Body Mass Index-Adjusted Body Weight Loss Grading Predicts Overall Survival in Esophageal Squamous Cell Carcinoma Patients

Abstract

Purpose

Various malnutrition and inflammation criteria were associated with prognosis of esophageal squamous cell carcinoma (ESCC) patients. Nonetheless, the interplay of clinicopathological features, malnutrition, and inflammation criteria with overall survival in ESCC patients remains unclear.

Methods

We retrospectively reviewed medical records of 205 patients diagnosed with ESCC between 2007 and 2012, and evaluated the status of participant malnutrition and inflammation, including body mass index < 18.5 kg/m², body weight loss > 5.0%, serum albumin level < 3.5 g/dl, neutrophil-to-lymphocyte ratio > 3.5, platelet-to-lymphocyte ratio > 20, prognostic nutrition index < 40, blood total lymphocyte count < 1600 cells/mm³, and grades of body mass index-adjusted body weight loss (combined BMI-BWL). We assessed the association of clinicopathological features, nutritional status, and inflammation condition with overall survival using univariate and multivariate Cox regression analyses.

Results

The mean overall survival of ESCC patients was 28.8 mo,. The multivariate logistic regression model after adjustment for clinicopathological variables, malnutrition status, inflammation condition, and co-morbid status found that tumor stage and grades of combined BMI-BML served as equally important prognostic factors for overall survival.

Conclusions

Advanced tumor stage and high grades of combined BMI-BWL were independent prognostic factors for overall survival in ESCC patients.

Acknowledgments

We are grateful to Li-Ting Lien for technical contributions, and the staff members of Department of Hematology/Oncology of Chang Gung Memorial Hospital for their valuable assistance.

Author Contributions

KYY was responsible for designing the study protocol, conducting the research, interpreting the results and revising the entire manuscript. YPP organized the original data and drafted the entire manuscript. HCK conducted statistical analysis and generated Table 1. TYH collected demographic data and generated Table 2. JYL analyzed the survival data and generated Figure 1. WCC provided scholarly interpretation and revised part of the Discussion. CHL contributed to data extraction and background information. PHC revised the final version of the Introduction and Discussion.

All authors critically revised, read, and approved the final manuscript, and agreed to be fully accountable for ensuring the integrity and accuracy of the work.

Disclosure statement

We declare no conflicts of interest in employment (other than primary affiliations), commercial grants, other commercial research support, ownership interest, consultant/advisory board, or honoraria from speakers’ bureau.

Additional information

Funding

This study was supported by grants (CGRPG2F0061 and CMRPG2J0041) from the Chung Gang Memorial Hospital, Keelung (Taiwan).