A Systematic Review and Meta-Analysis of the Significance of Body Mass Index on Kidney Cancer Outcomes

Kim, Lawrence H.; Doan, Paul; He, Yilu; Lau, Howard; Pleass, Henry; Patel, Manish I.

doi:10.1097/ju.0000000000001377

Cited by 34 publications

(30 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fewer than 5% of cases were underweight, preventing analysis of a population associated with adverse clinical outcomes in multiple cancer types, and a relatively small sample size may have obscured differences between overweight and obese patients. [26][27][28] Finally, the present study does not provide mechanistic insight into these novel clinical observations.…”

Section: Discussionmentioning

confidence: 76%

“…Because underweight BMI has been associated with inferior clinical outcomes in multiple cancer types, we examined whether these patients could be driving our observed results. [26][27][28] However, using the WHO definition of BMI<18.5, we identified only nine patients (3%) in this category. As would be expected given such small numbers, sensitivity analysis performed after removing these cases demonstrated no meaningful differences from our overall findings (online supplemental figure 4).…”

Section: Clinical Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

Association between body mass index, dosing strategy, and efficacy of immune checkpoint inhibitors

Ahmed

Itzstein

Sheffield

et al. 2021

J Immunother Cancer

View full text Add to dashboard Cite

BackgroundIncreased body mass index (BMI) has been associated with improved response to immune checkpoint inhibitors (ICIs) in multiple cancer types. We evaluated associations between BMI, ICI dosing strategy, and clinical outcomes.MethodsWe abstracted clinical data on patients with cancer treated with ICI, including age, sex, cancer type, BMI, ICI type, dosing strategy (weight-based or fixed), radiographic response, overall survival (OS), and progression-free survival (PFS). We compared clinical outcomes between low-BMI and high-BMI populations using Kaplan-Meier curves, Cox regressions, and Pearson product-moment correlation coefficients.ResultsA total of 297 patients were enrolled, of whom 40% were women and 59% were overweight (BMI≥25). Of these, 204 (69%) received fixed and 93 (31%) received weight-based ICI dosing. In the overall cohort, overweight BMI was associated with improved PFS (HR 0.69; 95% CI 0.51 to 0.94; p=0.02) and had a trend toward improved OS (HR 0.77; 95% CI 0.57 to 1.04; p=0.08). For both endpoints, improved outcomes in the overweight population were limited to patients who received weight-based ICI dosing (PFS HR 0.53; p=0.04 for weight-based; vs HR 0.79; p=0.2 for fixed dosing) (OS HR 0.56; p=0.03 for weight-based; vs HR 0.89; p=0.54 for fixed dosing). In multivariable analysis, BMI was not associated with PFS or OS. However, the interaction of BMI≥25 and weight-based dosing had a trend toward association with PFS (HR 0.53; 95% CI 0.26 to 1.10; p=0.09) and was associated with OS (HR 0.50; 95% CI 0.25 to 0.99; p=0.05). Patients with BMI<25 tended to have better outcomes with fixed-dose compared with weight-based ICI, while patients with BMI≥25 tended to have better outcomes with weight-based ICI, although these differences did not achieve statistical significance. There was no association between radiographic response and BMI with fixed-dose ICI (p=0.97), but a near-significant trend with weight-based ICI (p=0.1). In subset analyses, the association between BMI, ICI dosing strategy, and clinical outcomes appeared limited to men.ConclusionsThe clinical benefit of ICI in high-BMI populations appears limited to individuals receiving weight-based ICI dosing. Further research into optimal ICI dosing strategies may be warranted.

show abstract

Section: Discussionmentioning

confidence: 76%

Section: Clinical Outcomesmentioning

confidence: 99%

Association between body mass index, dosing strategy, and efficacy of immune checkpoint inhibitors

Ahmed

Itzstein

Sheffield

et al. 2021

J Immunother Cancer

View full text Add to dashboard Cite

show abstract

“…Obesity is a major worldwide health condition linked to angiogenic-related diseases such as diabetes, cardiovascular events, and cancer (1). Although there is a clear trend between diabetes, heart diseases, and obesity, the relationship between obesity and cancer is confusing, being a risk factor in some aspects and a protective factor in others (1,2). Some angiogenic growth factors and hormones are produced by fatty tissues (3), including vascular and endothelial growth factor (VEGF), tumoral necrosis factor (TNF), and leptin (4).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Body Mass Index on Survival of Metastatic Renal Cancer

Plonski

Fernández-Pello

Jiménez

et al. 2021

jkcvhl

View full text Add to dashboard Cite

Obesity has been established as a risk factor for renal cell carcinoma (RCC). Recently, studies have described obesity as a probable protecting factor in the metastatic stage of RCC. In this study, we assessed the relationship between body mass index (BMI) and overall survival in patients under systemic therapy.The correlation between BMI and overall median survival was studied in 76 patients diagnosed with metastatic RCC under systemic therapy. The groups were divided into overweight and obesity (BMI > 25 kg/m2) and underweight or normal (BMI < 25 kg/m2). Statistical analysis was performed using the Cox regression model adjusted by gender.A total of 76 patients were studied: 16 women (21%) and 60 men (79%). The median BMI was 27.96 kg/m2; 24 patients (31.6%) had low BMI and 52 (68.4%) had high BMI. Median overall survival in the group with BMI > 25 kg/m2 was 17 months (95% confidence interval [CI]: 13–34 months), while in the group with BMI ≤ 25 kg/m2, it was 14 months (95% CI: 8–20 months). When adjusted by gender, the group with BMI > 25 kg/m2 presented a hazards ratio of 0.54 (95% CI: 0.30–0.96), P = 0.044 (Log Rank).A high BMI significantly acts as a protecting factor. We observed an increased overall survival of overweight and obese patients within the context of metastatic RCC under systemic treatment. These data confirm the findings published in other studies that suggest the role of lipid metabolism in this type of tumors.

show abstract

Skeletal muscle and visceral adipose radiodensities are pre‐surgical, non‐invasive markers of aggressive kidney cancer

Furberg,

Bradshaw,

Knezevic

et al. 2024

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

IntroductionMost studies on body composition in kidney cancer have been conducted among patients with metastatic disease. Given that aggressive tumours can adversely impact body composition and even non‐metastatic tumours can be aggressive, we evaluated associations between pre‐surgical body composition features and tumour pathological features in patients with non‐metastatic clear cell renal cell cancer (ccRCC).MethodsThe Resolve Cohort consists of 1239 patients with non‐metastatic ccRCC who underwent nephrectomy at Memorial Sloan Kettering Cancer Center between 2000 and 2020. The cross‐sectional areas and radiodensities of skeletal muscle, visceral adipose, and subcutaneous adipose tissues were determined from pre‐surgical computed tomography (CT) scans at the third lumbar vertebrae using Automatica software. Pearson's correlation coefficients describe inter‐relationships among BMI and body composition variables, while odds ratios (OR) and 95% confidence intervals (CI) estimate associations between continuous body composition features (per 1‐standard deviation) and advanced stage (Stage III vs. Stages I–II) and high Fuhrman grade (Grades 3–4 vs. 1–2) from multivariable logistic regression models that considered the potential impact of biological sex, contrast enhanced CTs, and early age at onset of ccRCC.ResultsThe cohort was predominantly male (69%), white (89%), and had a median age of 58. The proportion of patients presenting with advanced stage and high‐grade disease were 31% and 51%, respectively. In models that adjusted for demographics and all body composition variables simultaneously, decreasing skeletal muscle radiodensity (i.e., more fat infiltration) but increasing visceral adipose tissue radiodensity (i.e., more lipid depletion) were associated with advanced tumour features. Per 8.4 HU decrease in skeletal muscle radiodensity, the odds of presenting with advanced stage was 1.61 (95% CI: 1.34–1.93). Per 7.22 HU increase in visceral adipose tissue radiodensity, the odds of presenting with advanced stage was 1.45 (95% CI: 1.22–1.74). Skeletal muscle index (i.e., sarcopenia) was not associated with either tumour feature. Similar associations were observed for Fuhrman grade, a more direct marker of tumour aggressiveness. Associations did not differ by sex, contrast use, or age at onset of ccRCC.ConclusionsLipid infiltrated skeletal muscle, but lipid depleted visceral adipose tissue were independently associated with advanced tumour features in non‐metastatic ccRCC. Findings highlight the importance of evaluating the full range of body composition features simultaneously in multivariable models. Interpreting pre‐surgical CTs for body composition for patients may be a novel and non‐invasive way to identify patients with aggressive renal tumours, which is clinically relevant as renal biopsies are not routinely performed.

show abstract

A Systematic Review and Meta-Analysis of the Significance of Body Mass Index on Kidney Cancer Outcomes

Cited by 34 publications

References 0 publications

Association between body mass index, dosing strategy, and efficacy of immune checkpoint inhibitors

Association between body mass index, dosing strategy, and efficacy of immune checkpoint inhibitors

Impact of Body Mass Index on Survival of Metastatic Renal Cancer

Skeletal muscle and visceral adipose radiodensities are pre‐surgical, non‐invasive markers of aggressive kidney cancer

Contact Info

Product

Resources

About