Shalata Walid, Gothelf Itamar, Dudnik Yulia, Cohen Ahron Yehonatan, Abu Jama Ashraf, Liba Tom, Dan Ofir, Tourkey Lena, Shalata Sondos, Agbarya Abed, Meirovitz Amichay, Yakobson Alexander
The Legacy Heritage Cancer Center, Dr. Larry Norton Institute, Soroka Medical Center, Beer-Sheva 8410501, Israel.
Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel.
Cancers (Basel). 2025 Mar 29;17(7):1149. doi: 10.3390/cancers17071149.
Immune checkpoint inhibitors (ICIs) have revolutionized the management of advanced non-small cell lung cancer (NSCLC). Emerging evidence suggests a potential association between elevated body mass index (BMI) and enhanced ICI efficacy, yet this relationship remains inconclusive and warrants further investigation. This study aims to evaluate the impact of BMI on treatment efficacy and survival outcomes in advanced NSCLC patients treated with first-line ICI therapy.
A retrospective study was conducted at a multi-center registry to evaluate the impact of baseline BMI on overall survival (OS) and progression-free survival (PFS) in patients with stage IV NSCLC who received first-line ICI therapies. Treatment regimens included pembrolizumab or the combination of ipilimumab and nivolumab, administered either as monotherapy or in combination with chemotherapy, at the oncology department between January 2018 and December 2023. BMI was categorized according to the World Health Organization (WHO) classification, and OS and PFS were evaluated using Kaplan-Meier survival analysis and the Cox proportional hazards regression model.
Among 346 patients, 12.72% were underweight, 45.38% normal weight, 29.19% overweight, and 12.72% obese. Overweight and obese patients were more likely to receive pembrolizumab ( = 0.039) and less likely to undergo chemotherapy ( = 0.012). No significant differences in median overall survival (OS, log-rank: = 0.155) or progression-free survival (PFS, log-rank: = 0.370) were observed across BMI categories. However, differences emerged upon further analysis of PD-L1 levels (OS, log-rank: = 0.029; PFS, log-rank: = 0.044), additional chemotherapy (OS, log-rank: = 0.009; PFS, log-rank: = 0.021), type of immune checkpoint inhibitor (OS, log-rank: < 0.001; PFS, log-rank: < 0.001), and histologic diagnosis (OS, log-rank: = 0.011; PFS, log-rank: = 0.003).
BMI was not an independent predictor of survival outcomes in advanced NSCLC treated with ICI. Incorporating BMI with other patient-specific factors into personalized immunotherapy strategies highlights the importance of tailored approaches to improve patient care and clinical outcomes.
免疫检查点抑制剂（ICIs）彻底改变了晚期非小细胞肺癌（NSCLC）的治疗方式。新出现的证据表明，体重指数（BMI）升高与ICI疗效增强之间可能存在关联，但这种关系仍不明确，值得进一步研究。本研究旨在评估BMI对接受一线ICI治疗的晚期NSCLC患者治疗疗效和生存结果的影响。
在一个多中心登记处进行了一项回顾性研究，以评估基线BMI对接受一线ICI治疗的IV期NSCLC患者总生存期（OS）和无进展生存期（PFS）的影响。治疗方案包括帕博利珠单抗或伊匹木单抗与纳武利尤单抗的联合用药，可作为单一疗法或与化疗联合使用，于2018年1月至2023年12月在肿瘤科进行。BMI根据世界卫生组织（WHO）分类进行划分，OS和PFS使用Kaplan-Meier生存分析和Cox比例风险回归模型进行评估。
在346例患者中，12.72%体重过轻，45.38%体重正常，29.19%超重，12.72%肥胖。超重和肥胖患者更有可能接受帕博利珠单抗治疗（P = 0.039），而接受化疗的可能性较小（P = 0.012）。在不同BMI类别中，未观察到中位总生存期（OS，对数秩检验：P = 0.155）或无进展生存期（PFS，对数秩检验：P = 0.370）有显著差异。然而，在进一步分析PD-L1水平（OS，对数秩检验：P = 0.029；PFS，对数秩检验：P = 0.044）、额外化疗（OS，对数秩检验：P = 0.009；PFS，对数秩检验：P = 0.021）、免疫检查点抑制剂类型（OS，对数秩检验：P < 0.001；PFS，对数秩检验：P < 0.001）和组织学诊断（OS，对数秩检验：P = 0.011；PFS，对数秩检验：P = 0.003）时出现了差异。
BMI不是ICI治疗的晚期NSCLC生存结果的独立预测因素。将BMI与其他患者特异性因素纳入个性化免疫治疗策略突出了采用定制方法改善患者护理和临床结果的重要性。
