Abstract
BackgroundBody mass index (BMI) has a U-shaped association with lung cancer risk. However, the effect of BMI on prognosis is controversial. This retrospective study aimed to investigate the effect of BMI on the survival of patients with stage I non-small cell lung cancer (NSCLC) after surgical resection.MethodsIn total, 624 consecutive stage I NSCLC patients who underwent radical resection were classified into four groups according to their BMI: underweight (BMI < 18.5 kg/m2), normal weight (BMI = 18.5–22.4 kg/m2), overweight (BMI = 22.5–28.0 kg/m2), and obese (BMI > 28.0 kg/m2). The effect of BMI on progression-free survival (PFS) and overall survival (OS) was estimated using the Kaplan–Meier method and Cox proportional hazards model. Postoperative complications in each group were analyzed using the Chi square test or Fisher’s exact test.ResultsA univariate analysis showed that PFS and OS were longer in the overweight group than in other groups (both P < 0.05). A multivariate analysis showed that OS was longer in the overweight group than in other groups (compared with the other three groups in combination: hazard ratio [HR] = 1.87, 95% confidence interval [CI] 1.30–2.68, P = 0.003; compared with the underweight group: HR = 2.24, 95% CI 1.18–4.25, P = 0.013; compared with the normal weight group: HR = 1.58, 95% CI 1.07–2.33, P = 0.022; compared with the obese group: HR = 2.87, 95% CI 1.48–5.59, P = 0.002), but PFS was similar among the groups (HR = 1.28, 95% CI 0.97–1.68, P = 0.080). A subgroup analysis showed an association between being overweight and prolonged OS in patients at stage T1a (P = 0.024), T1b (P = 0.051), and T2a (P = 0.02), as well as in patients with a non-smoking history (P = 0.001). Overweight patients had lower rates of postoperative complications, such as respiratory failure (compared with the underweight and obese groups: P = 0.014), myocardial infarction (compared with the obese group: P = 0.033), and perioperative death (compared with the other three groups: P = 0.016).ConclusionsPreoperative BMI is an independent prognostic factor for stage I NSCLC patients after resection, with overweight patients having a favorable prognosis.
Highlights
Body mass index (BMI) has a U-shaped association with lung cancer risk
624 patients were included in the study and were divided into four groups according to BMI
As compared with a lower BMI, a higher BMI was associated with higher rates of hypertension (P < 0.001), smoking (P = 0.001), and high preoperative forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratios (P = 0.011)
Summary
Body mass index (BMI) has a U-shaped association with lung cancer risk. The effect of BMI on prognosis is controversial This retrospective study aimed to investigate the effect of BMI on the survival of patients with stage I non-small cell lung cancer (NSCLC) after surgical resection. Despite advances in surgical techniques and the incorporation of new therapeutic approaches, the 5-year survival rate for lung cancer patients has remained low [1, 4]. The association between the body mass index (BMI) and the risk of lung cancer has been well established [7,8,9,10,11,12]. Some studies have shown that lung cancer mortality is lower in obese patients [13,14,15,16], but these studies have lacked
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