The prognostic influence of body mass index, resting energy expenditure and fasting blood glucose on postoperative patients with esophageal cancer.

Zhiming Chen,Yongjun Zhu,Dhruba Kadel,Gang Chen,Liewen Pang,Ning Wu

doi:10.1186/s12876-016-0549-6

Zhiming Chen, Yongjun Zhu + Show 4 more

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https://doi.org/10.1186/s12876-016-0549-6

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Journal: BMC gastroenterology	Publication Date: Dec 1, 2016
Citations: 20	License type: cc-by

Affiliation: Huashan Hospital, Fudan University

Abstract

BackgroundBody mass index (BMI), resting energy expenditure (REE) and fasting blood glucose (FBG) are major preoperative assessments of patients’ nutrition and metabolic state. The relations and effects of these indices on esophageal cancer patients’ postoperative short-term and long-term outcomes remain controversial and unclear. We aimed to study the impact of BMI, REE and FBG in esophageal cancer patients undergoing esophagectomy.MethodsThree hundred and six esophageal cancer patients who underwent esophagectomy were observed retrospectively. Clinical characteristics, postoperative complications and survival analysis were compared among different BMI, REE and FBG groups.ResultsThere were significant linear relationships between REE, BMI and FBG indices, patients with low BMI tended to have low REE (p < 0.001) and low FBG (p = 0.003). No significant difference was found in case of mortality and postoperative complications among different groups. Low BMI (X 2 = 6.141, p = 0.046), REE (X 2 = 6.630, p = 0.010) and FBG (X 2 = 5.379, p = 0.020) were related to poor survival. FBG ≤90 mg/dL was independently associated with poor survival (HR = 0.695; 95 % CI 0.489–0.987, p = 0.042). BMI and REE came to be stronger prognostic factors on lymph node-negative patients and proved to be independent prognostic indicators (HR = 0.540; 95 % CI 0.304–0.959, p = 0.035 and HR = 0.457; 95 % CI 0.216–0.967, p = 0.041, respectively).ConclusionsBMI, REE and FBG are important prognostic factors in patients with esophageal cancer undergoing esophagectomy and preoperative evaluation of these indices help to determine the prognosis in these patients.

Highlights

Body mass index (BMI), resting energy expenditure (REE) and fasting blood glucose (FBG) are major preoperative assessments of patients’ nutrition and metabolic state
Previous studies reported that high BMI was associated with increased risk of Esophageal adencarcinoma (EAC) while low BMI with Esophageal squamous cell carcinoma (ESCC) [4]
Compared with 245 (80.1 %) patients with REE per kg total body weight (REE/kg) < 23.2, 61 (19.9 %) patients with REE/kg ≥23.2 had significant worse survival, so 23.2 kcal.day−1.kg−1 was set as the cutoff point

Summary

Introduction

Body mass index (BMI), resting energy expenditure (REE) and fasting blood glucose (FBG) are major preoperative assessments of patients’ nutrition and metabolic state. The relations and effects of these indices on esophageal cancer patients’ postoperative short-term and long-term outcomes remain controversial and unclear. We aimed to study the impact of BMI, REE and FBG in esophageal cancer patients undergoing esophagectomy. Esophageal adencarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) are the most frequent histological subtypes. ESCC is the dominant histological subtype in china [2]. The potential prognostic indicators of esophageal cancer include histological variants Previous studies reported that high BMI was associated with increased risk of EAC while low BMI with ESCC [4]. High BMI in surgical patients is thought to be associated with increased comorbidities and postoperative complications, but the influence of high BMI on survival in patients undergoing esophagectomy is controversial.

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