Prognostic impact of body mass index stratified by smoking status in patients with esophageal squamous cell carcinoma

Global incidence, mortality, and burden of esophageal cancer, and its correlation with SDI, metabolic risks, fasting plasma glucose, LDL cholesterol, and body mass index: An ecological study

Background and Aims

Esophageal cancer (EC) is one of the most common gastrointestinal malignancies. The geographical variation shows the influence of genetic factors, ethnicity, and distribution of various risk factors. Accurate knowledge of EC epidemiology at the global level will help to develop management strategies. Therefore, the present study was conducted to investigate the global and regional disease burden of EC, including the incidence, mortality, and burden of this cancer in 2019.

Methods

Incidence, mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) associated with EC in 204 countries in different classifications were extracted from the global burden of disease study. After collecting information on metabolic risks, fasting plasma glucose (FPG), low-density lipoprotein (LDL) cholesterol, and body mass index (body mass index), the relationship between age-standardized incidence rate (ASIR), mortality rate, and DALYs with these variables was determined.

Results

In 2019, 534,563 new cases of EC were reported worldwide. The highest ASIR is related to regions with medium sociodemographic index (SDI), and high middle income according to the World Bank, the Asian continent, and the western Pacific region. In 2019, a total of 498,067 deaths from EC were recorded. The highest mortality rate due to ASR is in countries with medium SDI and countries with upper middle income of the World Bank. In 2019, 1,166,017 DALYs were reported due to EC. The ASIR, ASDR, and DALYS ASR of EC showed a significant negative linear correlation with SDI, metabolic risks, high FPG, high LDL cholesterol, and high BMI (p < 0.05).

Conclusions

The results of this study showed significant gender and geographic variation in the incidence, mortality, and burden of EC. It is recommended to design and implement preventive approaches based on known risk factors and improve quality and access to efficient and appropriate treatments.

Association between body mass index and oesophageal cancer mortality: a pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium

BACKGROUND

The association between body mass index (BMI) and oesophageal cancer (OC) has been consistently negative among Asians, whereas different associations based on histological OC subtypes have been observed in Europeans and North Americans. We examined the association between BMI and OC mortality in the Asia Cohort Consortium.

METHODS

We performed a pooled analysis to evaluate the association between BMI and OC mortality among 842 630 Asians from 18 cohort studies. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs.

RESULTS

A wide J-shaped association between BMI and overall OC mortality was observed. The OC mortality risk was increased for underweight (BMI <18.5 kg/m2: HR = 2.20, 95% CI 1.80-2.70) and extreme obesity (BMI ≥35 kg/m2: HR = 4.38, 95% CI 2.25-8.52) relative to the reference BMI (23-25 kg/m2). This association pattern was confirmed by several alternative analyses based on OC incidence and meta-analysis. A similar wide J-shaped association was observed in oesophageal squamous cell carcinoma (OSCC). Smoking and alcohol synergistically increased the OC mortality risk in underweight participants (HR = 6.96, 95% CI 4.54-10.67) relative to that in reference BMI participants not exposed to smoking and alcohol.

CONCLUSION

Extreme obesity and being underweight were associated with an OC mortality risk among Asians. OC mortality and BMI formed a wide J-shaped association mirrored by OSCC mortality. Although the effect of BMI on OSCC and oesophageal adenocarcinoma mortality can be different in Asians, further research based on a large case-control study is recommended.

Prognostic Value of Body Mass Index Stratified by Alcohol Drinking Status in Patients With Esophageal Squamous Cell Carcinoma

BACKGROUND

The goal of this study was to investigate the prognostic value of body mass index (BMI) in patients with esophageal squamous cell carcinoma (ESCC) when stratified by alcohol drinking status.

METHODS

A total of 620 patients with ESCC who underwent esophagectomy were analyzed. A receiver operating characteristic curve was constructed to set the appropriate cutoff point for BMI. Alcohol drinking was divided into ever and never. Kaplan-Meier and multivariate Cox regression analyses were conducted to investigate the association between clinicopathological factors and survival.

RESULTS

The cutoff point was 18.75 kg/m² for BMI. Two hundred and twenty-nine patients were ever drinkers, while the other 391 patients were never drinkers. The ever drinker group was found to have more males, longer tumor lengths, advanced pT category disease, advanced pN category disease, and lower tumor locations. However, no significant difference in BMI was found between ever drinkers and never drinkers. For ever drinkers, low BMI was significantly correlated with worse overall survival (hazard ratio = 1.690; P=0.035) and cancer-specific survival (hazard ratio = 1.763; P=0.024) than high BMI after adjusting for other factors. However, BMI was not a prognostic factor in univariate and multivariate analyses for never drinkers.

CONCLUSIONS

BMI is a prognostic factor only in ever drinkers with ESCC but not in never drinkers. Further studies are needed to elucidate the mechanism underlying the effect of the interaction between BMI and alcohol consumption on the prognosis of patients with ESCC.

Burden of esophageal cancer and its attributable risk factors in 204 countries and territories from 1990 to 2019

BACKGROUND

Esophageal cancer is a global health concern. Regularly updated data about the burden of esophageal cancer are essential for formulating specific public policies. We aimed to estimate the global, regional, and national burden and trends of esophageal cancer and its attributable risk factors from 1990 to 2019, by age, sex and socio-demographic index (SDI).

METHODS

Data about the incidence, death, disability-adjusted life-years (DALYs), and age-standardized rates were collected from Global Burden of Disease study 2019. Estimated annual percentage changes were used to quantify the temporal trends of age-standardized rates. Moreover, the risk factors attributable to esophageal cancer deaths were also presented.

RESULTS

There were 534,563 incident cases and 498,067 deaths in 2019, contributing to 11,666,017 DALYs. The absolute numbers of incidence, death, and DALYs had increased from 1990 to 2019, contrasting with declined changes in their corresponding age-standardized rates. The burden of esophageal cancer varied across different regions and countries, and the age-standardized rates were negative with SDI. Almost half of the esophageal cancer was concentrated in China. Males accounted for most of the burden of esophageal cancer, and the onset age tended to be older. The death of esophageal cancer was primarily attributable to smoking, followed by alcohol use, high body mass index, diet low in fruits and diet low in vegetables.

CONCLUSION

The burden of esophageal cancer was heterogeneous across regions and countries by sex, age, and SDI, providing information for governments that may help to formulate more targeted policies.

Clinical characteristics and survival of 5283 esophageal cancer patients: A multicenter study from eighteen hospitals across six regions in China

Objective

This study aimed to investigate the potential determining epidemiological and clinical risk factors affecting the survival of esophageal cancer (EC) patients across multiple hospitals in China.

Methods

This was a multicenter study comprising of newly diagnosed EC cases from Beijing, Hebei, Henan, Hubei, Zhejiang, and Guangdong Province of China. Their baseline characteristics and treatment methods data were collected from their medical records. The EpiData software was used for data quality control. The Kaplan‐Meier method was used to estimate their overall survival (OS), and the Cox's proportional hazard regression model was used to estimate hazard ratios (HR) and 95% confidence interval (CI).

Results

The 3‐ and 5‐year OS rates of the 5283 investigated EC patients were 49.98% and 39.07%, respectively. Their median survival was 36.00 months. The median survival time of females was longer than that of males (females vs. males: 45.00 vs. 33.00, P < 0.001). The 5‐year OS rate of patients who never‐smoked was higher than that of smokers (never‐smokers vs smokers: 40.73% vs. 37.84%, P = 0.001). There was no significant difference in the 5‐year OS rate between drinkers and never‐drinkers (drinkers vs never‐drinkers: 34.22% vs. 29.65%, P = 0.330). In multivariate analysis, pathological stage (stage II: HR = 1.80, 95% CI = 1.40‐2.31; stage III: HR = 2.62, 95% CI = 2.06‐3.34; stage IV: HR = 3.90, 95% CI = 2.98‐5.09), poor differentiation/undifferentiated (HR = 1.34, 95% CI = 1.11‐1.63), not married status (HR = 2.45, 95% CI = 1.49‐4.04), production and service personnel (HR = 1.36, 95% CI = 1.01‐1.83) and farming/fishing (HR = 1.40, 95% CI = 1.12‐1.76) were independent prognostic risk factors for poor EC survival. Tumors in the thoracic or abdominal part of the esophagus, female and family history of any cancer were independent factors predictive of a good EC OS.

Conclusion

Gender, marital status, occupation, family history of any cancer, tumor topographical site, differentiation status, and pathological stage were associated with the survival rate of EC. This study reveals important clinical characteristics of esophageal cancer patients in China and provides helpful information for their clinical management and surveillance.

Augmenting cancer registry data with health survey data with no cases in common: the relationship between pre-diagnosis health behaviour and post-diagnosis survival in oesophageal cancer

Background

For epidemiological research, cancer registry datasets often need to be augmented with additional data. Data linkage is not feasible when there are no cases in common between data sets. We present a novel approach to augmenting cancer registry data by imputing pre-diagnosis health behaviour and estimating its relationship with post-diagnosis survival time.

Methods

Six measures of pre-diagnosis health behaviours (focussing on tobacco smoking, ‘at risk’ alcohol consumption, overweight and exercise) were imputed for 28,000 cancer registry data records of US oesophageal cancers using cold deck imputation from an unrelated health behaviour dataset. Each data point was imputed twice. This calibration allowed us to estimate the misclassification rate. We applied statistical correction for the misclassification to estimate the relative risk of dying within 1 year of diagnosis for each of the imputed behaviour variables. Subgroup analyses were conducted for adenocarcinoma and squamous cell carcinoma separately.

Results

Simulated survival data confirmed that accurate estimates of true relative risks could be retrieved for health behaviours with greater than 5% prevalence, although confidence intervals were wide. Applied to real datasets, the estimated relative risks were largely consistent with current knowledge. For example, tobacco smoking status 5 years prior to diagnosis was associated with an increased age-adjusted risk of all cause death within 1 year of diagnosis for oesophageal squamous cell carcinoma (RR = 1.99 95% CI 1.24,3.12) but not oesophageal adenocarcinoma RR = 1.61, 95% CI 0.79,2.57).

Conclusions

We have demonstrated a novel imputation-based algorithm for augmenting cancer registry data for epidemiological research which can be used when there are no cases in common between data sets. The algorithm allows investigation of research questions which could not be addressed through direct data linkage.

Using estimated probability of pre-diagnosis behavior as a predictor of cancer survival time: an example in esophageal cancer

Background

Information on the associations between pre-diagnosis health behavior and post-diagnosis survival time in esophageal cancer could assist in planning health services but can be difficult to obtain using established study designs. We postulated that, with a large data set, using estimated probability for a behavior as a predictor of survival times could provide useful insight as to the impact of actual behavior.

Methods

Data from a national health survey and logistic regression were used to calculate the probability of selected health behaviors from participant’s demographic characteristics for each esophageal cancer case within a large cancer registry data base. The associations between survival time and the probability of the health behaviors were investigated using Cox regression.

Results

Observed associations include: a 0.1 increase in the probability of smoking 1 year prior to diagnosis was detrimental to survival (Hazard Ratio (HR) 1.21, 95% CI 1.19,1.23); a 0.1 increase in the probability of hazardous alcohol consumption 10 years prior to diagnosis was associated with decreased survival in squamous cell cancer (HR 1.29, 95% CI 1.07, 1.56) but not adenocarcinoma (HR 1.08, 95% CI 0.94,1.25); a 0.1 increase in the probability of physical activity outside the workplace is protective (HR 0.83, 95% CI 0.81,0.84).

Conclusions

We conclude that probability for health behavior estimated from demographic characteristics can provide an initial assessment of the association between pre-diagnosis health behavior and post-diagnosis health outcomes, allowing some sharing of information across otherwise unrelated data collections.

Comprehensive bioinformation analysis of methylated and differentially expressed genes in esophageal squamous cell carcinoma

Differentially methylated genes (DMGs) play a crucial role in the etiology and pathogenesis of esophageal squamous cell carcinoma (ESCC).