A propensity-matched comparison of survival after lung resection in patients with a high versus low body mass index.
ABSTRACT An inverse relationship between body mass index (BMI) and the risk of lung cancer has been reported in several studies. In this study, we aimed to assess whether BMI can affect survival after lung resection for cancer.
We reviewed patient data for a 10-year period; 337 patients with BMI ≥30 who underwent lung resection for non-small cell lung cancer were identified. This group of patients was matched at a ratio of 1:1 to a group with BMI <30 and with similar characteristics such as sex, age, lung function test, history of smoking, diabetes, peripheral vascular disease, stroke, myocardial infarction, chronic obstructive pulmonary disease (COPD), procedure type, histology and stage of tumour. We also used the Kaplan-Meier survival curves before and after matching for the above mentioned patient characteristics.
Before adjusting for the preoperative and operative characteristics, despite more history of diabetes, hypertension and renal impairment in patients with BMI ≥30 compared to those with BMI <30 (BMI = 18.5-30 and < 8.5), the survival rate was found to be significantly higher when analysed univariately (P = 0.02). This difference remained significant after adjusting for all the characteristics, suggesting a significantly higher survival rate in the group with BMI ≥30 (P = 0.04).
Unlike in breast cancer, a high BMI in lung cancer patients after resection has protective effects. This may be due to the better nutritional status of the patient, a less aggressive cancer type that has not resulted in weight loss at the time of presentation or it may be due to certain hormones released from the adipose tissue. BMI can be a predictor of outcome after lung resection in cancer patients.
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ABSTRACT: Obesity and lung cancer are major public health problems. The purpose of this work is to review the data concerning this association. We report clinical and epidemiological data on obesity and discuss the impact on the incidence of lung cancer, as well as the safety and efficiency of anti-tumor treatments. Obesity does not contribute to the occurrence of lung cancer, unlike other malignancies. Patients may be more likely to undergo treatment at lower risk. Regarding surgery, obesity makes anaesthesia more difficult, increases the operative duration but does not increase postoperative morbidity and mortality. Chemotherapy and radiotherapy seem to be administered according to the same criteria as patients with normal weight. Paradoxically, survival rates of lung cancer are better in obese patients as well after surgery than after non-surgical treatment. Obesity is related to many neoplasms but not to lung cancer. Regarding long-term survival all treatments combined, it has a favorable effect: this is the "obesity paradox". Copyright © 2014 Elsevier Masson SAS. All rights reserved.Revue de Pneumologie Clinique 02/2015; DOI:10.1016/j.pneumo.2014.11.006 · 0.19 Impact Factor
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ABSTRACT: Obesity has increased dramatically in the American population during the past 2 decades. Approximately 35% of adults are obese. Although obesity represents a major health issue, the association between obesity and operative outcomes has been a subject of controversy. We queried the National Surgical Quality Improvement Program (NSQIP) database to determine whether an increased body mass index (BMI) affects the outcomes of pulmonary resection for lung cancer. We identified 6,567 patients with a diagnosis of lung cancer who underwent pulmonary resection from 2005 to 2012 in the NSQIP database. We stratified this population into 6 BMI groups according to the World Health Organization classification. The primary outcome measured was 30-day mortality; secondary outcomes included length of stay (LOS), operative time, and NSQIP-measured postoperative complications. We performed both unadjusted analysis and adjusted multivariable analysis, controlling for statistically significant variables. Adjusted multivariable logistic regression showed no increase in 30-day mortality, overall morbidity, and serious morbidity among obese patients. Adjusted Poisson regression revealed greater operative times for both obese and underweight patients compared with normal weight patients. Overall, obese patients were younger and had a greater percentage of preoperative comorbidities, including diabetes, hypertension, dyspnea, renal disease, and history of previous cardiac surgery. The prevalence of active smokers was greater among patients with low and normal BMI. Underweight patients had a greater risk-adjusted LOS relative to normal weight patients, whereas overweight and mildly obese patients had lesser risk-adjusted LOS. The results of our analysis suggest that obesity does not confer greater mortality and morbidity after lung resection. Copyright © 2015 Elsevier Inc. All rights reserved.Surgery 02/2015; 157(4). DOI:10.1016/j.surg.2014.10.016 · 3.11 Impact Factor
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ABSTRACT: Previous studies have indicated that clustering of components of metabolic syndrome (MetS) increases the risk for the development of several cancers such as colon, prostate, and breast cancer. However, the prognostic role of MetS in early-stage non-small cell lung cancer (NSCLC) has not been well defined. We reviewed the clinical data and pre-treatment information of MetS of 545 patients with NSCLC who underwent radical surgery and were pathologically diagnosed as stage IB of NSCLC. The influence of MetS and/or its components on survival outcome was examined using Kaplan-Meier and Cox proportional hazards analyses. The patients with MetS showed no difference in survival outcome regarding overall survival (OS) and disease-free survival (DFS) compared with patients without MetS in univariate, multivariate, and stratification analyses. However, in univariate analysis, a high high density lipoprotein level was a good prediction factor for DFS (median DFS with vs. without MetS: 124.3 vs. 115.1 months P = 0.036). Other single MetS components showed no association with OS and DFS in early-stage NSCLC. For other clinical characteristic, the age and adjuvant therapy were the independent prognostic factors of OS in univariate and multivariate analyses. MetS and/or its components do not have significant prognostic value in early-stage NSCLC.Medical Oncology 01/2015; 32(1):423. DOI:10.1007/s12032-014-0423-8 · 2.06 Impact Factor