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Association Between BMI and Tumour Regression After Neoadjuvant Therapy in Oesophageal Cancers: Insights From a
Susanne D Otto1, Ioannis Pozios1, Wael Rayya1
1Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin, Germany.
Background:
For locally advanced oesophageal carcinoma, multimodal therapy is the standard of care, but prognosis remains poor. Obesity has risen markedly in the last decades. The impact of obesity on response to neoadjuvant treatment remains unclear. This study evaluates the association between body mass index (BMI) and histopathological tumour regression following neoadjuvant therapy in oesophageal cancer.
Materials And Methods:
We performed an analysis using the prospective database from the DGAV|registry oesophageal surgery provided by the German Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV). The primary outcome was histopathological tumour regression grade by the Becker classification. The primary explanatory variable was BMI. Descriptive statistics were followed by uni- and multivariate regression analyses adjusted for tumour histology, neoadjuvant regimen, age, sex, ECOG status, comorbidities, dysphagia and weight loss. Associations were evaluated using a multivariate regression (partial proportional odds) model.
Results:
Six hundred and forty-seven patients were included, comprising 432 adenocarcinomas (including AEG I/II) and 215 squamous cell carcinomas (SCC). After adjustment for clinical and tumour-related covariates, higher BMI was independently associated with a favourable histopathological response: No association was observed for the transition to Becker grade ≥ 1b; however, higher BMI was associated with reduced odds of Becker grade ≥ 2 (OR 0.97, 95% CI 0.94-1.00, p = 0.04) and Becker grade ≥ 3 (OR 0.93, 95% CI 0.90-0.96, p < 0.001). In addition, SCC, absence of dysphagia, radiochemotherapy and low ECOG score were independently associated with favourable regression, whereas no independent associations were observed for age, sex, diabetes status, comorbidities or pretherapeutic weight loss.
Conclusion:
Analysis of the German DGAV|registry revealed that higher BMI was significantly associated with improved histopathological tumour regression following multimodal therapy for oesophageal cancer. These findings suggest potential differences in tumour biology among patients with elevated BMI, underscoring the need for further mechanistic investigation.