Associations between body mass index, weight loss and overall survival in patients with advanced lung cancer
Abstract Background Weight loss (WL) has been associated with shorter survival in patients with advanced cancer, while obesity has been associated with longer survival. Integrating body mass index (BMI) and WL provides a powerful prognostic tool but has not been well‐studied in lung cancer patients,...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-12-01
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| Series: | Journal of Cachexia, Sarcopenia and Muscle |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jcsm.13095 |
| _version_ | 1797204126843535360 |
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| author | Cameron Oswalt Yingzhou Liu Herbert Pang Jennifer Le‐Rademacher Xiaofei Wang Jeffrey Crawford |
| author_facet | Cameron Oswalt Yingzhou Liu Herbert Pang Jennifer Le‐Rademacher Xiaofei Wang Jeffrey Crawford |
| author_sort | Cameron Oswalt |
| collection | DOAJ |
| description | Abstract Background Weight loss (WL) has been associated with shorter survival in patients with advanced cancer, while obesity has been associated with longer survival. Integrating body mass index (BMI) and WL provides a powerful prognostic tool but has not been well‐studied in lung cancer patients, particularly in the setting of clinical trials. Methods We analysed patient data (n = 10 128) from 63 National Cancer Institute sponsored advanced non‐small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) trials. Risk matrices were created using BMI and WL percentage, which were divided into ‘grades’ based on median survival. Relationships between survival, BMI and WL percentage were examined using Kaplan–Meier estimators and Cox proportional hazards (PH) models with restricted cubic splines. Results For NSCLC, a twofold difference was noted in median survival between the BMI > 28 and WL ≤ 5% group (13.5 months) compared with the BMI < 20 and WL > 5% group (6.6 months). These associations were less pronounced in SCLC. Kaplan–Meier curves showed significant survival differences between grades for both NSCLC and SCLC (log‐rank, P < 0.0001). In Stage IV NSCLC, Cox PH analyses with restricted cubic splines demonstrated significant associations between BMI and survival in both WL ≤ 5% (P = 0.0004) and >5% (P = 0.0129) groups, as well as in WL > 5% in Stage III (P = 0.0306). In SCLC, these relationships were more complex. Conclusions BMI and WL have strong associations with overall survival in patients with advanced lung cancer, with a greater impact seen in NSCLC compared with SCLC. The integration of a BMI/WL grading scale may provide additional prognostic information and should be included in the evaluation of therapeutic interventions in future clinical trials in advanced lung cancer. |
| first_indexed | 2024-04-11T13:59:29Z |
| format | Article |
| id | doaj.art-941d0a588e1e4c2ab4738e0b927445f0 |
| institution | Directory Open Access Journal |
| issn | 2190-5991 2190-6009 |
| language | English |
| last_indexed | 2024-04-24T08:30:17Z |
| publishDate | 2022-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Cachexia, Sarcopenia and Muscle |
| spelling | doaj.art-941d0a588e1e4c2ab4738e0b927445f02024-04-16T20:10:21ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092022-12-011362650266010.1002/jcsm.13095Associations between body mass index, weight loss and overall survival in patients with advanced lung cancerCameron Oswalt0Yingzhou Liu1Herbert Pang2Jennifer Le‐Rademacher3Xiaofei Wang4Jeffrey Crawford5Hematology & Oncology Fellow, Department of Medicine Duke University Health System Durham NC USADepartment of Biostatistics and Medical Informatics University of Wisconsin–Madison Madison WI USADepartment of Biostatistics and Bioinformatics Duke Cancer Institute Durham NC USADivision of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences Mayo Clinic Rochester MN USADepartment of Biostatistics and Bioinformatics Duke Cancer Institute Durham NC USADivision of Medical Oncology, Department of Medicine Duke Cancer Institute Durham NC USAAbstract Background Weight loss (WL) has been associated with shorter survival in patients with advanced cancer, while obesity has been associated with longer survival. Integrating body mass index (BMI) and WL provides a powerful prognostic tool but has not been well‐studied in lung cancer patients, particularly in the setting of clinical trials. Methods We analysed patient data (n = 10 128) from 63 National Cancer Institute sponsored advanced non‐small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) trials. Risk matrices were created using BMI and WL percentage, which were divided into ‘grades’ based on median survival. Relationships between survival, BMI and WL percentage were examined using Kaplan–Meier estimators and Cox proportional hazards (PH) models with restricted cubic splines. Results For NSCLC, a twofold difference was noted in median survival between the BMI > 28 and WL ≤ 5% group (13.5 months) compared with the BMI < 20 and WL > 5% group (6.6 months). These associations were less pronounced in SCLC. Kaplan–Meier curves showed significant survival differences between grades for both NSCLC and SCLC (log‐rank, P < 0.0001). In Stage IV NSCLC, Cox PH analyses with restricted cubic splines demonstrated significant associations between BMI and survival in both WL ≤ 5% (P = 0.0004) and >5% (P = 0.0129) groups, as well as in WL > 5% in Stage III (P = 0.0306). In SCLC, these relationships were more complex. Conclusions BMI and WL have strong associations with overall survival in patients with advanced lung cancer, with a greater impact seen in NSCLC compared with SCLC. The integration of a BMI/WL grading scale may provide additional prognostic information and should be included in the evaluation of therapeutic interventions in future clinical trials in advanced lung cancer.https://doi.org/10.1002/jcsm.13095lung cancerbody compositionBMIweight loss |
| spellingShingle | Cameron Oswalt Yingzhou Liu Herbert Pang Jennifer Le‐Rademacher Xiaofei Wang Jeffrey Crawford Associations between body mass index, weight loss and overall survival in patients with advanced lung cancer Journal of Cachexia, Sarcopenia and Muscle lung cancer body composition BMI weight loss |
| title | Associations between body mass index, weight loss and overall survival in patients with advanced lung cancer |
| title_full | Associations between body mass index, weight loss and overall survival in patients with advanced lung cancer |
| title_fullStr | Associations between body mass index, weight loss and overall survival in patients with advanced lung cancer |
| title_full_unstemmed | Associations between body mass index, weight loss and overall survival in patients with advanced lung cancer |
| title_short | Associations between body mass index, weight loss and overall survival in patients with advanced lung cancer |
| title_sort | associations between body mass index weight loss and overall survival in patients with advanced lung cancer |
| topic | lung cancer body composition BMI weight loss |
| url | https://doi.org/10.1002/jcsm.13095 |
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