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Impact of pre-diagnosis behavior on risk of death from esophageal cancer: a systematic review and meta-analysis

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Abstract

Purpose

Most people diagnosed with esophageal cancer will die from their disease, but it is not known whether survival is influenced by pre-morbid behavior. We undertook a systematic review and meta-analysis to investigate the impact of pre-diagnosis behavior on risk of death for esophageal cancer.

Methods

We performed a systematic review of studies reporting on the relationship between pre-diagnosis smoking, alcohol consumption, overweight and obesity, physical activity and regular consumption of nonsteroidal anti-inflammatory drugs, and risk of death from esophageal squamous cell carcinoma (ESCC) and adenocarcinomas (EACs). Study characteristics are presented and aggregate results are compiled using meta-analysis.

Results

From an initial pool of 644 non-duplicate records, 13 articles arising from 12 studies met the inclusion criteria. Considerable variation was observed between studies in location, measurement categories, adjustment for other risks, and results. Pooled estimates suggested that for ESCC pre-diagnosis smoking was associated with a 1.19 times [95 % confidence interval (CI) 1.04–1.36] increased risk of death and pre-diagnosis alcohol consumption with a 1.36 times increased risk of death (95 % CI 1.15–1.61). No significant effects were observed for EAC. We observed a lower risk of death for both ESCC and EAC associated with high pre-diagnosis body mass index (BMI) ≥25 kg/m2 (ESCC hazard ratio 0.80, 95 % CI 0.67–0.95; EAC 0.80, 95 % CI 0.68–0.95), although there was significant heterogeneity across studies.

Conclusions

Our findings suggest that a number of modifiable pre-diagnosis risk factors have a carryover effect on the risk of death from esophageal cancer. These include smoking, drinking alcohol, and BMI.

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Acknowledgments

We acknowledge Katrina Chaudhary, Science and Health Librarian, University of Western Sydney, for her assistance with the search criteria.

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Authors and Affiliations

  1. Centre for Research in Mathematics, University of Western Sydney, Sydney, NSW, Australia

    Paul P. Fahey & Glenn Stone

  2. School of Science and Health, University of Western Sydney, Sydney, NSW, Australia

    Paul P. Fahey & Thomas Astell-Burt

  3. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

    Kylie-Ann Mallitt

  4. School of Computing, Engineering and Mathematics, University of Western Sydney, Sydney, NSW, Australia

    Glenn Stone

  5. QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

    David C. Whiteman

Authors
  1. Paul P. Fahey
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  2. Kylie-Ann Mallitt
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  3. Thomas Astell-Burt
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  4. Glenn Stone
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  5. David C. Whiteman
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Correspondence to Paul P. Fahey.

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The authors declare that they have no conflict of interest.

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PubMed search criteria and additional results arising from the meta-analyses (PDF 325 kb)

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Fahey, P.P., Mallitt, KA., Astell-Burt, T. et al. Impact of pre-diagnosis behavior on risk of death from esophageal cancer: a systematic review and meta-analysis. Cancer Causes Control 26, 1365–1373 (2015). https://doi.org/10.1007/s10552-015-0635-z

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  • DOI: https://doi.org/10.1007/s10552-015-0635-z

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