Obesity is associated with long-term improved survival in definitively treated locally advanced non-small cell lung cancer (NSCLC)

Lam, Vincent K.; Bentzen, Søren M.; Mohindra, Pranshu; Nichols, Elizabeth M.; Bhooshan, Neha; Vyfhuis, M.A.L.; Scilla, Katherine A.; Feigenberg, Steven J.; Edelman, Martin J.; Feliciano, Josephine

doi:10.1016/j.lungcan.2016.11.017

Cited by 65 publications

(49 citation statements)

References 28 publications

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“…Furthermore, large population analyses typically do not report on patient-specific variables such as nutrition (ie, BMI and albumin) or immunologic status (ie, NLR), both of which have been shown to be independent predictors of survival in LA-NSCLC. 8,9 In contrast, some other studies have failed to demonstrate an OS advantage with marital status in patients with NSCLC. For example, in a meta-analysis that evaluated the influence of race, gender, and marital status on 1,365 nonoperative NSCLC patients who were enrolled in 9 Radiation Therapy Oncology Group (RTOG) trials, the investigators did not find marital status to be independently predictive of survival.…”

Section: Discussionmentioning

confidence: 97%

“…3 Population-based assessments are important in relaying information about trends and general outcomes based on marital status, but because they are large, they often lack patient-specific information such as nutrition, immunologic status, and variability in treatment paradigms, all of which can independently have an impact on overall survival (OS) in stage III NSCLC. [8][9][10] In addition, population analyses have typically included patients of all cancer stages and hence involved a multitude of treatment approaches ranging from curative to palliative. There are limited well-annotated institutional data on the association of marital status on nonmetastatic, locally advanced (LA-NSCLC) in the setting of National Comprehensive Cancer Network-guided, standard-of-care definitive treatment.…”

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confidence: 99%

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Marriage predicts for survival in patients with stage III non–small-cell lung cancer

Vyfhuis¹

2018

JCSO

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Background Comprehensive analysis of prognostic significance of marital status in patients with stage III non-small-cell lung cancer (NSCLC) when adjusted for patient-, disease-, and treatment-specific factors, including the interaction with racial, nutritional, and immunologic status, is lacking. Objective To evaluate whether marital status is an independent predictor of clinical outcomes in patients with stage III NSCLC who are treated uniformly with curative intent. Methods The Kaplan-Meier method and Cox proportional hazards model were used to estimate the overall survival and freedom from recurrence (FFR) in 355 patients with stage III NSCLC who were treated during 2000-2013. Results 52% of patients in the cohort were married and were more likely to self-identify as white (P < .0001), reside in zip codes with a higher household median income (P < .0001), have Eastern Cooperative Oncology Group Performance Status of 0 (P = .001), have higher pretreatment albumin (P = .009), undergo surgery (P = .001), and have insurance (P = .029). On multivariate analysis, marital status remained an independent predictor of survival and was associated with a 40% decreased risk of death (P < .0001), further stratifying outcomes beyond gender and stage grouping. FFR was comparable between the 2 groups (P = .108). Limitations Retrospective analysis; information on individual support system beyond the marital and insurance status and zip code income was not available. Conclusions In a cancer such as NSCLC, in which modern therapeutic approaches have yielded only modest survival improvements despite considerable treatment-related toxicity, marital status remains an independent predictor for survival. Marriage is likely a surrogate for better psychosocial support; the scale of survival improvements seen justifies investments into supportive care interventional strategies to help advance overall outcomes.

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Section: Discussionmentioning

confidence: 97%

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confidence: 99%

Marriage predicts for survival in patients with stage III non–small-cell lung cancer

Vyfhuis¹

2018

JCSO

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“…However, a favorable influence of overweight and obesity on the course of some neoplastic diseases have been also observed (17)(18)(19). Recently, a few studies have reported a relation between obesity and overweight and better prognosis in some cancer patients (20)(21)(22). In patients with locally advanced non-small-cell lung cancer obesity was associated with increased OS (22).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a few studies have reported a relation between obesity and overweight and better prognosis in some cancer patients (20)(21)(22). In patients with locally advanced non-small-cell lung cancer obesity was associated with increased OS (22). In the early stage of colorectal cancer, the risk of death was lowest in the overweight patients (20).…”

Section: Discussionmentioning

confidence: 99%

Influence of Obesity on the Course of Malignant Neoplastic Disease in Patients After Pulmonary Metastasectomy

Rzechonek

Błasiak

Pniewski³

et al. 2018

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Abstract. Background (82.1±83.5 months vs. 43.0±44.4, p<0.01 and 110.7±81.3 months vs. 69.9±52.9 p<0.005, respectively). Survival after pulmonary metastasectomy was 27.2±25.6 months and was longer in obese and overweight patients than in normal weight patients (20.2±18.4 months vs. 29.4±26.5, p<0.05). Conclusion: Being obese or overweight is a favorable prognostic factor in patients after surgical resection of lung metastases of different malignancies.With the increasing epidemic of obesity in the world, the incidence of malignancies related to obesity also increases (1). Obesity-related cancers include breast cancer in postmenopausal women, colon cancer, cancer of the lower esophagus, gastric cancer, liver cancer, gall bladder cancer, pancreatic cancer, uterine cancer, ovarian cancer and renal cancer (2). Obesity is also associated with increased risk of metastases, including lung metastases, in some cancers (3).In the course of some malignancies a paradoxical phenomenon has been observed, indicating that obesity may be an oncogenic factor and -at the same time -may constitute a favorable prognostic factor (4, 5). The dual and opposite influence of obesity on the course of the same disease has been called the obesity paradox and has been described in some chronic diseases, including cardiovascular (6) and cerebrovascular diseases (7). These paradoxical effects of obesity may occur also in patients with metastases, including patients with malignancies not related to obesity. In a recent large-scale study of 4,010 cancer patients in good general condition, with distant metastases, median OS was twice as high in obese patients as in normal weight patients (8). However, there are also reports stating that there is no beneficial effect of obesity on metastatic neoplastic disease (9-11).The problem of the influence of obesity on the course of metastatic malignancies has not yet been unequivocally explained. Especially, there are no studies on the influence of obesity on survival of patients with operable lung metastases. Therefore, this study was undertaken to evaluate the long-term outcome of surgical treatment of obese and non-obese patients who after resection of primary neoplasm had lung metastases removed. Materials and MethodsData from 99 patients who had a resection of lung metastasis from different primary malignancies between 2001 and 2016 were analyzed. The study was retrospective, and the condition for including patients in the study was access to anesthesia documentation containing body weight and height prior to performing pulmonary metastasectomy. Analysis was performed in the groups depending on body mass index (BMI). Underweight was diagnosed when the BMI 197

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“…For example, it was shown that statin use after a lung cancer diagnosis was highly associated with increasing BMI and predicted improved survival. 26 However, a recent populationbased study of 533 patients has clarified that there is no protective association between antidiabetic medication (including sulfonylureas, insulin or thiazolidinediones, and metformin) and cancer mortality in patients with lung cancer. 50…”

Section: Adipokines and Endocrine Changesmentioning

confidence: 99%

Obesity Paradox in Lung Cancer Prognosis: Evolving Biological Insights and Clinical Implications

Zhang

Liu

Shao

et al. 2017

Journal of Thoracic Oncology

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The survival rate of lung cancer remains low despite the progress of surgery and chemotherapy. With the increasing comorbidity of obesity in patients with lung cancer, new challenges are emerging in the management of this patient population. A key issue of interest is the prognostic effect of obesity on surgical and chemotherapeutic outcomes in patients with lung cancer, which is fueled by the growing observation of survival benefits in overweight or obese patients. This unexpected inverse relationship between obesity and lung cancer mortality, called the obesity paradox, remains poorly understood. The evolving insights into the heterogeneity of obesity phenotypes and associated biological connections with lung cancer progression in recent years may help explain some of the seemingly paradoxical relationship, and well-designed clinical studies looking at the causal role of obesity-associated molecules are expected. Here, we examine potential biological mechanisms behind the protective effects of obesity in lung cancer. We highlight the need to clarify the clinical implications of this relationship toward an updated intervention strategy in the clinical care of patients with lung cancer and obesity.

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Obesity is associated with long-term improved survival in definitively treated locally advanced non-small cell lung cancer (NSCLC)

Cited by 65 publications

References 28 publications

Marriage predicts for survival in patients with stage III non–small-cell lung cancer

Marriage predicts for survival in patients with stage III non–small-cell lung cancer

Influence of Obesity on the Course of Malignant Neoplastic Disease in Patients After Pulmonary Metastasectomy

Obesity Paradox in Lung Cancer Prognosis: Evolving Biological Insights and Clinical Implications

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