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

Mei Jiang, Aline F. Fares, Daniel Shepshelovich, Ping Yang, David Christiani, Jie Zhang, Kouya Shiraishi, Brid M. Ryan, Chu Chen, Ann G. Schwartz, Adonina Tardon, Sanjay Shete, Matthew B. Schabath, M. Dawn Teare, Loic Le Marchand, Zuo Feng Zhang, John K. Field, Hermann Brenner, Nancy Diao, Juntao XieTakashi Kohno, Curtis C. Harris, Angela S. Wenzlaff, Guillermo Fernandez-Tardon, Yuanqing Ye, Fiona Taylor, Lynne R. Wilkens, Michael Davies, Yi Liu, Matt J. Barnett, Gary E. Goodman, Hal Morgenstern, Bernd Holleczek, Sera Thomas, M. Catherine Brown, Rayjean J. Hung, Wei Xu, Geoffrey Liu

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)58-65
Number of pages8
JournalLung Cancer
Volume152
DOIs
StatePublished - Feb 2021

Keywords

  • Body mass index
  • Interaction
  • Lung cancer
  • Obesity

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

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