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: The aggregate of epidemiological studies indicates a significantly elevated risk for cancer in people with a high body mass index (BMI); a "dose-response" effect exists with increasing risk as BMI increases from the normal to overweight to obese categories. Successful sustained weight loss decreases future risk. The relationship of being overweight to the risk for leukemia in the aggregate has been supported in several large cohort studies and two meta-analyses of cohort and case-control studies. One meta-analysis found an elevated risk for each of the four major subtypes of leukemia. A significant association between the risk for non-Hodgkin's lymphoma and elevated BMI was supported by a meta-analysis of 13 cohort and nine case-control studies. The risk for diffuse large B-cell lymphoma may be especially significant. A high BMI increases the risk for myeloma, as judged by a meta-analysis of 11 cohort and four case-control studies. The biological relationship of obesity to the risk for cancer (biological plausibility) is unresolved. The two major causal final pathways could be "inductive" or "selective." The metabolic, endocrinologic, immunologic, and inflammatory-like changes resulting from obesity may increase the cell mutation rate, dysregulate gene function, disturb DNA repair, or induce epigenetic changes, favoring the induction of neoplastic transformation (inductive). Alternatively, obesity may create an environment in which pre-existing clones that are dormant are permitted (selected) to emerge.The Oncologist 10/2010; 15(10):1083-101. · 4.10 Impact Factor
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ABSTRACT: The association of weight, body mass index and other anthropometric measurements with cancer was investigated in a cohort of 7,840 men, examined and interviewed from 1965-1968 in Hawaii. After 23 years of follow-up, histologically confirmed incident cases of prostate (n = 306), colon (n = 289), lung (n = 236), stomach (n = 229) and rectal (n = 108) cancer were identified. Body weight was positively associated with prostate cancer. This direct association was stronger for cases diagnosed 11 or more years after examination than for those diagnosed earlier. A similar pattern was also present for the risk of colon cancer in association with weight and body mass index. For lung cancer, increased subscapular and triceps skinfold thickness were each associated with decreased risk with adjustment for cigarette smoking, but the inverse association did not persist as the time interval from exam to cancer diagnosis lengthened. There was no significant association between anthropometric measurements and stomach or rectal cancer.International Journal of Cancer 06/1994; 57(3):313-7. · 6.20 Impact Factor
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ABSTRACT: To evaluate the effect of obesity on intensive care unit mortality, duration of mechanical ventilation, and intensive care unit length of stay among critically ill medical and surgical patients. Meta-analysis of studies comparing outcomes in obese (body mass index of > or = 30 kg/m2) and nonobese (body mass index of < 30 kg/m2) critically ill patients in intensive care settings. MEDLINE, BIOSIS Previews, PubMed, Cochrane library, citation review of relevant primary and review articles, and contact with expert informants. Not applicable. A total of 62,045 critically ill subjects. Descriptive and outcome data regarding intensive care unit mortality and morbidity were extracted by two independent reviewers, according to predetermined criteria. Data were analyzed using a random-effects model. Fourteen studies met inclusion criteria, with 15,347 obese patients representing 25% of the pooled study population. Data analysis revealed that obesity was not associated with an increased risk of intensive care unit mortality (relative risk, 1.00; 95% confidence interval, 0.86-1.16; p = .97). However, duration of mechanical ventilation and intensive care unit length of stay were significantly longer in the obese group by 1.48 days (95% confidence interval, 0.07-2.89; p = .04) and 1.08 days (95% confidence interval, 0.27-1.88; p = .009), respectively, compared with the nonobese group. In a subgroup analysis, an improved survival was observed in obese patients with body mass index ranging between 30 and 39.9 kg/m2 compared with nonobese patients (relative risk, 0.86; 95% confidence interval, 0.81-0.91; p < .001). Obesity in critically ill patients is not associated with excess mortality but is significantly related to prolonged duration of mechanical ventilation and intensive care unit length of stay. Future studies should target this population for intervention studies to reduce their greater resource utilization.Critical care medicine 01/2008; 36(1):151-8. · 6.37 Impact Factor