Jiang Mei, Fares Aline F, Shepshelovich Daniel, Yang Ping, Christiani David, Zhang Jie, Shiraishi Kouya, Ryan Brid M, Chen Chu, Schwartz Ann G, Tardon Adonina, Shete Sanjay, Schabath Matthew B, Teare M Dawn, Le Marchand Loic, Zhang Zuo-Feng, Field John K, Brenner Hermann, Diao Nancy, Xie Juntao, Kohno Takashi, Harris Curtis C, Wenzlaff Angela S, Fernandez-Tardon Guillermo, Ye Yuanqing, Taylor Fiona, Wilkens Lynne R, Davies Michael, Liu Yi, Barnett Matt J, Goodman Gary E, Morgenstern Hal, Holleczek Bernd, Thomas Sera, Brown M Catherine, Hung Rayjean J, Xu Wei, Liu Geoffrey
Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Hospital de Base, São José do Rio Preto, São Paulo, Brazil.
Lung Cancer. 2021 Feb;152:58-65. doi: 10.1016/j.lungcan.2020.11.029. Epub 2020 Dec 4.
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 and overall survival (OS) in non-small-cell-lung-cancer (NSCLC).
Data from 16 individual ILCCO studies were pooled to assess interactions between BMI and the following factors on OS: self-reported race, smoking status and sex, using Cox models (adjusted hazard ratios; aHR) with interaction terms and adjusted penalized smoothing spline plots in stratified analyses.
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-BMI patients, being underweight was associated with poor survival among white patients (OS, aHR = 1.66) but not among black patients (aHR = 1.06; p = 0.02). Comparing overweight/obese to normal weight patients, Black NSCLC patients who were overweight/obese also had relatively better OS (p = 0.06) when compared to White-patients. BMI was least associated with survival in Asian-patients and never-smokers. The outcomes of female ever-smokers at the extremes of BMI were associated with worse outcomes in both the underweight (p<0.001) and obese categories (p = 0.004) relative to the normal-BMI category, when compared to male ever-smokers.
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-patients had 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-patients and never-smokers, may account for differences in these BMI-OS relationships.
体重指数（BMI）与肺癌预后之间的关系是异质性的。我们评估了性别、吸烟和种族对非小细胞肺癌（NSCLC）患者BMI与总生存期（OS）关系的影响。
汇总来自16项ILCCO个体研究的数据，使用带有交互项的Cox模型（调整后风险比；aHR）和分层分析中的调整惩罚平滑样条图，评估BMI与以下因素对OS的交互作用：自我报告的种族、吸烟状况和性别。
在20937例有BMI值的NSCLC患者中，女性占47%；从不吸烟者占14%；白人患者占76%。BMI显示出因种族而异的生存期差异，与正常BMI患者相比，体重过轻与白人患者的生存期较差相关（OS，aHR = 1.66），但与黑人患者无关（aHR = 1.06；p = 0.02）。与正常体重患者相比，超重/肥胖的黑人NSCLC患者的OS也相对较好（p = 0.06）。BMI与亚洲患者和从不吸烟者的生存期关联最小。与男性曾经吸烟者相比，BMI处于极端值的女性曾经吸烟者在体重过轻（p<0.001）和肥胖类别（p = 0.004）中的结局均比正常BMI类别更差。
体重过轻和肥胖的女性曾经吸烟者与白人患者较差的结局相关。在亚洲患者和从不吸烟者中未观察到这些BMI关联。与白人患者相比，黑人患者在BMI极端值时的结局更有利。黑人患者的身体组成以及亚洲患者和从不吸烟者中更常见的NSCLC亚型可能解释了这些BMI与OS关系的差异。
