Open AccessObesity and outcomes in patients treated with chemoradiotherapy for esophageal carcinoma
Author(s) -
Wang J.,
Myles B.,
Wei C.,
Chang J. Y.,
Hofstetter W. L.,
Ajani J. A.,
Swisher S. G.,
Cox J. D.,
Komaki R.,
Liao Z.,
Lin S. H.
Publication year - 2013
Publication title -
diseases of the esophagus
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 63
eISSN - 1442-2050
pISSN - 1120-8694
DOI - 10.1111/dote.12074
Subject(s) - medicine , esophageal cancer , chemoradiotherapy , body mass index , proportional hazards model , univariate analysis , gastroenterology , esophagitis , oncology , multivariate analysis , carcinoma , cancer , disease , reflux
Summary Body mass index ( BMI ) is a risk factor for comorbid illnesses and cancer development. It was hypothesized that obesity status affects disease outcomes and treatment‐related toxicities in esophageal cancer patients treated with chemoradiotherapy ( CRT ). From M arch 2002 to A pril 2010, 405 patients with non‐metastatic esophageal carcinoma at MD A nderson C ancer C enter treated with either definitive or neoadjuvant CRT were retrospectively analyzed. Patients were categorized as either obese ( BMI ≥ 25 kg/m 2 ) or nonobese ( BMI < 25 kg/m 2 ). Progression‐free survival and overall survival times were examined using the K aplan– M eier method and C ox proportional hazards regression analysis. One hundred fifteen (28.4%) patients were classified as nonobese and 290 (71.6%) as obese. Obese patients were more likely than others to have several comorbid diseases ( P < 0.001), adenocarcinoma located distally ( P < 0.001), and have undergone surgery ( P = 0.004). Obesity was not associated with either worse operative morbidity/mortality ( P > 0.05) or worse positron emission tomography tumor response ( P = 0.46) on univariate analysis, nor with worse pathologic complete response ( P = 0.98) on multivariate analysis. There was also no difference in overall survival, locoregional control, or metastasis‐free survival between obese and nonobese patients ( P = 0.86). However, higher BMI was associated with reduced risk of chemoradiation‐induced high‐grade esophagitis ( P = 0.021), esophageal stricture ( P < 0.001), and high‐grade hematologic toxicity ( P < 0.001). In esophageal cancer patients treated with CRT , obesity is not predictive of poorer disease outcomes or operative morbidities; instead, data suggest it may be associated with decreased risk of acute chemotherapy‐ and radiotherapy‐related treatment toxicities.