Low body mass index is associated with poor treatment outcome following radiotherapy in esophageal squamous cell carcinoma

Abstract

Purpose: We aimed to determine whether patients with esophageal cancer with a low baseline body mass index (BMI) have a poor prognosis following radiotherapy (RT).Materials and Methods: We retrospectively analyzed data from 50 patients with esophageal cancer to determine whether a low starting BMI (before RT) was associated with a poor outcome. All study participants were diagnosed with non-metastatic esophageal squamous cell carcinoma (SCC).Results: The number of patients at each T stage were as follows: 7 (14%) patients at T1, 18 (36%) at T2, 19 (38%) at T3, and 6 (12%) at T4. Based on BMI, 7 (14%) patients were defined as underweight. A low BMI was common in patients with T3/T4 stage esophageal cancer (7/43, p = 0.01). Overall, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 26.3% and 69.2%, respectively. In univariate analysis, clinical factors associated with poor PFS included being underweight (BMI <18.5 kg/m2; p = 0.011) and a positive N status (p = 0.017). Univariate analysis also revealed that being underweight was associated with a decrease in OS (p = 0.003). However, being underweight was not an independent prognostic factor for PFS and OS. Conclusion: Patients with esophageal SCC with a low starting BMI (BMI <18.5 kg/m2) are more prone to have a negative survival outcome following RT than patients who are considered to be normal weight or overweight. For this reason, it is important that clinicians pay more attention to BMI when treating patients with esophageal SCC.

Risk for Esophageal Cancer Based on Lifestyle Factors–Smoking, Alcohol Consumption, and Body Mass Index: Insight from a South Korean Population Study in a Low-Incidence Area

“…Esophageal squamous cell carcinoma is the predominant form of esophageal cancer in South Korea [5]; thus, our data on esophageal cancer were assumed to be mainly drawn from esophageal squamous cell carcinoma. The association of being underweight with an increased likelihood of esophageal cancer in our study may be because severe weight loss may weaken the immune system and easily exacerbate esophageal cancer pathogenesis [3]. In recent gene enrichment and pathway analysis, downregulated differential expression genes in esophageal squamous cell carcinomas that mainly participated in the biological processes have been associated with neutrophil activation in the immune response, neutrophil degranulation, and neutrophilmedicated immunity [53].…”

“…Esophageal carcinomas constitute a significant global health challenge, ranking seventh in prevalence and sixth in cancer-related mortality [1]. These malignancies are highly aggressive and challenging to treat, with a low 5-year survival rate of 10-30% [1,2], with poor outcomes that are partly attributable to an advanced stage at diagnosis, as well as the inherent resistance of esophageal cancers to systemic therapy because of histological, molecular, and etiological heterogeneity [3]. In recent decades, the occurrence of esophageal cancer in South Korea has decreased, making it the fifteenth most prevalent cancer, constituting 1.0% of all cancer cases [4,5].…”