Vedire Yeshwanth, Kalvapudi Sukumar, Yendamuri Sai
Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA.
J Thorac Dis. 2023 May 30;15(5):2806-2823. doi: 10.21037/jtd-22-1835. Epub 2023 May 8.
A highly nuanced relationship exists between obesity and lung cancer. The association between obesity and lung cancer risk/prognosis varies depending on age, gender, race, and the metric used to quantify adiposity. Increased body mass index (BMI) is counterintuitively associated with decreased lung cancer incidence and mortality, giving rise to the term 'obesity paradox'. Potential explanations for this paradox are BMI being a poor measure of obesity, confounding by smoking and reverse causation. A literature search of this topic yields conflicting conclusions from various authors. We aim to clarify the relationship between various measures of obesity, lung cancer risk, and lung cancer prognosis.
The PubMed database was searched on 10 August 2022 to identify published research studies. Literature published in English between 2018 and 2022 were included. Sixty-nine publications were considered relevant, and their full text studied to collate information for this review.
Lower lung cancer incidence and better prognosis was associated with increased BMI even after accounting for smoking and pre-clinical weight loss. Individuals with high BMI also responded better to treatment modalities such as immunotherapy compared to individuals with a normal BMI. However, these associations varied highly depending on age, gender, and race. Inability of BMI to measure body habitus is the main driver behind this variability. The use of anthropometric indicators and image-based techniques to quantify central obesity easily and accurately is on the rise. Increase in central adiposity is associated with increased incidence and poorer prognosis of lung cancer, contrasting BMI.
The obesity paradox may arise due to the improper use of BMI as a measure of body composition. Measures of central obesity better portray the deleterious effects of obesity and are more appropriate to be discussed when talking about lung cancer. The use of obesity metrics based on anthropometric measurements and imaging modalities has been shown to be feasible and practical. However, a lack of standardization makes it difficult to interpret the results of studies using these metrics. Further research must be done to understand the association between these obesity metrics and lung cancer.
肥胖与肺癌之间存在一种高度微妙的关系。肥胖与肺癌风险/预后之间的关联因年龄、性别、种族以及用于量化肥胖的指标而异。体重指数（BMI）升高与肺癌发病率和死亡率降低存在反直觉的关联，由此产生了“肥胖悖论”这一术语。对这一悖论的潜在解释包括BMI作为肥胖衡量指标存在缺陷、受吸烟因素的混杂影响以及反向因果关系。对该主题的文献检索得出了不同作者相互矛盾的结论。我们旨在阐明各种肥胖衡量指标、肺癌风险和肺癌预后之间的关系。
于2022年8月10日在PubMed数据库中进行检索，以识别已发表的研究。纳入2018年至2022年期间以英文发表的文献。69篇出版物被认为相关，并对其全文进行研究，以整理本综述所需的信息。
即使在考虑吸烟和临床前体重减轻因素后，BMI升高仍与肺癌发病率降低和预后改善相关。与BMI正常的个体相比，BMI高的个体对免疫治疗等治疗方式的反应也更好。然而，这些关联因年龄、性别和种族的不同而有很大差异。BMI无法衡量身体形态是造成这种差异的主要原因。使用人体测量指标和基于图像的技术来轻松、准确地量化中心性肥胖的情况正在增加。与BMI相反，中心性肥胖增加与肺癌发病率升高和预后较差相关。
肥胖悖论可能是由于不恰当地使用BMI作为身体成分的衡量指标所致。中心性肥胖的衡量指标能更好地描述肥胖的有害影响，在讨论肺癌时更适合进行探讨。基于人体测量和成像方式的肥胖指标已被证明是可行和实用的。然而，缺乏标准化使得难以解释使用这些指标的研究结果。必须开展进一步研究以了解这些肥胖指标与肺癌之间的关联。
