The Reality of Lung Cancer Paradox: The Impact of Body Mass Index on Long-Term Survival of Resected Lung Cancer. A French Nationwide Analysis from the Epithor Database
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Epithor, the French National Database of General Thoracic Surgery
2.2. Patient Population
2.3. Retrieved Clinical Variables
2.4. Outcome Definition
2.5. Statistical Analysis
3. Results
3.1. Correlations of BMI
3.2. Survival
3.3. Stratification by Sex
3.4. Subgroup Exploratory Analyses
4. Discussion
Strengths and Limitations of the Study
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Features | No. Missing (%) | Whole Sample n = 54,631 | Underweight n = 2468 | Normal Weight n = 25,482 | Overweight n = 18,765 | Obesity n = 7877 | p |
---|---|---|---|---|---|---|---|
Period, no. (%) | 0 (0) | <0.0001 | |||||
2003–2006 | 7815 (14.3) | 357 (14.5) | 3888 (15.3) | 2657 (14.2) | 907 (11.5) | ||
2007–2010 | 13,410 (24.5) | 581 (23.5) | 6342 (24.9) | 4632 (24.7) | 1844 (23.4) | ||
2011–2014 | 16,851 (30.8) | 756 (30.6) | 7791 (30.6) | 5793 (30.9) | 2491 (31.6) | ||
2015–2017 | 16,555 (30.3) | 774 (31.4) | 7461 (29.3) | 5683 (30.3) | 2635 (33.5) | ||
Sex, no. (%) | 1 (<0.1) | <0.0001 | |||||
Female | 16,448 (30.1) | 1298 (52.6) | 8787 (34.5) | 4162 (22.2) | 2187 (27.8) | ||
Male | 38,182 (69.9) | 1170 (47.4) | 16,695 (65.5) | 14,602 (77.8) | 5690 (72.2) | ||
Age, mean (SD) y | 51 (0.1) | 64.1 (10.1) | 60.1 (10.5) | 63.0 (10.5) | 65.6 (9.5) | 65.3 (9.1) | <0.0001 |
Weight, mean (SD) kg | 39 (<0.1) | 72.9 (15.3) | 48.5 (5.7) | 64.0 (8.6) | 78.9 (8.5) | 95.3 (12.7) | <0.0001 |
Height, mean (SD) cm | 39 (<0.1) | 169.5 (8.4) | 167.3 (8.5) | 169.2 (8.4) | 170.4 (8.1) | 169.2 (8.6) | <0.0001 |
Body mass index, mean (SD) kg/m2 | 39 (<0.1) | 25.3 (4.6) | 17.3 (1.0) | 22.3 (1.8) | 27.1 (1.4) | 33.2 (3.3) | <0.0001 |
Charlson comorbidity index, mean (SD) | 0 (0.0) | 4.4 (2.2) | 3.9 (2.0) | 4.2 (2.2) | 4.6 (2.2) | 4.6 (2.1) | <0.0001 |
Performance status, no. (%) | 2953 (5.4) | <0.0001 | |||||
0 | 23,479 (45.4) | 845 (36.9) | 11,689 (48.4) | 8227 (46.4) | 2704 (36.3) | ||
1 | 23,318 (45.1) | 1099 (48.0) | 10,301 (42.6) | 8047 (45.4) | 3861 (51.8) | ||
2–4 | 4881 (9.4) | 346 (15.1) | 2183 (9.0) | 1453 (8.2) | 892 (12.0) | ||
Histology, no. (%) | 3500 (6.4) | <0.0001 | |||||
Adenocarcinoma | 30,187 (59.0) | 1426 (61.2) | 14,561 (61.0) | 10,181 (58.0) | 3998 (54.4) | ||
Squamous-cell carcinoma | 14,176 (27.7) | 580 (24.9) | 6204 (26.0) | 5106 (29.1) | 2276 (31.0) | ||
Carcinoid tumor, typical | 1744 (3.4) | 54 (2.3) | 683 (2.9) | 594 (3.4) | 412 (5.6) | ||
Large-cell carcinoma, undifferentiated | 1598 (3.1) | 96 (4.1) | 836 (3.5) | 487 (2.8) | 178 (2.4) | ||
Large-cell carcinoma, neuroendocrine | 961 (1.9) | 51 (2.2) | 455 (1.9) | 316 (1.8) | 139 (1.9) | ||
Carcinoid tumor, atypical | 609 (1.2) | 23 (1.0) | 232 (1.0) | 236 (1.3) | 118 (1.6) | ||
Small-cell lung carcinoma | 474 (0.9) | 18 (0.8) | 212 (0.9) | 175 (1.0) | 68 (0.9) | ||
Sarcomatoid carcinoma | 385 (0.8) | 32 (1.4) | 210 (0.9) | 101 (0.6) | 41 (0.6) | ||
Other | 997 (1.9) | 50 (2.1) | 474 (2.0) | 354 (2.0) | 116 (1.6) | ||
Stage | 14,887 (27.3) | <0.0001 | |||||
0/occult | 186 (0.5) | 11 (0.6) | 96 (0.5) | 58 (0.4) | 19 (0.3) | ||
I | 21,374 (53.8) | 952 (52.8) | 9776 (52.6) | 7413 (54.3) | 3222 (56.7) | ||
II | 7391 (18.6) | 352 (19.5) | 3531 (19.0) | 2518 (18.4) | 985 (17.3) | ||
III | 8454 (21.3) | 341 (18.9) | 3942 (21.2) | 2950 (21.6) | 1215 (21.4) | ||
IV | 2339 (5.9) | 147 (8.2) | 1237 (6.7) | 709 (5.2) | 245 (4.3) | ||
Surgical procedure, no. (%) | 0 (0) | <0.0001 | |||||
Pneumonectomy | 5516 (10.1) | 236 (9.6) | 2738 (10.7) | 1878 (10.0) | 662 (8.4) | ||
Other | 49,115 (89.9) | 2232 (90.4) | 22,744 (89.3) | 16,887 (90.0) | 7215 (91.6) | ||
Side, no. (%) | 305 (0.6) | 0.071 | |||||
Right | 31,412 (57.8) | 1460 (59.3) | 14,721 (58.1) | 10,760 (57.7) | 4447 (56.8) | ||
Left | 22,914 (42.2) | 1000 (40.7) | 10,609 (41.9) | 7904 (42.3) | 3386 (43.2) |
Features | Unadjusted | Model 1 | Model 2 | Model 3 * |
---|---|---|---|---|
n = 54,631 | n = 54,631 | n = 54,631 | n = 54,376 | |
Deaths = 17,094 | Deaths = 17,094 | Deaths = 17,094 | Deaths = 17,043 | |
BMI category | ||||
Underweight | 1.24 (1.16–1.33) | 1.61 (1.50–1.72) | 1.50 (1.40–1.61) | 1.51 (1.41–1.63) |
Normal weight | 1 (reference) | 1 (reference) | 1 (reference) | 1 (reference) |
Overweight | 0.95 (0.92–0.98) | 0.81 (0.79–0.84) | 0.83 (0.80–0.86) | 0.84 (0.81–0.87) |
Obesity | 0.88 (0.84–0.92) | 0.79 (0.76–0.83) | 0.79 (0.75–0.83) | 0.80 (0.76–0.84) |
Period | ||||
2003–2006 | — | 1 (reference) | 1 (reference) | 1 (reference) |
2007–2010 | — | 0.92 (0.88–0.97) | 0.93 (0.89–0.98) | 0.94 (0.90–0.99) |
2011–2014 | — | 0.93 (0.89–0.97) | 0.96 (0.92–1.01) | 0.98 (0.94–1.03) |
2015–2017 | — | 1.00 (0.95–1.04) | 1.05 (1.00–1.10) | 1.08 (1.03–1.14) |
Sex, no. (%) | ||||
Female | — | 1 (reference) | 1 (reference) | 1 (reference) |
Male | — | 3.07 (2.93–3.22) | 2.90 (2.77–3.04) | 2.90 (2.77–3.04) |
Age (per decade) | — | 1.08 (1.05–1.10) | 1.06 (1.04–1.09) | 1.09 (1.07–1.11) |
Charlson comorbidity index (per point until a score of 6 **) | — | 1.11 (1.10–1.13) | 1.09 (1.07–1.10) | 1.09 (1.07–1.10) |
Performance status | ||||
0 | — | — | 1 (reference) | 1 (reference) |
1 | — | — | 1.22 (1.18–1.27) | 1.20 (1.16–1.25) |
2–4 | — | — | 1.67 (1.59–1.76) | 1.61 (1.53–1.70) |
Surgical procedure | ||||
Pneumonectomy | — | 1.75 (1.67–1.83) | 1.69 (1.61–1.77) | 1.24 (1.18–1.30) |
Other | — | 1 (reference) | 1 (reference) | 1 (reference) |
Side | ||||
Right | — | 1 (reference) | 1 (reference) | 1 (reference) |
Left | — | 0.98 (0.95–1.01) | 0.98 (0.95–1.01) | 0.98 (0.95–1.01) |
Histology | ||||
Adenocarcinoma | — | — | 1 (reference) | 1 (reference) |
Squamous-cell carcinoma | — | — | 1.04 (1.00–1.08) | 1.06 (1.02–1.10) |
Carcinoid tumor, typical | — | — | 0.29 (0.23–0.37) | 0.34 (0.27–0.43) |
Large-cell carcinoma, undifferentiated | — | — | 1.32 (1.22–1.43) | 1.27 (1.18–1.38) |
Large-cell carcinoma, neuroendocrine | — | — | 1.32 (1.19–1.47) | 1.32 (1.19–1.47) |
Carcinoid tumor, atypical | — | — | 0.54 (0.43–0.67) | 0.56 (0.45–0.70) |
Small-cell lung carcinoma | — | — | 1.66 (1.45–1.90) | 1.65 (1.44–1.89) |
Sarcomatoid carcinoma | — | — | 1.62 (1.38–1.89) | 1.57 (1.34–1.83) |
Other | — | — | 1.18 (1.05–1.32) | 1.18 (1.05–1.33) |
Stage | ||||
I | — | — | — | 1 (reference) |
II | — | — | — | 1.62 (1.54–1.71) |
III | — | — | — | 2.33 (2.22–2.44) |
IV | — | — | — | 2.93 (2.73–3.14) |
BMI Category | Females n = 16,448 Deaths = 2109 | Males n = 38,183 Deaths = 14,985 | p |
---|---|---|---|
Unadjusted | |||
Underweight | 1.49 (1.29–1.71) | 1.51 (1.40–1.64) | 0.83 |
Normal weight | 1 (reference) | 1 (reference) | — |
Overweight | 0.81 (0.72–0.90) | 0.85 (0.82–0.88) | 0.37 |
Obesity | 0.72 (0.63–0.84) | 0.83 (0.79–0.88) | 0.069 |
Model 1 * | |||
Underweight | 1.41 (1.23–1.62) | 1.55 (1.43–1.68) | 0.25 |
Normal weight | 1 (reference) | 1 (reference) | — |
Overweight | 0.78 (0.70–0.87) | 0.83 (0.80–0.86) | 0.35 |
Obesity | 0.68 (0.58–0.78) | 0.79 (0.75–0.83) | 0.049 |
Model 2 † | |||
Underweight | 1.38 (1.20–1.58) | 1.53 (1.42–1.66) | 0.19 |
Normal weight | 1 (reference) | 1 (reference) | |
Overweight | 0.81 (0.73–0.91) | 0.83 (0.80–0.86) | 0.69 |
Obesity | 0.73 (0.63–0.84) | 0.80 (0.76–0.84) | 0.22 |
Model 3 ‡ | |||
Underweight | 1.38 (1.20–1.59) | 1.55 (1.42–1.68) | 0.18 |
Normal weight | 1 (reference) | 1 (reference) | |
Overweight | 0.82 (0.73–0.91) | 0.84 (0.81–0.87) | 0.65 |
Obesity | 0.73 (0.63–0.84) | 0.81 (0.77–0.86) | 0.16 |
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Alifano, M.; Daffré, E.; Iannelli, A.; Brouchet, L.; Falcoz, P.E.; Le Pimpec Barthes, F.; Bernard, A.; Pages, P.B.; Thomas, P.A.; Dahan, M.; et al. The Reality of Lung Cancer Paradox: The Impact of Body Mass Index on Long-Term Survival of Resected Lung Cancer. A French Nationwide Analysis from the Epithor Database. Cancers 2021, 13, 4574. https://doi.org/10.3390/cancers13184574
Alifano M, Daffré E, Iannelli A, Brouchet L, Falcoz PE, Le Pimpec Barthes F, Bernard A, Pages PB, Thomas PA, Dahan M, et al. The Reality of Lung Cancer Paradox: The Impact of Body Mass Index on Long-Term Survival of Resected Lung Cancer. A French Nationwide Analysis from the Epithor Database. Cancers. 2021; 13(18):4574. https://doi.org/10.3390/cancers13184574
Chicago/Turabian StyleAlifano, Marco, Elisa Daffré, Antonio Iannelli, Laurent Brouchet, Pierre Emmanuel Falcoz, Françoise Le Pimpec Barthes, Alain Bernard, Pierre Benoit Pages, Pascal Alexandre Thomas, Marcel Dahan, and et al. 2021. "The Reality of Lung Cancer Paradox: The Impact of Body Mass Index on Long-Term Survival of Resected Lung Cancer. A French Nationwide Analysis from the Epithor Database" Cancers 13, no. 18: 4574. https://doi.org/10.3390/cancers13184574