The relationship between body-mass index and overall survival in non-small cell lung cancer by sex, smoking status, and race: A pooled analysis of 20,937 International lung Cancer consortium (ILCCO) patients

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Jiang, Mei, Fares, Aline F, Shepshelovich, Daniel, Yang, Ping, Christiani, David, Zhang, Jie, Shiraishi, Kouya, Ryan, Brid M, Chen, Chu, Schwartz, Ann G et al (show 28 more authors) , Tardon, Adonina, Shete, Sanjay, Schabath, Matthew B, Teare, M Dawn, Le Marchand, Loic, Zhang, Zuo-Feng, Field, John K ORCID: 0000-0003-3951-6365, 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 ORCID: 0000-0002-7609-4977, Liu, Yi, Barnett, Matt J, Goodman, Gary E, Morgenstern, Hal, Holleczek, Bernd, Thomas, Sera, Brown, M Catherine, Hung, Rayjean J, Xu, Wei and Liu, Geoffrey (2021) The relationship between body-mass index and overall survival in non-small cell lung cancer by sex, smoking status, and race: A pooled analysis of 20,937 International lung Cancer consortium (ILCCO) patients Lung Cancer, 152. pp. 58-65. ISSN 0169-5002, 1872-8332

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Abstract

Introduction: 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). Methods: 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. Results: 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<inf>interaction</inf> = 0.02). Comparing overweight/obese to normal weight patients, Black NSCLC patients who were overweight/obese also had relatively better OS (p<inf>interaction</inf> = 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<inf>interaction</inf><0.001) and obese categories (p<inf>interaction</inf> = 0.004) relative to the normal-BMI category, when compared to male ever-smokers. Conclusion: 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.

Item Type:	Article
Uncontrolled Keywords:	Body mass index, Obesity, Lung cancer, Interaction
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Systems, Molec & Integrative Biology > Inst. Systems, Molec & Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	07 Apr 2021 09:59
Last Modified:	22 Jan 2026 08:26
DOI:	10.1016/j.lungcan.2020.11.029
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3114833
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