Abstract:
Objective To explore the influence of body mass index (BMI) on postoperative complications and survival in patients with esophageal squamous cell carcinoma (ESCC) using propensity score matched (PSM) methods.
Methods We retrospectively analyzed clinical data of 533 patients with ESCC who were admitted for thoracic surgery in Shandong Provincial Hospital, between January 2011 and December 2012. After conducting PSM methods to balance the covariates, the incidence of postoperative complications and survival rate were compared between the two groups. The effects of BMI on postoperative complications and survival were analyzed with multivariate Logistic regression and Cox proportional hazard analyses, respectively. Survival analysis was performed using Kaplan-Meier curves and Log-rank test.
Results After adjusting the PSM and confounding variables, the two groups were well matched (146 patients each) without significant differences in baseline characteristics. The incidence of wound infection and respiratory system complications in the H-BMI group (BMI≥25 kg/m2) were significantly higher than those in the N-BMI group (18.5-25 kg/m2) (P < 0.05). H-BMI was an independent risk factor for wound infection and respiratory system complications. In the present study, no significant difference was observed in the 3-year overall survival between H-BMI and N-BMI patients (54.1% vs. 47.8%, P=0.212). Patients with H-BMI had significantly better 5-year overall survival than those with N-BMI (39% vs. 25%, P=0.016). The subgroup analysis showed that patients with H-BMI had a better overall survival than those with N-BMI in stages Ⅰ-Ⅱ (47.3% vs. 29.0%, P=0.032). However, this difference was not significant when patients were stratified into stages Ⅲ and Ⅳ (24.5% vs. 16.7%, P=0.393).
Conclusions H-BMI appears not to decrease the overall survival of patients with ESCC. Therefore, ESCC in patients with H-BMI can receive surgical treatment safely, but proper intraoperative management and close postoperative monitoring should be performed.