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

Zhang, Xueli; Liu, Yamin; Shao, Hua; Zheng, Xiao

doi:10.1016/j.jtho.2017.07.022

Cited by 86 publications

(103 citation statements)

References 73 publications

(94 reference statements)

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“…Lung cancer studies have reported a poorly understood reverse association between BMI and mortality known as the obesity paradox. 53 Similar findings have been reported for other cancers, including colon cancer and melanoma. [54][55][56][57] Research in this area has raised the suggestion of a subgroup of obese individuals who are considered "metabolically healthy obese."…”

Section: Discussionsupporting

confidence: 80%

“…These data are in line with other reports highlighting challenges with the use of a single nutritional marker and the importance of body composition as a predictor of treatment‐ and disease‐related outcomes. Lung cancer studies have reported a poorly understood reverse association between BMI and mortality known as the obesity paradox . Similar findings have been reported for other cancers, including colon cancer and melanoma .…”

Section: Discussionsupporting

confidence: 67%

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Associations between nutritional factors and chemotherapy toxicity in older adults with solid tumors

Dotan

Tew

Mohile

et al. 2020

Cancer

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Background Nutritional status can directly affect morbidity and mortality in older adults with cancer. This study evaluated the association between pretreatment body mass index (BMI), albumin level, and unintentional weight loss (UWL) in the prior 6 months and chemotherapy toxicity among older adults with solid tumors. Methods This was a secondary analysis of a prospective, multicenter study involving chemotherapy‐treated patients 65 years old or older. Geriatric assessment, BMI, albumin level, and UWL data were collected before treatment. Multivariable logistic regression models evaluated the associations between nutritional factors and the risk of grade 3 or higher (grade 3+) chemotherapy toxicity. Results Seven hundred fifty patients with a median age of 72 years (range, 65‐94 years) and mostly stage IV disease were enrolled. The median pretreatment BMI and albumin values were 26 kg/m2 (range, 15.1‐52.1 kg/m2) and 3.9 mg/dL (range, 1.0‐5.0 mg/dL), respectively. Nearly 50% of the patients reported UWL, with 17.6% reporting >10% UWL. Multivariable analysis revealed no association between >10% UWL and a risk for grade 3+ chemotherapy toxicity (adjusted odds ratio [AOR], 0.87; P = .58). Multivariable analysis showed a trend toward an association between a BMI ≥ 30 kg/m2 and a decreased risk of grade 3+ chemotherapy toxicity (AOR, 0.65; P = .06), whereas a low albumin level (≤3.6 mg/dL) was associated with a higher risk of grade 3+ chemotherapy toxicity (AOR, 1.50; P = .03). An analysis of the joint effect of BMI and albumin demonstrated the lowest risk of grade 3+ chemotherapy toxicity among patients with high BMIs (≥30 kg/m2) and normal albumin levels (AOR, 0.41; P = .008). Conclusions Among older adults with solid tumors, higher BMIs and normal albumin levels are associated with a lower risk of grade 3+ chemotherapy toxicity. Additional research is warranted to define the clinical significance of nutritional markers and to inform future interventions.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 67%

Associations between nutritional factors and chemotherapy toxicity in older adults with solid tumors

Dotan

Tew

Mohile

et al. 2020

Cancer

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“…Obesity is a factor associated with the risk of occurrence of multiple malignancies (1, 2, 13-15) and the risk of developing metastases in the course of some malignancies (3,16). 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).…”

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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“…Our nding that a reduced BMI was independently linked to the development of lung cancer contradicts the conventional notion that obesity is pathogenically linked to carcinogenesis [32,33]. Several studies highlighted an obesity paradox suggesting that obesity may be protective and associated with reduced lung cancer mortality after surgery or chemotherapy [32,34,35]. Although the mechanisms behind this paradoxical relationship are not fully understood, anti-tumor adipokines, anti-tumor energy reserve, metabolic tness, relative lack of sarcopenia, etc., have been suggested as potential biological mechanisms to explain this obesity paradox [34].…”

Section: Discussionmentioning

confidence: 72%

Cancer development in COPD patients: retrospective analysis of the National Health Insurance Service-National Sample Cohort in Korea

Ahn¹,

Lee

Park

et al. 2020

Preprint

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Background: COPD is a well-known risk factor for lung cancer, independent of smoking behavior. By investigating the retrospective National Health Insurance Service-National Sample Cohort (NHIS-NSC) in Korea, this study attempted to prove the hypothesis that COPD is a risk factor for major cancers developing outside of the lungs. We also aimed to investigate the environmental factors associated with the development of lung cancer in COPD patients.Methods: This study analyzed data from the NHIS-NSC over a 12-year period. Among the 514,795 subjects in the NHIS-NSC, 16,757 patients who were diagnosed with any cancer from 2002 to 2003 were excluded. This cohort enrolled six arms consisting of never-smokers without COPD (N=313,553), former smokers without COPD (N=41,359), smokers without COPD (N=112,627), never-smokers with COPD (N=7,789), former smokers with COPD (N=1,085), and smokers with COPD (N=2,677). Results: Incident rate of lung cancer per 100,000 person-year was higher according to smoking and COPD (216 in non-COPD and 757 in COPD among never-smokers, 271 in non-COPD and 1266 in COPD among former smokers, 394 in non-COPD and 1560 in COPD among former smokers, p<0.01). Age, male gender, lower BMI, low exercise level, smoking, and COPD were independent factors associated with the development of lung cancer (p<0.01). Multi-variable analyses showed that COPD, regardless of smoking status, contributed to the development of lung cancer, and colorectal cancer and liver cancer among other major cancers (p < 0.01). Conclusion: Our data suggested that COPD was an independent risk factor for the development of lung cancer, and colorectal cancer and liver cancer among other major cancers in the Korean population, regardless of smoking status.

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

Cited by 86 publications

References 73 publications

Associations between nutritional factors and chemotherapy toxicity in older adults with solid tumors

Associations between nutritional factors and chemotherapy toxicity in older adults with solid tumors

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

Cancer development in COPD patients: retrospective analysis of the National Health Insurance Service-National Sample Cohort in Korea

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