DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
J Surg Res. 2011 Sep;170(1):e75-83. doi: 10.1016/j.jss.2011.04.061. Epub 2011 May 23.
Lung cancer is the second most common neoplasm and the leading cause of cancer deaths in the United States. In cancer, weight loss and obesity are associated with reduced survival. However, the effect of obesity or weight loss at presentation on lung cancer survival has not been well studied.
Using an extensive cancer dataset, we identified 76,086 patients diagnosed with lung cancer during the period of 1998-2002, of which 14,751 patients presented with obesity and/or weight loss. We examined the relationship between survival and weight loss or obesity at diagnosis using univariate and multivariate analysis.
Median survival time (MST) for all lung cancer patients was 8.7 mo. Patients presenting with weight loss (15.8%) had shorter MST versus those who did not (6.4 versus 9.2 mo, P < 0.001) and patients with weight loss had significantly shortened MST for all stages and histologic subtypes. In contrast, obese patients at presentation (5.4%) had longer MST relative to non-obese patients (13.0 versus 8.6 mo, P < 0.001), which was significant across all stages and histologic subtypes. Multivariate analysis revealed that the absence of weight loss was an independent, positive predictor of improved survival (HR = 0.087, P < 0.001), while the absence of obesity was an independent predictor of worsened survival in lung cancer (HR = 1.16, P < 0.001).
Our results demonstrate an inverse relationship between survival and weight loss at presentation and a potentially protective effect of obesity in lung cancer survival, which could be due to greater physiologic reserves, thereby prolonging life by slowing the progress of cancer cachexia.
肺癌是美国第二常见的肿瘤，也是癌症死亡的主要原因。在癌症中，体重减轻和肥胖与生存时间缩短有关。然而，目前尚不清楚初诊时肥胖或体重减轻对肺癌生存的影响。
我们利用一个广泛的癌症数据集，确定了 1998 年至 2002 年间诊断为肺癌的 76086 例患者，其中 14751 例患者存在肥胖和/或体重减轻。我们使用单变量和多变量分析来研究生存与诊断时体重减轻或肥胖之间的关系。
所有肺癌患者的中位生存时间（MST）为 8.7 个月。与未出现体重减轻的患者（6.4 个月）相比，出现体重减轻（15.8%）的患者 MST 更短（P < 0.001），所有分期和组织学亚型的患者均出现体重减轻，MST 显著缩短。相比之下，初诊时肥胖（5.4%）的患者 MST 相对较长（13.0 个月比 8.6 个月，P < 0.001），所有分期和组织学亚型均有统计学意义。多变量分析显示，无体重减轻是生存时间改善的独立、阳性预测因素（HR = 0.087，P < 0.001），而无肥胖是肺癌生存时间恶化的独立预测因素（HR = 1.16，P < 0.001）。
我们的结果表明，初诊时的体重减轻与生存时间呈反比，肥胖在肺癌生存中可能具有保护作用，这可能是由于机体的生理储备更多，从而通过减缓癌症恶病质的进展来延长生命。
