Influence of body mass index on postoperative complications and long-term prognosis in patients with esophageal squamous cell carcinoma

doi:10.11958/20230090

Abstract

Abstract:

Objective To investigate the influence of body mass index (BMI) on postoperative complications and long-term prognosis in patients with esophageal squamous cell carcinoma (ESCC). Methods A total of 1 479 patients with ESCC who underwent radical resection were included in this study. According to BMI, 100 patients were divided into the low BMI group (BMI<18.5 kg/m²), 850 cases were divided into the normal BMI group (18.5 kg/m²≤BMI<24 kg/m²) and 529 cases were divided into the high BMI group (BMI≥24 kg/m²). Postoperative complications of patients were compared between the three BMI groups. Kaplan-Meier survival curve was used to compare the overall survival of the three groups, and Cox proportional risk model was used to analyze the influence of BMI on prognosis of patients. Results Compared with the normal BMI group, the incidence of incision infection was increased in the high BMI group, and the incidence rates of pulmonary infection and arrhythmia were increased in the low BMI group (P<0.05). Compared with the low BMI group, the incidence of arrhythmia was lower in the high BMI group (P<0.05). There were no significant differences in the incidence of anastomotic leakage, respiratory failure, chylothorax and vocal cord paralysis between the three groups (P>0.05). Kaplan-Meier survival curve showed that the 5-year cumulative overall survival rate of patients was significantly lower in the low BMI group than that in the normal BMI group (Log-rank χ²=16.857, P<0.01) and the high BMI group (Log-rank χ²=18.802, P<0.01), while there was no significant difference in 5-year cumulative overall survival rate between the high BMI group and the normal BMI group (Log-rank χ²=0.324, P=0.569). Multivariate Cox regression analysis showed that low BMI was an independent risk factor for the prognosis of patients with esophageal squamous cell carcinoma (HR=1.449, 95% CI: 1.084-1.938, P<0.05). Conclusion High BMI increases the incidence of incision infection after esophagectomy in patients with ESCC. Low BMI increases the incidence of pulmonary infections and arrhythmia, and is an independent predictor for poor overall survival.

Key words: body mass index, esophageal neoplasms, carcinoma, squamous cell, postoperative complications, prognosis

CLC Number:

R735.1

Figures/Tables 6

References 22

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组别	n	年龄/岁	性别（男/女）	吸烟史	饮酒史	糖尿病	高血压
正常BMI组	850	63.00（57.00，67.00）	713/137	523（61.5）	399（46.9）	92（10.8）	197（23.2）
低BMI组	100	64.00（57.00，69.75）	84/16	65（65.0）	57（57.0）	9（9.0）	24（24.0）
高BMI组	529	63.00（58.00，67.00）	425/104	286（54.1）^a	241（45.6）	85（16.1）^a	153（28.9）
χ²		0.700	2.991	9.065^＊	4.447	9.405^＊＊	5.792

组别	n	年龄/岁	性别（男/女）	吸烟史	饮酒史	糖尿病	高血压
正常BMI组	850	63.00（57.00，67.00）	713/137	523（61.5）	399（46.9）	92（10.8）	197（23.2）
低BMI组	100	64.00（57.00，69.75）	84/16	65（65.0）	57（57.0）	9（9.0）	24（24.0）
高BMI组	529	63.00（58.00，67.00）	425/104	286（54.1）^a	241（45.6）	85（16.1）^a	153（28.9）
χ²		0.700	2.991	9.065^＊	4.447	9.405^＊＊	5.792

组别	n	肿瘤部位（上/中/下段）	肿瘤长度/cm	分化程度（高/中/低分化）	pT分期（T_1—2/T_3—4）	pN分期（N₀/N_1—3）	pTNM分期（Ⅰ—Ⅱ/Ⅲ—Ⅳ）
正常BMI组	850	98/526/226	3.50（2.50，4.50）	103/435/312	343/507	475/375	501/349
低BMI组	100	10/55/35	4.00（2.55，5.50）^a	8/67/25	29/71	43/57^a	45/55^a
高BMI组	529	65/324/140	3.50（2.50，4.50）^b	63/271/195	253/276^ab	308/221^b	331/198^b
χ²		3.580	11.780^＊＊	9.350	15.189^＊＊	7.905^＊	10.863^＊＊

组别	n	肿瘤部位（上/中/下段）	肿瘤长度/cm	分化程度（高/中/低分化）	pT分期（T_1—2/T_3—4）	pN分期（N₀/N_1—3）	pTNM分期（Ⅰ—Ⅱ/Ⅲ—Ⅳ）
正常BMI组	850	98/526/226	3.50（2.50，4.50）	103/435/312	343/507	475/375	501/349
低BMI组	100	10/55/35	4.00（2.55，5.50）^a	8/67/25	29/71	43/57^a	45/55^a
高BMI组	529	65/324/140	3.50（2.50，4.50）^b	63/271/195	253/276^ab	308/221^b	331/198^b
χ²		3.580	11.780^＊＊	9.350	15.189^＊＊	7.905^＊	10.863^＊＊

组别	n	ASA分级（Ⅰ-Ⅱ级/Ⅲ级）	手术方式（开胸/微创）	淋巴结清扫数目/个	手术时长/min	住院时长/d	有术后辅助治疗
正常BMI组	850	730/120	377/473	14.0（10.0，20.0）	235.00（203.00，267.25）	14.00（10.75，19.00）	410（48.2）
低BMI组	100	79/21	53/47	12.5（9.0，19.0）	224.50（183.50，260.75）	14.00（11.00，24.50）	45（45.0）
高BMI组	529	454/75	216/313	13.0（9.0，18.0）^a	249.00（215.50，283.00）^ab	14.00（11.00，22.50）	276（52.2）
χ²		3.518	5.432	19.719^＊＊	34.216^＊＊	3.516	2.864