Obesity and Oesophageal Cancer

Abstract

(150-250 words)A substantial increase in the incidence of oesophageal adenocarcinoma has been observed in western countries during the past 30 years, which may be related to the parallel rise of the obesity prevalence. On the other hand, incidence rates of oesophageal squamous cell carcinomas, the other major histological type of oesophageal cancer, have remained relatively stable.Epidemiological research of the past decades has identified obesity as risk factor for oesophageal adenocarcinoma. Studies investigating general obesity as assessed by body mass index provide evidence for a strong positive association with oesophageal adenocarcinoma. Studies investigating abdominal obesity in relation to oesophageal adenocarcinoma observed also positive associations, which may be independent of general obesity. Some studies indicate that early life obesity is also associated with higher risk of oesophageal adenocarcinoma, but it is as to date unclear whether these associations are independent of adult obesity. Part of the positive association between obesity and oesophageal adenocarcinoma may be explained through obesityrelated mechanical promotion of gastrooesophageal reflux disease, which is one of the main risk factors for oesophageal adenocarcinoma. Other lines of evidence point to an independent role of metabolic pathways modulating cell proliferation, apoptosis and cell growth such as proinflammatory cytokines, adipokines and insulin resistance, the role of which in oesophageal carcinogenesis is, however, as to date insufficiently understood. Studies investigating obesity in 2 relation to squamous cell carcinoma observed inverse relationships, but the underlying mechanisms remain unclear.

Prognostic effect of different etiologies in patients with gastric cardia cancer

“…[35,36] Obesity was implicated in a spectrum of reflux-related esophageal diseases ranging from esophageal inflammation (erosive esophagitis), metaplasia (Barrett esophagus) to neoplasia (gastroesophageal cancer). [37][38][39][40] Due to possible heterogeneity in the pathogenesis and biological behavior of gastric cardia cancer, we subanalyzed patients with cardia cancer according to obesity, presence of GERD, and H pylori infection with associated gastritis. There were no differences in recurrence rate, overall survival, and disease-free survival.…”

Strenuous occupational physical activity: Potential association with esophageal squamous cell carcinoma risk

“…41 Unlike EADC, BMI has been inversely associated with ESCC with unclear underlying mechanisms. 60 Therefore, residual confounding of BMI and exposure to occupational hazards cannot be ruled out in the current study as they might not be included in the adjustments due to missing information. Further, this case-control study was not designed as an occupational epidemiologic study; we were not able to validate the measures of physical activity as in IPAQ or metabolic equivalents of task-hours.…”

Trends and projections in the incidence of oesophageal cancer in the Netherlands: An age‐period‐cohort analysis from 1989 to 2041

“…33,45 A considerable body of evidence also links a high incidence of OAC to a high prevalence of obesity, especially with regard to abdominal (visceral) fat, which is more common among males. 9,46,47 Identified as contributing to the development of GORD, 48 obesity also constitutes an independent risk factor for OAC. 47,49 In the most highly developed countries, 43% of all OAC cases are estimated to be attributable to obesity.…”

“… 6 Gastro‐oesophageal reflux disease (GORD), Barrett's oesophagus (BO) and obesity are the main factors associated with OAC. 7 , 8 , 9 Changes in the prevalence of these risk factors over time may affect the incidence trends in oesophageal cancer. The development of new diagnostic tools and treatment options for oesophageal cancer can also influence the incidence rates of oesophageal cancer over time.…”