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
Menée à partir de données portant sur 20 937 patients atteints d'un cancer du poumon non à petites cellules, cette étude analyse l'association entre l'indice de masse corporelle et la survie globale, en fonction du sexe, de l'appartenance ethnique et du statut tabagique
Résumé en anglais
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 andoverall survival (OS) in non-small-cell-lung-cancer (NSCLC).
Methods : Data from 16 individual ILCCO studies were pooled to assess interactions between BMIand the following factors on OS: self-reported race, smoking status and sex, usingCox models (adjusted hazard ratios; aHR) with interaction terms and adjusted penalizedsmoothing 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-BMIpatients, being underweight was associated with poor survival among white patients(OS, aHR = 1.66) but not among black patients (aHR = 1.06; p interaction = 0.02). Comparing overweight/obese to normal weight patients, Black NSCLC patientswho were overweight/obese also had relatively better OS (p interaction = 0.06) when compared to White-patients. BMI was least associated with survival inAsian-patients and never-smokers. The outcomes of female ever-smokers at the extremesof BMI were associated with worse outcomes in both the underweight (p interaction<0.001) and obese categories (p interaction = 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-patientshad 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-patientsand never-smokers, may account for differences in these BMI-OS relationships.
