Decreased body mass index is associated with impaired survival in lung cancer patients with brain metastases: A retrospective analysis of 624 patients

Abstract

Body mass index (BMI) is a prognostic factor in several cancer types. We investigated the prognostic role of BMI in a large patient cohort with newly diagnosed lung cancer brain metastases (BM) between 1990 and 2013. BMI at diagnosis of BM and graded prognostic assessment (GPA) were calculated. Definitions were underweight (BMI <18.50), weight within normal range (BMI 18.50-24.99) and overweight (BMI ≥ 25.00). A total of 624 patients (men 401/624 [64.3%]; women 223/624 [35.7%]; median age of 61 [range 33-88]) were analysed. Histology was non-small cell lung cancer in 417/622 (66.8%), small cell lung cancer (SCLC) in 205/624 (32.9%) and not otherwise specified in 2/624 (0.3%) patients. About 313/624 (50.2%) had normal BMI, 272/624 (43.5%) were overweight and 39/624 (6.3%) were underweight. Underweight patients had shorter median overall survival (3 months) compared to patients with normal BMI (7 months) and overweight (8 months; p < .001; log rank test). At multivariate analysis, higher GPA class (HR 1.430; 95% cumulative incidence, CI 1.279-1.598; p < .001; Cox regression model), SCLC histology (HR 1.310; 95% CI 1.101-1.558) and presence of underweight (HR 1.845; 95% CI 1.317-2.585; p = .014; Cox regression model) were independent prognostic factors. Underweight at diagnosis of BM in lung cancer is associated with an unfavourable prognosis.

Role that anorexia and weight loss play in patients with stage IV lung cancer

“…The presence of anorexia or weight loss in patients with advanced lung cancer is not a new finding. 12 , 20 - 22 However, we have demonstrated that the concomitance of these conditions is an important predictor of shorter survival. Other studies have shown that the presence of these symptoms may result in complications, including reduced tolerance to chemotherapy, as well as decreased mobility and functionality, leading to a worse quality of life and a consequent reduction of survival.…”

Body Mass Index (BMI), BMI Change, and Overall Survival in Patients With SCLC and NSCLC: A Pooled Analysis of the International Lung Cancer Consortium

“…6,[12][13][14][15][16][17][18][19] In studies covering both resectable and metastatic lung cancers, the worst outcomes were observed in underweight patients as defined by having a body mass index (BMI) less than 18.5 kg/m 2 . 6,[12][13][14][15][20][21][22][23][24][25][26][27][28][29] Being severely underweight may be an indicator of cancer cachexia, which is a well-described marker of poor outcome on cancer mortality. [30][31][32][33][34][35] Weight in the years before lung cancer diagnosis has also been assessed.…”

High Body Mass Index Was Related to Favorable Therapeutic Efficacy of Epidermal Growth Factor Receptor Targeted Therapy in Advanced Non-Small Cell Lung Cancer

“…Patients of weight gain had better PFS and OS [24]. Another report was retrospectively performed in lung cancer patients with brain metastases, those with high BMI had a better prognosis [25]. The seemingly paradox, or namely obesity cancer paradox, was put-forward in a recent published meta-analysis.…”