT have significantly improved the 5-year OS and DFS (OS, 70.8% vs. 52.8%, p <0.0001; DFS, 66.5% vs. 50.2%, p < 0.0001). Multivariate Cox analyses in the matched samples revealed that S + POCT were independently associated with longer OS (hazard ratio (HR) = 0.56, 95% confidence index (CI) 0.41-0.77, p < 0.0001) and longer DFS (HR = 0.60, 95% CI 0.45-0.82, p = 0.001) than surgery alone. Subgroup analyses showed that prognostic effect of POCT was significantly influenced by the number of resected lymph node (≤ 20) and pStage IIB but not influenced by the number of node > 20 and pStage IIA. Postoperative adjuvant chemotherapy is strongly associated with improved OS and DFS in patients with pT3N0M0 TESCC. A multicenter, randomized, phase III clinical trial is warranted to confirm these findings.

Health hazards of obesity have been recognized for centuries, appearing, for example, in writings attributed to Hippocrates. From the later decades of the 20th century through the present, there have been numerous epidemiological studies of the relationship between excess weight and the total, or all-cause, mortality rate,1 a critical cumulative measure of the public health impact of any health condition. Using body mass index (BMI), an indicator of relative weight for height (weight [kg]/height [m]2) and a frequently used surrogate for assessment of excess body fat, these studies have found linear, U-shaped, or J-shaped relationships between total mortality and BMI. That is, in some studies, both the thin and the obese were more likely to die than those in between. There is, however, always a point at which increasing BMI is associated with increasing mortality risk, but the BMI at which this occurs varies across studies and populations.2 Currently,3 overweight in adults is defined as a BMI of 25.0 to <30.0 kg/m2 and obesity as a BMI of ≥30.0 kg/m2 (Table 1). A number of studies have found no significant relationship between BMI in the overweight range and mortality rate4 and have shown the nadir of mortality risk to be in the overweight range. In particular, commentaries in both the lay press5–7 and scientific literature2,8,9 subsequent to recent reports from National Health and Nutrition Examination Surveys (NHANES)10,11 have highlighted the confusion and controversy regarding this issue. Some have interpreted the recent data to mean that overweight is not detrimental to health and is not in itself a public health concern and that drawing attention to the need for weight loss in this range will have negative effects on the health and well-being of the general population.8 Others have argued …

Squamous cell carcinoma is the main subtype of esophageal cancer in East Asia. The effect of the number of lymph nodes (LNs) removed to treat middle and lower thoracic esophageal squamous cell carcinoma (ESCC) in China remains controversial. Therefore, the present study aimed to investigate the impact of the number of LNs removed during lymphadenectomy on the survival of patients with middle and lower thoracic ESCC. Data were obtained from the Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database from January 2010 to April 2020. Either three-field systematic lymphadenectomy (3F group) or two-field systematic lymphadenectomy (2F group) was performed for ESCC cases with or without suspicious tumor-positive cervical LNs, respectively. Subgroups were designed for further analysis based on the quartile number of resected LNs. After 50.7 months of median follow-up, 1,659 patients who underwent esophagectomy were enrolled. The median overall survival (OS) of the 2F and 3F groups was 50.0 months and 58.5 months, respectively. The OS rates at 1, 3 and 5 years were 86, 57 and 47%, respectively, in the 2F group, and 83, 52 and 47%, respectively, in the 3F group (P=0.732). The average OS of the 3F B and D groups was 57.7 months and 30.2 months, respectively (P=0.006). In the 2F group, the OS between subgroups was not significantly different. In conclusion, resection of >15 LNs during two-field dissection in patients with ESCC undergoing esophagectomy did not affect their survival outcomes. In three-field lymphadenectomy, the extent of LNs removed could lead to different survival outcomes.

Background: Body mass index (BMI) has been widely investigated as a potential prognostic factor in breast cancer; however, its clinical relevance in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer treated with CDK4/6 inhibitors remains controversial, particularly in contemporary real-world settings. This study aimed to evaluate the association between baseline BMI and clinical outcomes, including survival and treatment-related toxicity, in a real-world cohort. Methods: This single-centre retrospective observational cohort study included patients with HR+/HER2- metastatic breast cancer treated with endocrine therapy and a CDK4/6 inhibitor (palbociclib or ribociclib) in the metastatic setting between January 2018 and May 2025. Patients were categorised by baseline BMI (<25 vs. ≥25 kg/m2). Progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan-Meier method and Cox proportional hazards models. To minimise confounding, propensity score matching (PSM) with a 1:3 nearest-neighbour algorithm was performed. Non-linear associations between continuous BMI and survival outcomes were explored using restricted cubic spline analyses. Treatment-related adverse events were evaluated according to CTCAE v5.0. Results: A total of 456 patients were included; 321 (70.4%) had a BMI ≥ 25 kg/m2, and 135 (29.6%) had a BMI < 25 kg/m2. Propensity score matching produced a balanced cohort of 220 patients. The reduction in sample size after matching reflects the need to achieve close baseline comparability between groups. In the matched cohort, no statistically significant differences in PFS (log-rank p = 0.55) or OS (log-rank p = 0.31) were observed across BMI categories. BMI was not an independent predictor of PFS or OS in multivariable analyses. However, restricted cubic spline modelling revealed a non-linear relationship between continuous BMI and survival outcomes, with increased risk at extreme BMI values, underscoring the limitations of dichotomous BMI categorisation. Conclusions: In this real-world cohort of patients with HR+/HER2- metastatic breast cancer treated with CDK4/6 inhibitors, dichotomised BMI categories were not independently associated with survival outcomes. However, modelling BMI as a continuous variable revealed a non-linear (U-shaped) relationship, with increased risk at both the low and high ends of the BMI distribution. These findings suggest that the prognostic impact of BMI is non-linear and may be obscured by simple dichotomous categorisation.

Relation between chemotherapy dose, oestrogen receptor expression, and body-mass index

FRI0099 Obese patients with rheumatoid arthritis have reduced response rates to biologic anti-rheumatic agents: a comparison between european and american ra patients

Background: In cancer follow-up (FU), in addition to the evaluation of disease free and overall survival probabilities, there is a fundamental need of assessing the recurrence dynamics. In BC as well as in other cancers, the hazard function for first recurrence presents multiple peaks, with a first major peak occurring before three years of FU. Although the baseline risk is modulated by known prognostic factors with possible time dependent effects such as the estrogen receptor (ER), so far no other factor proved to disentangle this multi-peak behavior. Here, we postulated that adiposity, which is closely related to a state of hyperinsulinemia and chronic inflammation, and reflected by increased patient's BMI, could influence the recurrence dynamics. Material and methods: In this study 777 patients with early node-positive BC from a phase III randomized clinical trial were considered (Piccart et al. JCO 2001). The trial compared intermediate or full doses of epirubicin–cyclophosphamide with cyclophosphamide, methotrexate and 5-fluorouracil. BMI was calculated using the WHO classification and was available for 734 patients, of whom 27(4%) were underweight, 377(51%) normal, 213(29%) overweight and 117(16%) obese. Underweight and normal patients were grouped together. Disease free survival (DFS), loco-regional and distant recurrence endpoints were considered. Median FU-time was 15.4 years. Cox regression analysis was performed, adjusting for standard clinico-pathological variables and treatment. Piecewise exponential models with cubic natural and regularized tensor product splines were carried out to estimate the hazard function according to categorical and continuous BMI, respectively. Results: Older age at diagnosis, postmenopausal status, and increased tumor size were significantly associated with increased BMI. Adjusted Cox models supported the association between overweight and disease recurrence (HR=1.39; 95%CI=1.05-1.84) as well as distant metastases (HR=1.41; 95%CI=1.01-1.97). There was no evidence of association for loco-regional recurrences. We observed a multi-peak behavior of distant recurrences for all BMI categories. Although, there was no shift of the first peak of recurrences according to BMI categories, occurring at ∼2.5 years of FU, a major increase in peak heights for the overweight and obese patients was evident. Obese patients showed a sharper first peak. When considering the three BMI categories according to the ER-status, we observed the worst prognosis for overweight ER-negative patients, as well as different recurrence patterns (Table). NormalOverweightObeseER-positiveMain recurrence peak culminating at 2 years, with multiple smaller peaks laterOne broad peak around 3 years and one smaller around 10 yearsOne narrow peak at 2 years and one smaller around 10 yearsER-negativeSimilar pattern to ER-positive BC, with however major increase in height of first peakOne broad peak around 3 years, with a major increase in height compared to ER-positive BCOne peak at 2-3 years Conclusion: This is the first study to show that both the ER-status of the tumor and the patient's BMI at diagnosis are influencing the recurrence dynamics related to BC dormancy. Citation Format: Biganzoli E, Desmedt C, Fornili M, Three-arms Investigators, de Azambuja E, Di Leo A, Sotiriou C, Piccart M, Demicheli R. Investigation of the recurrence dynamics of breast cancer (BC) according to the body mass index (BMI) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD4-06.