Nadia Saeed1, Ravi Shridhar2, Khaldoun Almhanna1, Sarah Hoffe3, Michael Chuong3, Kenneth Meredith4. 1. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA. 2. Department of Radiation Oncology, University of Central Florida, Orlando, FL, USA. 3. Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA. 4. Department Gastrointestinal Oncology, Florida State University, Sarasota Memorial Hospital, Sarasota, FL, USA.
Abstract
BACKGROUND: Various methods of quantifying and correlating obesity to outcomes for patients with esophageal adenocarcinoma (EA) have been evaluated. Published data suggest that quantification of adiposity may be more accurate than body mass index (BMI) as a prognostic factor. We report our analysis of adiposity as a prognostic factor in a series of patients with EA. METHODS: This single institution retrospective review included patients with EA who underwent esophagectomy from 1994-2008. Patients with BMI <20 were excluded. Using the preoperative CT scan, the visceral (VFA), subcutaneous (SFA), and total abdominal fat (TFA) areas were calculated. Each was contoured on a Siemens Leonardo workstation at the level of the iliac crest (L4/5). The Hounsfield threshold was -30 to -130. Outcomes were analyzed using Kaplan-Meier method and log-rank analysis. Multivariate analysis (MVA) was performed using the Cox proportion hazard regression model. RESULTS: We identified 126 patients for the analysis. There were no statistically significant differences in overall survival or disease-free survival between groups above and below the medians for TFA, SFA, or VFA/SFA ratio. However, an increase in VFA was significantly associated with worsened OS and DFS when we further classified patients into quartiles. Patients with VFA ≥182 cm2 had larger tumor size (P=0.016), fewer involved lymph nodes (P=0.047), longer operating times (P=0.032), and were more likely to be males (P=0.042). CONCLUSIONS: Published data have demonstrated an association between treatment outcomes and degree of adiposity; our study found a correlation between VFA and OS and DFS in patients with EA. Median TFA, SFA, and VFA/SFA were not prognostic on MVA. While VFA >182 cm2 was associated with larger tumors, there were also fewer lymph nodes harvested in this group.
BACKGROUND: Various methods of quantifying and correlating obesity to outcomes for patients with esophageal adenocarcinoma (EA) have been evaluated. Published data suggest that quantification of adiposity may be more accurate than body mass index (BMI) as a prognostic factor. We report our analysis of adiposity as a prognostic factor in a series of patients with EA. METHODS: This single institution retrospective review included patients with EA who underwent esophagectomy from 1994-2008. Patients with BMI <20 were excluded. Using the preoperative CT scan, the visceral (VFA), subcutaneous (SFA), and total abdominal fat (TFA) areas were calculated. Each was contoured on a Siemens Leonardo workstation at the level of the iliac crest (L4/5). The Hounsfield threshold was -30 to -130. Outcomes were analyzed using Kaplan-Meier method and log-rank analysis. Multivariate analysis (MVA) was performed using the Cox proportion hazard regression model. RESULTS: We identified 126 patients for the analysis. There were no statistically significant differences in overall survival or disease-free survival between groups above and below the medians for TFA, SFA, or VFA/SFA ratio. However, an increase in VFA was significantly associated with worsened OS and DFS when we further classified patients into quartiles. Patients with VFA ≥182 cm2 had larger tumor size (P=0.016), fewer involved lymph nodes (P=0.047), longer operating times (P=0.032), and were more likely to be males (P=0.042). CONCLUSIONS: Published data have demonstrated an association between treatment outcomes and degree of adiposity; our study found a correlation between VFA and OS and DFS in patients with EA. Median TFA, SFA, and VFA/SFA were not prognostic on MVA. While VFA >182 cm2 was associated with larger tumors, there were also fewer lymph nodes harvested in this group.
Entities:
Keywords:
GI tract; obesity surgery; overweight; treatment outcomes; visceral obesity
Authors: Eamonn M M Quigley; Brian C Jacobson; Johannes Lenglinger; Joel H Rubenstein; Hashem El-Serag; Michele Cicala; Richard W McCallum; Marc S Levine; Richard M Gore Journal: Ann N Y Acad Sci Date: 2011-09 Impact factor: 5.691
Authors: Annika Steffen; Matthias B Schulze; Tobias Pischon; Thomas Dietrich; Esther Molina; Maria-Dolores Chirlaque; Aurelio Barricarte; Pilar Amiano; J Ramón Quirós; Rosario Tumino; Amalia Mattiello; Domenico Palli; Paolo Vineis; Claudia Agnoli; Gesthimani Misirli; Paolo Boffetta; Rudolf Kaaks; Sabine Rohrmann; H Bas Bueno-de-Mesquita; Petra H M Peeters; Anne M May; Elizabeth A Spencer; Naomi E Allen; Sheila Bingham; Anne Tjønneland; Jytte Halkjaer; Kim Overvad; Jakob Stegger; Jonas Manjer; Björn Lindkvist; Göran Hallmanns; Roger Stenling; Eiliv Lund; Elio Riboli; Carlos A Gonzalez; Heiner Boeing Journal: Cancer Epidemiol Biomarkers Prev Date: 2009-06-30 Impact factor: 4.254
Authors: Ravi Shridhar; Thomas Hayman; Sarah E Hoffe; Jill Weber; Khaldoun Almhanna; Michael Chuong; Richard C Karl; Kenneth L Meredith Journal: J Gastrointest Surg Date: 2012-03-08 Impact factor: 3.452
Authors: Cristina Bosetti; Fabio Levi; Jacques Ferlay; Werner Garavello; Franca Lucchini; Paola Bertuccio; Eva Negri; Carlo La Vecchia Journal: Int J Cancer Date: 2008-03-01 Impact factor: 7.396
Authors: P J Navin; M R Moynagh; E J Atkinson; P Tirumanisetty; N K LeBrasseur; A Kumar; S Khosla; N Takahashi Journal: Clin Nutr Date: 2020-10-29 Impact factor: 7.643
Authors: Eliza R C Hagens; Minke L Feenstra; Maarten A van Egmond; Hanneke W M van Laarhoven; Maarten C C M Hulshof; Piers R Boshier; Donald E Low; Mark I van Berge Henegouwen; Suzanne S Gisbertz Journal: J Cachexia Sarcopenia Muscle Date: 2020-02-25 Impact factor: 12.910