Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Jan;31(1):262-268.
doi: 10.1158/1055-9965.EPI-21-0503. Epub 2021 Nov 2.

Postdiagnosis BMI Change Is Associated with Non-Small Cell Lung Cancer Survival

Qianyu Yuan  1 , Mulong Du  1   2 , Elizabeth Loehrer  3 , Bruce E Johnson  4   5 , Justin F Gainor  6   7 , Michael Lanuti  6 , Yi Li  8 , David C Christiani  9   10
Affiliations
Observational Study

Postdiagnosis BMI Change Is Associated with Non-Small Cell Lung Cancer Survival

Qianyu Yuan et al. Cancer Epidemiol Biomarkers Prev. 2022 Jan.

Abstract

Background: Body mass index (BMI) change after a lung cancer diagnosis has been associated with non-small cell lung cancer (NSCLC) survival. This study aimed to quantify the association based on a large-scale observational study.

Methods: Included in the study were 7,547 patients with NSCLC with prospectively collected BMI data from Massachusetts General Hospital and Brigham and Women's Hospital/Dana-Farber Cancer Institute. Cox proportional hazards regression with time-dependent covariates was used to estimate effect of time-varying postdiagnosis BMI change rate (% per month) on overall survival (OS), stratified by clinical subgroups. Spline analysis was conducted to quantify the nonlinear association. A Mendelian Randomization (MR) analysis with a total of 3,495 patients further validated the association.

Results: There was a J-shape association between postdiagnosis BMI change and OS among patients with NSCLC. Specifically, a moderate BMI decrease [0.5-2.0; HR = 2.45; 95% confidence interval (CI), 2.25-2.67] and large BMI decrease (≥2.0; HR = 4.65; 95% CI, 4.15-5.20) were strongly associated with worse OS, whereas moderate weight gain (0.5-2.0) reduced the risk for mortality (HR = 0.78; 95% CI, 0.68-0.89) and large weight gain (≥2.0) slightly increased the risk of mortality without reaching statistical significance (HR = 1.10; 95% CI, 0.86-1.42). MR analyses supported the potential causal roles of postdiagnosis BMI change in survival.

Conclusions: This study indicates that BMI change after diagnosis was associated with mortality risk.

Impact: Our findings, which reinforce the importance of postdiagnosis BMI surveillance, suggest that weight loss or large weight gain may be unwarranted.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

The authors declare no potential conflicts of interest

Figures

Figure 1
Figure 1
Associations between post-diagnosis BMI change (% per month) and OS based on penalized smoothing spline (A) in 7547 NSCLC patients and (B) stratified by at-diagnosis BMI. The reference value (HR = 1) was set at change equals to 0. Time-dependent Cox proportional model with the change of BMI (% per month) as a time-dependent covariate and adjusted the sex, age at diagnosis, race, year of diagnosis, smoking history, stage, and histological type, at-diagnosis BMI and treatment status.
Figure 2
Figure 2
Associations between post-diagnosis BMI change and OS in subsets of patients. (A) BMI decrease vs. stable (B) BMI increase vs. stable The squares represent the size of each subgroup and are centered on the HR. The whiskers represent the 95% CIs.
Figure 3.
Figure 3.
SNP-exposure (post-diagnosis BMI change) and SNP-outcome (NSCLC survival) coefficients used in the MR analysis with 3 SNPs as instrument variables. The line represents the inverse-variance-weighted estimate.
See this image and copyright information in PMC

References

    1. Dahlberg SE, Schiller JH, Bonomi PB, Sandler AB, Brahmer JR, Ramalingam SS, et al. Body mass index and its association with clinical outcomes for advanced non-small-cell lung cancer patients enrolled on Eastern Cooperative Oncology Group clinical trials. J Thorac Oncol 2013;8(9):1121–7 doi 10.1097/JTO.0b013e31829cf942. - DOI - PMC - PubMed
    1. Gupta A, Majumder K, Arora N, Mayo HG, Singh PP, Beg MS, et al. Premorbid body mass index and mortality in patients with lung cancer: A systematic review and meta-analysis. Lung Cancer 2016;102:49–59 doi 10.1016/j.lungcan.2016.10.017. - DOI - PubMed
    1. Kimura M, Naito T, Kenmotsu H, Taira T, Wakuda K, Oyakawa T, et al. Prognostic impact of cancer cachexia in patients with advanced non-small cell lung cancer. Support Care Cancer 2015;23(6):1699–708 doi 10.1007/s00520-014-2534-3. - DOI - PubMed
    1. Lam VK, Bentzen SM, Mohindra P, Nichols EM, Bhooshan N, Vyfhuis M, et al. Obesity is associated with long-term improved survival in definitively treated locally advanced non-small cell lung cancer (NSCLC). Lung Cancer 2017;104:52–7 doi 10.1016/j.lungcan.2016.11.017. - DOI - PubMed
    1. Nakagawa T, Toyazaki T, Chiba N, Ueda Y, Gotoh M. Prognostic value of body mass index and change in body weight in postoperative outcomes of lung cancer surgery. Interact Cardiovasc Thorac Surg 2016;23(4):560–6 doi 10.1093/icvts/ivw175. - DOI - PubMed

Publication types