Body Mass Index, Weight Loss, and Mortality Risk in Advanced-Stage Non-Small Cell Lung Cancer Patients: A Focus on EGFR Mutation

Yu-Mu Chen,Chia-Cheng Tseng,Kuo-Tung Huang,Chin-Chou Wang,Wen-Feng Fang,Ya-Chun Chang,Chiung-Yu Lin,Chien-Hao Lai,Huang-Chih Chang,Tung-Ying Chao,Yung-Che Chen,Hung-Chen Chen,Meng-Chih Lin,Yi-Hsuan Tsai

doi:10.3390/nu13113761

Abstract

Body mass index (BMI) influences the prognosis of patients with non-small cell lung cancer (NSCLC), including both early-stage and late-stage NSCLC patients that are undergoing chemotherapies. However, earlier research on the relationship between BMI and survival in patients taking epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) yielded contradictory results. These publications either had a limited number of patients or were getting TKIs in various lines of therapy, which might explain why the outcomes were contradictory. As a result, we undertook retrospective study to examine the effect of BMI on survival outcomes in patients with advanced EGFR mutant NSCLC receiving first-line EGFR-TKIs. We also compared the findings to those with wild-type EGFR. Between November 2010 and March 2014, 513 patients with advanced NSCLC were enrolled in the study. According to the adjusted BMI cut-off point for Asia, 35 out of 513 (6.8%) patients were underweight (BMI < 18.5 kg/m2), whereas 197 (38.4%) were overweight (BMI > 24 kg/m2). Overweight patients with wild-type EGFR exhibited longer progression-free survival (4.6 vs. 2.1 months, p = 0.003) and overall survival (OS) (8.9 vs. 4.3 months, p = 0.003) than underweight patients. Overweight patients with EGFR mutations had a longer OS than normal-weight patients (23.0 vs. 20.2 months, p = 0.025). Bodyweight reduction was related to a shorter OS in both the mutant EGFR patients (17.1 vs. 30.5 months, p < 0.001) and the wild-type EGFR patients (7.8 vs. 18.7 months, p < 0.001). In conclusion, advanced stages NSCLC patients with a lower BMI and early weight loss had a worse outcome that was independent of EGFR mutation status.

Highlights

Lung cancer is the most frequent disease that is diagnosed and is the main cause of cancer mortality globally [1]
A total of 513 advanced non-small cell lung cancer (NSCLC) patients who were tested for epidermal growth factor receptor (EGFR) mutation status were included in the final study out of 1510 lung cancer patients (Figure 1)
There were no significant differences in the age, eastern cooperative oncology group (ECOG) PS, tumor stage, or sites of distant metastases including brain, bone, liver, and pleura between patients with the wild type and mutant EGFR (Table 1)

Summary

Introduction

Lung cancer is the most frequent disease that is diagnosed and is the main cause of cancer mortality globally [1]. The incidence of lung cancer, on the other hand, was found to have an inverse relationship with BMI [2,3,4,5]. Higher body mass index (BMI) has been linked to a better prognosis in patients with early-stage non-small cell lung cancer (NSCLC) [6], as well as in NSCLC patients who were undergoing chemotherapies [7,8,9]. Lung cancer treatments have advanced considerably in recent years [10]. The discovery of EGFR-tyrosine kinase inhibitors (TKIs) enhanced the life quality and survival in advanced

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Discussion

Conclusion