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

Mei Jiang; Aline F Fares; Daniel Shepshelovich; Ping Yang; David Christiani; Jie Zhang; Kouya Shiraishi; Brid M Ryan; Chu Chen; Ann G Schwartz; Adonina Tardon; Sanjay Shete; Matthew B Schabath; M Dawn Teare; Loic Le Marchand; Zuo-Feng Zhang; John K Field; Hermann Brenner; Nancy Diao; Juntao Xie; Takashi Kohno; Curtis C Harris; Angela S Wenzlaff; Guillermo Fernandez-Tardon; Yuanqing Ye; Fiona Taylor; Lynne R Wilkens; Michael Davies; Yi Liu; Matt J Barnett; Gary E Goodman; Hal Morgenstern; Bernd Holleczek; Sera Thomas; M Catherine Brown; Rayjean J Hung; Wei Xu; Geoffrey Liu

doi:10.1016/j.lungcan.2020.11.029

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. 2021 Feb:152:58-65. doi: 10.1016/j.lungcan.2020.11.029. Epub 2020 Dec 4.

Authors

Mei Jiang¹, Aline F Fares², Daniel Shepshelovich³, Ping Yang⁴, David Christiani⁵, Jie Zhang⁶, Kouya Shiraishi⁷, Brid M Ryan⁸, Chu Chen⁹, Ann G Schwartz¹⁰, Adonina Tardon¹¹, Sanjay Shete¹², Matthew B Schabath¹³, M Dawn Teare¹⁴, Loic Le Marchand¹⁵, Zuo-Feng Zhang¹⁶, John K Field¹⁷, Hermann Brenner¹⁸, Nancy Diao⁵, Juntao Xie¹⁹, Takashi Kohno⁷, Curtis C Harris⁸, Angela S Wenzlaff¹⁰, Guillermo Fernandez-Tardon¹¹, Yuanqing Ye¹², Fiona Taylor¹⁴, Lynne R Wilkens¹⁵, Michael Davies¹⁷, Yi Liu²⁰, Matt J Barnett²¹, Gary E Goodman²², Hal Morgenstern²³, Bernd Holleczek²⁴, Sera Thomas²⁵, M Catherine Brown²⁶, Rayjean J Hung²⁷, Wei Xu²⁸, Geoffrey Liu²⁹

Affiliations

¹ Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Hospital de Base, São José do Rio Preto, São Paulo, Brazil.
³ Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁴ Mayo Clinic, Rochester, MI, USA.
⁵ Environmental Health Department, Harvard TH Chan School of Public Health and Harvard Medical School, Boston, MA, USA.
⁶ Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, USA; Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
⁷ Division of Genome Biology, National Cancer Research Institute, Tokyo, Japan.
⁸ Centre for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
⁹ Program in Epidemiology, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Epidemiology and Department of Otolaryngology: Head and Neck Surgery, University of Washington, Seattle, WA, USA.
¹⁰ Barbara Ann Karmanos Cancer Institute, Wayne State University Detroit, MI, USA.
¹¹ IUOPA, University of Oviedo and CIBERESP, Oviedo, Spain.
¹² University of Texas MD Anderson Cancer Center, Texas, USA.
¹³ H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
¹⁴ University of Sheffield, Sheffield, UK.
¹⁵ University of Hawaii Cancer Centre, Honolulu, HI, USA.
¹⁶ University of California Los Angeles School of Public Health, CA, USA.
¹⁷ The Roy Castle Lung Cancer Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK.
¹⁸ Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁹ Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
²⁰ Mayo Clinic, Rochester, MI, USA; PLA Hospital, Beijing, China.
²¹ Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
²² Swedish Cancer Institute, Seattle, WA, USA.
²³ Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA.
²⁴ Saarland Cancer Registry, Saarbrücken, Germany.
²⁵ Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.
²⁶ Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
²⁷ Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
²⁸ Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Electronic address: Wei.Xu@uhnresearch.ca.
²⁹ Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Departments of Medical Biophysics, Pharmacology and Toxicity, and IMS, University of Toronto, Toronto, ON, Canada. Electronic address: Geoffrey.liu@uhn.ca.

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_interaction = 0.02). Comparing overweight/obese to normal weight patients, Black NSCLC patients who were overweight/obese also had relatively better OS (p_interaction = 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_interaction<0.001) and obese categories (p_interaction = 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.

Keywords: Body mass index; Interaction; Lung cancer; Obesity.

Publication types

Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Carcinoma, Non-Small-Cell Lung*
Female
Humans
Lung Neoplasms*
Male
Overweight / complications
Overweight / epidemiology
Risk Factors
Smoking

Abstract

Publication types

MeSH terms

Grants and funding