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. 2019 Sep;14(9):1594-1607.
doi: 10.1016/j.jtho.2019.05.031. Epub 2019 Jun 1.

Body Mass Index (BMI), BMI Change, and Overall Survival in Patients With SCLC and NSCLC: A Pooled Analysis of the International Lung Cancer Consortium

Daniel Shepshelovich  1 , Wei Xu  2 , Lin Lu  3 , Aline Fares  4 , Ping Yang  5 , David Christiani  6 , Jie Zhang  7 , Kouya Shiraishi  8 , Brid M Ryan  9 , Chu Chen  10 , Ann G Schwartz  11 , Adonina Tardon  12 , Xifeng Wu  13 , Matthew B Schabath  14 , M Dawn Teare  15 , Loic Le Marchand  16 , Zuo-Feng Zhang  17 , John K Field  18 , Hermann Brenner  19 , Nancy Diao  6 , Juntao Xie  20 , Takashi Kohno  8 , Curtis C Harris  9 , Angela S Wenzlaff  11 , Guillermo Fernandez-Tardon  12 , Yuanqing Ye  13 , Fiona Taylor  15 , Lynne R Wilkens  16 , Michael Davies  18 , Yi Liu  21 , Matt J Barnett  22 , Gary E Goodman  23 , Hal Morgenstern  24 , Bernd Holleczek  25 , M Catherine Brown  4 , Geoffrey Liu  26 , Rayjean J Hung  27
Affiliations

Body Mass Index (BMI), BMI Change, and Overall Survival in Patients With SCLC and NSCLC: A Pooled Analysis of the International Lung Cancer Consortium

Daniel Shepshelovich et al. J Thorac Oncol. 2019 Sep.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] J Thorac Oncol. 2019 Nov;14(11):2024. doi: 10.1016/j.jtho.2019.09.003. J Thorac Oncol. 2019. PMID: 31668320 No abstract available.

Abstract

Introduction: The relationships between morbid obesity, changes in body mass index (BMI) before cancer diagnosis, and lung cancer outcomes by histology (SCLC and NSCLC) have not been well studied.

Methods: Individual level data analysis was performed on 25,430 patients with NSCLC and 2787 patients with SCLC from 16 studies of the International Lung Cancer Consortium evaluating the association between various BMI variables and lung cancer overall survival, reported as adjusted hazard ratios (aHRs) from Cox proportional hazards models and adjusted penalized smoothing spline plots.

Results: Overall survival of NSCLC had putative U-shaped hazard ratio relationships with BMI based on spline plots: being underweight (BMI < 18.5 kg/m2; aHR = 1.56; 95% confidence interval [CI]:1.43-1.70) or morbidly overweight (BMI > 40 kg/m2; aHR = 1.09; 95% CI: 0.95-1.26) at the time of diagnosis was associated with worse stage-specific prognosis, whereas being overweight (25 kg/m2 ≤ BMI < 30 kg/m2; aHR = 0.89; 95% CI: 0.85-0.95) or obese (30 kg/m2 ≤ BMI ≤ 40 kg/m2; aHR = 0.86; 95% CI: 0.82-0.91) was associated with improved survival. Although not significant, a similar pattern was seen with SCLC. Compared with an increased or stable BMI from the period between young adulthood until date of diagnosis, a decreased BMI was associated with worse outcomes in NSCLC (aHR = 1.24; 95% CI: 1.2-1.3) and SCLC patients (aHR=1.26 (95% CI: 1.0-1.6). Decreased BMI was consistently associated with worse outcome, across clinicodemographic subsets.

Conclusions: Both being underweight or morbidly obese at time of diagnosis is associated with lower stage-specific survival in independent assessments of NSCLC and SCLC patients. In addition, a decrease in BMI at lung cancer diagnosis relative to early adulthood is a consistent marker of poor survival.

Keywords: Body mass index; Lung cancer; Survival.

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Conflict of interest statement

Disclosures: The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
The hazard ratio of overall survival based on penalized smoothing spline by body mass index (BMI [kg/m2]) at diagnosis for (A) NSCLC and (B) SCLC, and Kaplan Meier survival curves for (C) NSCLC and (D) SCLC patients. BMI data points above 60 kg/m2 are sparse, explaining the wide confidence intervals in A and B. Data are sparse when BMI is greater than 60 kg/m2, and interpretation should be made with caution.
Figure 2.
Figure 2.
The hazard ratio of overall survival based on penalized smoothing spline by body mass index at young adulthood (BMI, kg/m2) for (A) NSCLC and (B) SCLC, and Kaplan Meier survival curves for (C) NSCLC patients and (D) SCLC patients. Young adulthood is defined as an age between 18 and 25 years, or approximately 20 years.
Figure 3.
Figure 3.
The hazard ratio of overall survival based on penalized smoothing spline by change in body mass index at diagnosis (ΔBMI, kg/m2) for (A) NSCLC and (B) SCLC, and Kaplan Meier survival curves for (C) NSCLC patients and (D) SCLC patients. The change compares the relationship between BMI at young adulthood (around 20 years of age) to the BMI at the time of the diagnosis as a means of correcting for heterogeneity of BMI in a healthy population.
See this image and copyright information in PMC

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