Gupta Arjun, Majumder Kaustav, Arora Nivedita, Mayo Helen G, Singh Preet Paul, Beg Muhammad S, Hughes Randall, Singh Siddharth, Johnson David H
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.
Department of Surgical Sciences, University of Minnesota, Minneapolis, MN, United States.
Lung Cancer. 2016 Dec;102:49-59. doi: 10.1016/j.lungcan.2016.10.017. Epub 2016 Nov 1.
We aimed to assess the association between premorbid obesity, measured using body mass index (BMI) and lung cancer-related mortality, through a systematic review and meta-analysis.
Observational studies reporting statistical measures of association between premorbid BMI categories and lung cancer-related mortality were included in our study. We estimated hazard ratios (aHR) with 95% confidence intervals (CI), comparing lung cancer-related mortality across BMI categories. The main outcome measure was lung cancer-related mortality in obese (BMI≥30kg/m) and overweight participants (BMI 25.0-29.9kg/m), compared with normal BMI participants.
We included 14 studies (including 2 pooled cohort studies) comprising 3,008,137 cancer-free participants at inception, reporting 28,592 lung cancer-related deaths. On meta-analysis, we observed a significantly lower lung cancer-related mortality in overweight (aHR, 0.76; 95% CI, 0.68-0.85) and obese (aHR, 0.68, 95% CI; 0.57-0.81) participants as compared to participants with normal BMI, with considerable heterogeneity; after excluding one study with large effect size, a more conservative and consistent association was observed between BMI and lung cancer-related mortality (overweight vs. normal BMI: aHR, 0.84; 95% CI, 0.79-0.90; obese vs. normal BMI: aHR, 0.81; 95% CI, 0.75-0.87), with moderate heterogeneity. Were similar in men vs. women, non-smokers vs. smokers, and Western vs Asia-Pacific populations.
Based on meta-analysis, we observed an independent protective association between premorbid obesity and lung cancer-related mortality. This association was observed across sex, smoking status and geographic region. Further studies are needed to prospectively study this association.
我们旨在通过系统评价和荟萃分析，评估使用体重指数（BMI）衡量的病前肥胖与肺癌相关死亡率之间的关联。
本研究纳入了报告病前BMI类别与肺癌相关死亡率之间关联的统计测量值的观察性研究。我们估计了风险比（aHR）及其95%置信区间（CI），比较了不同BMI类别的肺癌相关死亡率。主要结局指标是肥胖（BMI≥30kg/m²）和超重参与者（BMI 25.0 - 29.9kg/m²）与正常BMI参与者相比的肺癌相关死亡率。
我们纳入了14项研究（包括2项汇总队列研究），初始时有3,008,137名无癌症参与者，报告了28,592例肺癌相关死亡。荟萃分析显示，与正常BMI参与者相比，超重（aHR，0.76；95% CI，0.68 - 0.85）和肥胖（aHR，0.68，95% CI；0.57 - 0.81）参与者的肺癌相关死亡率显著降低，存在相当大的异质性；排除一项效应量较大的研究后，观察到BMI与肺癌相关死亡率之间存在更保守且一致的关联（超重与正常BMI相比：aHR，0.84；95% CI，0.79 - 0.90；肥胖与正常BMI相比：aHR，0.81；95% CI，0.75 - 0.87），异质性为中度。在男性与女性、非吸烟者与吸烟者以及西方与亚太人群中情况相似。
基于荟萃分析，我们观察到病前肥胖与肺癌相关死亡率之间存在独立的保护关联。这种关联在性别、吸烟状况和地理区域中均有观察到。需要进一步的研究来前瞻性地研究这种关联。
