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Overweight Patients Operated on for Cancer of the Esophagus Survive Longer Than Normal Weight and Obese Patients
Marco Scarpa*1, Matteo Cagol1, Silvia Bettini2, Rita Alfieri1, Amedeo Carraro1, Francesco Cavallin1, Elisabetta Trevellin2, Alberto Ruol3, Roberto Vettor2, Ermanno Ancona3,1, Carlo Castoro1
1Oncological Surgery Unit, Venetian Oncology Institute (IOV-IRCCS), Padova, Italy; 2Dept. of Medical and Surgical Sciences, University of Padova, Padova, Italy; 3Dept. of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy
Background. Esophageal adenocarcinoma is often associated to obesity and the relative risk to develop an esophageal adenocaricoma is 1.52 if the Body Mass Index (BMI) is increased of 5 Kgm-2. The aim of this study was to assess the surgical and oncological outcome and the survival of overweight and obese patients with esophageal cancer.
Patients and methods Data of 1127 patients with esophageal cancer presenting from 2000 to 2008 at the Regional Center of the Esophageal Diseases were prospectively collected. Detailed anthropometric data about the BMI before the disease onset were available for 464 patients who were then included in this study. Sixty seven of them were classified as obese (BMI>30), 199 were classified as overweight (BMI 25-29.9) and 168 were classified as normal weight (BMI<24.9). Outcome and survival of the three groups were compared. Frequency and survival analysis were preformed.
Results Overweight and obese patients with esophageal cancer were more often male (p<0.01), they tended to have more frequently multiple tumours (p=0.06) and they more often suffered high blood pressure (p<0.01) than normal weight patients. Adenocarcinoma was more frequent in overweight and obese patients (p<0.01). No significant difference was observed among the three groups in term of preoperative neoadjuvant therapy, type of operation, radicality of the esophagectomy and postoperative outcome. Nodal metastasis were more frequently localized in paraesophageal nodes in overweight and obese patients (p=0.01). No significant difference was observed among the three groups in term of disease free survival. At multivariate survival analysis the only independent predictors of overall survival after radical esophagectomy were a BMI between 25 and 29.9 [HR=0.63(0.43-0.93), p=0.02], pT stage 3 or 4 [HR=2.13 (1.34-3.26), p<0.01] and pN 1 status [HR=1.84 (1.20-2.82), p<0.01].
Conclusion This data seem to suggest that in spite of several unfavorable features a moderate increase of weight may be associated to increased long-term survival after esophagectomy for cancer.
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