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The relationship between body-mass index and overall survival in non-small cell lung cancer by sex, smoking status, and race: A pooled analysis of 20,937 International lung Cancer consortium (ILCCO) patients
- Jiang, Mei;
- Fares, Aline F;
- Shepshelovich, Daniel;
- Yang, Ping;
- Christiani, David;
- Zhang, Jie;
- Shiraishi, Kouya;
- Ryan, Brid M;
- Chen, Chu;
- Schwartz, Ann G;
- Tardon, Adonina;
- Shete, Sanjay;
- Schabath, Matthew B;
- Teare, M Dawn;
- Le Marchand, Loic;
- Zhang, Zuo-Feng;
- Field, John K;
- Brenner, Hermann;
- Diao, Nancy;
- Xie, Juntao;
- Kohno, Takashi;
- Harris, Curtis C;
- Wenzlaff, Angela S;
- Fernandez-Tardon, Guillermo;
- Ye, Yuanqing;
- Taylor, Fiona;
- Wilkens, Lynne R;
- Davies, Michael;
- Liu, Yi;
- Barnett, Matt J;
- Goodman, Gary E;
- Morgenstern, Hal;
- Holleczek, Bernd;
- Thomas, Sera;
- Brown, M Catherine;
- Hung, Rayjean J;
- Xu, Wei;
- Liu, Geoffrey
- et al.
Published Web Location
https://doi.org/10.1016/j.lungcan.2020.11.029Abstract
Introduction
The relationship between Body-Mass-Index (BMI) and lung cancer prognosis is heterogeneous. We evaluated the impact of sex, smoking and race on the relationship between BMI and overall survival (OS) in non-small-cell-lung-cancer (NSCLC).Methods
Data from 16 individual ILCCO studies were pooled to assess interactions between BMI and the following factors on OS: self-reported race, smoking status and sex, using Cox models (adjusted hazard ratios; aHR) with interaction terms and adjusted penalized smoothing spline plots in stratified analyses.Results
Among 20,937 NSCLC patients with BMI values, females = 47 %; never-smokers = 14 %; White-patients = 76 %. BMI showed differential survival according to race whereby compared to normal-BMI patients, being underweight was associated with poor survival among white patients (OS, aHR = 1.66) but not among black patients (aHR = 1.06; pinteraction = 0.02). Comparing overweight/obese to normal weight patients, Black NSCLC patients who were overweight/obese also had relatively better OS (pinteraction = 0.06) when compared to White-patients. BMI was least associated with survival in Asian-patients and never-smokers. The outcomes of female ever-smokers at the extremes of BMI were associated with worse outcomes in both the underweight (pinteraction<0.001) and obese categories (pinteraction = 0.004) relative to the normal-BMI category, when compared to male ever-smokers.Conclusion
Underweight and obese female ever-smokers were associated with worse outcomes in White-patients. These BMI associations were not observed in Asian-patients and never-smokers. Black-patients had more favorable outcomes in the extremes of BMI when compared to White-patients. Body composition in Black-patients, and NSCLC subtypes more commonly seen in Asian-patients and never-smokers, may account for differences in these BMI-OS relationships.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.
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