Positive Effect of Higher Adult Body Mass Index on Overall Survival of Digestive System Cancers Except Pancreatic Cancer: A Systematic Review and Meta-Analysis

Table 1

Characteristic of relevant studies on BMI and OS of DSC patients included in the meta-analysis.

Study	Country	Study type	Duration	Cancer site	Size	Point of BMI	BMI	Referent BMI	UV-HR; (95% CI)	MV-HR; (95% CI)	Covariates
Iyengar et al., 2014	USA	Retrospective study	2000–2009	Tongue	155	Before operation	≥30 25.0–29.9	18.5–24.9	1.86 (0.95, 3.63) 1.01 (0.97, 1.03)	2.23 (0.96, 4.98) 0.97 (0.46, 1.84)	Age, race, smoking, diabetes, T stage, tumor grade, invasion, lymph node metastasis, and postoperative radiation
Ottosson et al., 2014	Sweden	Retrospective study	1998–2006	Oropharynx	203	Before radiotherapy	>25	<20 20–25	3.31 (1.4, 7.83) 3.07 (1.74, 5.44)	3.78 (1.46, 9.75) 2.57 (1.43, 4.62)	Age, sex, stage, RT schedule, and surgery
Vlooswijk et al., 2016	Netherlands	Retrospective study	2008–2012	Oropharynx	276	Before radiotherapy	≥25	≤25	1.01 (0.96, 1.04)	NA	NA
Albergotti et al., 2016	USA	Retrospective study	2006–2014	Oropharynx	579	Before treatment	≥25	<25	0.49 (0.28, 0.87)	0.54 (0.3, 0.98)	Age, sex, smoking, race, stage, and drinking
Trivers et al., 2005	USA	Prospective study	1993–2000	Esophagus	1142	Before diagnosis	≥30 25–29.9	<25	0.84 (0.58, 1.19) 0.65 (0.5, 0.86)	0.78 (0.55, 1.12) 0.67 (0.51, 0.88)	Sex, stage, and income
Morgan et al., 2007	Wales	Prospective study	1995–2005	Esophagus	215	Before operation	≥25	≤25	NA	1.1 (0.73, 1.66)	Age, stage, and ASA grade
Healy et al., 2007	Ireland	Retrospective study	1998–2005	Esophagus	150	Before operation	≥30	<30	1.16 (0.66, 2.02)	NA	NA
Skipworth et al., 2009	UK	Prospective study	2001–2004	Esophagus	93	Before operation	>25	<25	0.78 (0.38, 1.6)	NA	NA
Madani et al., 2010	Canada	Prospective study	1991–2006	Esophagus	142	Before operation	≥30	<30	0.57 (0.38, 0.88)	0.57 (0.35, 0.93)	Age, sex, resection, grade, stage, and lymph node metastasis
Grotenhuis et al., 2010	Netherlands	Prospective study	1991–2007	Esophagus	556	Before operation	≥30	<18.5	0.58 (0.32, 1.04)	NA	NA
Hayashi et al., 2010	USA	Retrospective study	NA	Esophagus	301	Before treatment	≥25	<25	0.64 (0.44, 0.93)	0.62 (0.44, 0.88)	Age, weight loss, PVD, and stage
Melis et al., 2011	USA	Prospective study	1994–2010	Esophagus	490	Before operation	≥30	20–24	0.69 (0.51, 0.92)	NA	NA
Yoon et al., 2011	USA	Prospective study	1980–1997	Esophagus	778	Before operation	≥30	18.5–24.9	NA	1.01 (0.67, 2.23)	Age, sex, stage, grade, and weight loss
Scarpa et al., 2013	Italy	Retrospective study	2000–2008	Esophagus	278	Before diagnosis	>30	<20	NA	0.61 (0.4, 0.93)	Age, sex, stage, and weight loss
Blom et al., 2012	Netherlands	Prospective study	1993–2010	Esophagus	736	Before operation	≥30	<25	0.92 (0.8, 1.15)	NA	NA
Miao et al., 2015	China	Prospective study	2006–2012	Esophagus	1342	Before operation	≥25	18.5–24.9 <18.5	1.11 (0.89, 1.38); 1.48 (1.07, 2.04)	1.05 (0.84, 1.3) 1.16 (0.84, 1.6)	Age, sex, drinking, smoking, hypertension, diabetes, tumor length, differentiation, grade, stage, weight loss, and adjuvant chemoradiation
Minami et al., 2015	Japan	Prospective study	1997–2005	Stomach	1283	At diagnosis	≥25 18.5–23	23–25	NA	1.28 (0.93, 1.77) 1.5 (1.14, 1.98)	Age, sex, stage, histology, occupation, smoking, drinking, and family history
Ejaz et al., 2014	USA	Prospective study	2000–2012	Stomach	775	Before operation	≥30 25.0–29.9 <18.5	18.5–24.9	NA	1.13 (0.79, 1.61) 0.91 (0.66, 1.27) 1.5 (0.93, 2.41)	Age, race, preoperative albumin, chemotherapy, comorbidities, tumor size, type, morphology, T stage, AJCC stage, grade, lymph-vascular invasion, perineural invasion, and signet ring cell
Lee et al., 2015	Korea	Retrospective study	2000–2008	Stomach	1909	Before operation	≥25; <18.5	18.5–24.9	NA	0.64 (0.41, 1.02) 1.01 (0.72, 1.4)	Age, sex, surgery, tumor stage, histology, and curative resection
Liu et al., 2016	China	Prospective study	2004–2013	Stomach	320	Before operation	24–32.2	15.1–24	0.57 (0.37, 0.9)	0.31 (0.12, 0.8)	Age, sex, albumin, total cholesterol, triglyceride, high- and low-density lipoprotein cholesterol, cell differentiation, invasion; depth, lymph node metastasis, distant metastasis, and stage
Meyerhardt et al., 2008	USA	Prospective study	1999–2001	Colorectum	1053	After operation	≥35 30–34.9 25–29.9	18.5–24.9	0.88 (0.58, 1.36); 0.93 (0.66, 1.31); 0.84 (0.61, 1.15)	0.87 (0.54, 1.42) 0.9 (0.61, 1.34) 0.72 (0.5, 1.03)	Age, sex, bowel wall invasion, lymph node metastasis, bowel perforation, obstruction, baseline performance status, treatment,; weight loss, smoking, and activity level
Baade et al., 2011	Australia	Prospective study	2003-2004	Colorectum	1825	Before diagnosis	≥30 25–29.9 <18.5	18.5–24.9	NA	0.78 (0.59, 1.03) 0.75 (0.61, 0.94) 2.29 (1.47, 3.59)	Age, sex, physical activity, smoking status, marital status, education, insurance, tumor site, stage, treatment, and; comorbidities
Campbell et al., 2012	USA	Prospective study	1992–2007	Colorectum	1957	Before diagnosis	≥30 25–29.9 <18.5	18.5–24.9	NA	0.93 (0.75, 1.17); 0.83 (0.7, 1); 1.3 (0.82, 2.06)	Age, sex, smoking, physical activity, red meat intake, SEER summary, and stage at diagnosis
Kuiper et al., 2012	USA	Prospective study	1993–1998	Colorectum	587	Before diagnosis	≥30 25–29.9	18.5–24.9	NA	1.09 (0.65, 1.83); 0.77 (0.47, 1.27)	Age at diagnosis, education, time from diagnosis to measurement, tumor stage, race, education, drinking, smoking, hormone; replacement therapy, and prediagnostic physical activity
Li et al., 2009	USA	Retrospective study	2004–2008	Pancreas	609	At diagnosis	≥30 25–29.9	18.5–24.9	NA	1.86 (1.35, 2.56); 1.26 (0.94, 1.69)	Sex, race, diabetes, stage, tumor resection status, CA19-9 level, margin, and node status
Tsai et al., 2010	USA	Prospective study	1995–2005	Pancreas	795	Before operation	≥30 25–29.9	18.5–24.9	0.75 (0.58, 0.98) 0.73 (0.6, 0.88)	0.73 (0.56, 0.95) 0.74 (0.61, 0.89)	Age, sex, race, tumor differentiation and size, surgical details, perineural invasion, margin and node status, and weight loss
McWilliams et al., 2010	USA	Prospective study	2000–2009	Pancreas	1861	At diagnosis	≥30 25–29.9 <18.5	18.5–24.9	NA	1.25 (1.1, 1.41) 1.02 (0.89, 1.16) 1.42 (0.76, 2.68)	Age, sex, and diabetes status
Olson et al., 2010	USA	Retrospective study	2004–2008	Pancreas	314	At diagnosis or after treatment	≥30 25–29.9	18.5–24.9	1.17 (0.82, 1.68) 0.92 (0.89, 1.69)	1.38 (0.9, 2.11) 1.05 (0.7, 1.57)	Age, gender, smoking, diabetes, family history, chemotherapy, tumor stage, and history of allergies
Dandona et al., 2011	USA	Retrospective study	1995–2009	Pancreas	355	Before operation	≥30 25–29.9	18.5–24.9	0.85 (0.61, 1.2) 1.01 (0.76, 1.34)	NA	NA
Gong et al., 2012	USA	Retrospective study	1995–1999	Pancreas	510	At diagnosis	≥30 25–29.9	18.5–24.9	1.27 (0.93, 1.72) 1.01 (0.83, 1.22)	1.28 (0.91, 1.81) 1.04 (0.83, 1.28)	Age, sex, race, education level, smoking, and diabetes status
Gaujoux et al., 2012	USA	Prospective study	2000–2005	Pancreas	328	Before operation	≥30 25–29.9 <18.5	18.5–24.9	1.1 (0.8, 1.52); 1.21 (0.92, 1.6); 1.29 (0.67, 2.48)	NA	NA
Yuan et al., 2013	USA	Prospective study	1988–2010	Pancreas	902	Before diagnosis	≥30 25–29.9	18.5–24.9	NA	1.27 (1.03, 1.52) 0.94 (0.82, 1.07)	Age at diagnosis, sex, race, smoking, year, and stage at diagnosis
Pelucchi et al., 2014	Italy	Prospective study	1982–2007	Pancreas	644	At diagnosis	≥30 25–29.9	18.5–24.9	NA	1.32 (0.98, 1.79) 1.14 (0.94, 1.39)	Age and calendar period at diagnosis, study center, sex, and smoking
Kasenda et al., 2014	Switzerland	Retrospective study	1994–2004	Pancreas	483	At diagnosis	≥30 25–29.9 <18.5	18.5–24.9	2.02 (1.42, 2.89) 1.53 (1.22, 1.91) 1.06 (0.75, 1.46)	NA	NA

UV = univariate, MV = multivariate, HR= hazard ratio, RT = radiotherapy, ASA = American Society of Anesthesiology, NA = not available, PVD = peripheral vascular disease, SEER = surveillance, epidemiology, and END results.