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Abstract
BackgroundWe examined whether body mass index (BMI) changes in adulthood, prior to disease onset, are associated with overall survival among esophageal adenocarcinoma patients.MethodsWe included 285 histologically confirmed patients with a complete baseline BMI questionnaire. Using extended Cox regression models, we obtained adjusted hazard ratios (HRs) for the associations between overall survival and BMI at diagnosis, BMI 6 months before diagnosis, self‐reported average adult BMI, and ΔBMI (BMI 6 months before diagnosis minus average adult BMI), categorized into tertiles <0 kg/m2 (BMI loss), ≥0 and <1.25 kg/m2 (stable BMI), and ≥1.25 kg/m2 (BMI gain). We also assessed interaction between ΔBMI and average adult BMI (≥ kg/m2 versus <27.5 kg/m2) with overall survival.ResultsBody mass index at diagnosis >25 and <35 kg/m2 was associated with better overall survival. Compared to patients with stable BMI in adulthood, patients who gained BMI throughout adulthood had 1.68 times the all‐cause hazard of death (95% CI: 1.17‐2.43; P < .01), independent of diagnosis BMI and percent weight loss 6 months before diagnosis. Compared to patients with average adult BMI < 27.5 who maintained stable adult BMI, patients with average adult BMI ≥ 27.5 kg/m2 who gained BMI had the worst survival (HR = 3.05; 95% CI 1.62‐5.72; P < .01).ConclusionBody mass index gain in adulthood is associated with poor overall survival, and maintaining a normal body weight throughout adulthood is associated with the best overall survival among esophageal adenocarcinoma patients, independent of BMI at diagnosis.
Highlights
Esophageal adenocarcinoma (EA) is the most common histological subtype of esophageal cancer in the western world, and fewer than 20% of patients survive 5 years.[1]
We hypothesized that a-body mass index (BMI) changes may have different associations with survival depending on patients' starting BMI, so we tested whether the association with ΔBMI and overall survival in EA was modified by average Adult BMI (a-BMI)
While the small sample size precludes conclusion about associations in this group, we provided the same analyses with these six patients included in the supplemental material should readers wish to glean the pattern of association between body mass variables and overall survival for the underweight EA patients
Summary
Esophageal adenocarcinoma (EA) is the most common histological subtype of esophageal cancer in the western world, and fewer than 20% of patients survive 5 years.[1]. BMI 1 year prior to diagnosis is not associated with overall survival.[22,23] Yet, one study showed that high BMI in early adulthood (age 18-25) was associated with worse overall survival in EA.[22] substantial weight loss (>10% of body weight), after disease onset, in the months leading to diagnosis has been associated with poor overall survival in EA.[22,24]. Patients' adult weight changes prior to disease onset have not been considered as a prognostic factor. These weight changes may carry independent risks or benefits to disease outcomes and may help to elucidate the previously reported “obesity paradox” in EA. We hypothesized that a-BMI changes may have different associations with survival depending on patients' starting BMI, so we tested whether the association with ΔBMI and overall survival in EA was modified by average a-BMI
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