論文No2674
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,...Rayjean J. Hung,Wei Xu,Geoffrey Liu
LUNG CANCER, VOLUME 152, P58-65, FEBRUARY 01, 2021
＜背景＞
肥満度(BMI)と肺がんの予後との関連はさまざまな結果である。
我々は非小細胞肺がん(NSCLC)患者においてBMIと全生存期間(OS)との関連を、
性別、喫煙状態、人種の観点から検討した。
＜方法＞
16のILCCO研究のデータを蓄積してBMIとOSとの関連を次の因子を加味して検討した：
自己申告による人種、喫煙状態、性別。
Cox比例ハザードモデル（補正ハザード比; aHR)で層別化解析における交互作用、
補正penalized smoothing spline plotsで評価した。
＜結果＞
BMIの判明していた20,937名のNSCLC患者のうち、女性47%、非喫煙者14%、白人76%であった。
BMIは人種によってOSへの影響が異なっており、
白人では体重減少は予後が悪かった (OS, aHR = 1.66)が、黒人では関連しなかった(aHR = 1.06; p interaction = 0.02)。
体重正常と比較して過体重／肥満を比較した場合、黒人のNSCLC患者で
過体重／肥満は白人と比較して相対的にOSがよかった（p interaction=0.06)。
BMIはアジア人や非喫煙者において生存とあまり関連しなかった。
女性の既喫煙者で極度のBMI偏移は、やせ（p interaction<0.001)、肥満（p interaction=0.004)ともに予後が悪かった。
＜感想＞
白人において女性は肥満でもやせでも非小細胞肺がんの予後は悪かったようです。
BMIはアジア人や非喫煙者では予後との関連がなかったようです。
黒人の肥満者は白人よりも予後がよかったようです。
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.