Fukumoto Koichi, Mori Shoichi, Shintani Yasushi, Okami Jiro, Ito Hiroyuki, Ohtsuka Takashi, Toyooka Shinichi, Mori Takeshi, Watanabe Shun-Ichi, Asamura Hisao, Chida Masayuki, Date Hiroshi, Endo Shunsuke, Nagayasu Takeshi, Nakanishi Ryoichi, Miyaoka Etsuo, Okumura Meinoshin, Yoshino Ichiro
Department of Thoracic Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
Department of Thoracic Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
Lung Cancer. 2020 Nov;149:120-129. doi: 10.1016/j.lungcan.2020.09.011. Epub 2020 Sep 19.
The aim of this study was to evaluate the impact of the preoperative body mass index (BMI) on the postoperative outcomes in patients with completely resected non-small cell lung cancer (NSCLC).
The data of patients with NSCLC in whom R0 resection was achieved were extracted from the database of NSCLC samples accumulated by the Japanese Joint Committee of Lung Cancer Registry in the year 2010, and the surgical outcomes including postoperative morbidity, mortality and the prognosis, were evaluated.
Among 18,978 registered lung cancer cases, 16,509 patients (9996 men and 6513 women) were extracted. The median of age was 69 years old, and the histologic types included adenocarcinoma (n = 12,029), squamous cell carcinoma (n = 3286), large-cell carcinoma (n = 488) and others. The patients were divided into three groups according to their BMI: normal (BMI 18.5 to <25), underweight (BMI < 18.5) and overweight (BMI ≥ 25). Multivariate logistic regression analyses of factors associated with postoperative morbidity and mortality showed no significant differences among the three groups. In comparison to the normal group, the overall survival (OS) of the underweight group was significantly worse (p < 0.001) while that of the overweight group was marginally better (p = 0.075). A multivariate analysis of factors associated with OS showed that in addition to the age, sex and clinical stage, the preoperative BMI (underweight group vs. normal group: hazard ratio [HR] 1.417 [95% confidence interval {CI}: 1.278-1.572, p < 0.001], overweight group vs. normal group: HR 0.883 [95% CI: 0.806-0.967, p = 0.007]) was an independent prognostic factor. A multivariate analysis for the disease-free survival (DFS) also showed the preoperative BMI to be an independent significant prognostic factor.
The preoperative BMI is an independent prognostic factor in patients with completely resected NSCLC. A low preoperative BMI was associated with significantly poor survival in Japan.
本研究旨在评估术前体重指数（BMI）对完全切除的非小细胞肺癌（NSCLC）患者术后结局的影响。
从日本肺癌登记联合委员会2010年积累的NSCLC样本数据库中提取实现R0切除的NSCLC患者数据，并评估包括术后发病率、死亡率和预后在内的手术结局。
在18978例登记的肺癌病例中，提取了16509例患者（9996例男性和6513例女性）。年龄中位数为69岁，组织学类型包括腺癌（n = 12029）、鳞状细胞癌（n = 3286）、大细胞癌（n = 488）及其他。根据BMI将患者分为三组：正常（BMI 18.5至<25）、体重过轻（BMI < 18.5）和超重（BMI≥25）。对与术后发病率和死亡率相关因素的多因素逻辑回归分析显示，三组之间无显著差异。与正常组相比，体重过轻组的总生存期（OS）显著更差（p < 0.001），而超重组的总生存期略好（p = 0.075）。对与OS相关因素的多因素分析显示，除年龄、性别和临床分期外，术前BMI（体重过轻组与正常组：风险比[HR] 1.417 [95%置信区间{CI}：1.278 - 1.572，p < 0.001]，超重组与正常组：HR 0.883 [95% CI：0.806 - 0.967，p = 0.007]）是一个独立的预后因素。对无病生存期（DFS）的多因素分析也显示术前BMI是一个独立的显著预后因素。
术前BMI是完全切除的NSCLC患者的独立预后因素。在日本，术前BMI低与显著较差的生存率相关。
