Premorbid body mass index and mortality in patients with lung cancer: A systematic review and meta-analysis

Arjun Gupta, Kaustav Majumder, Nivedita Arora, Helen G. Mayo, Preet Paul Singh, Muhammad S. Beg, Randall Hughes, Siddharth Singh, David H. Johnson

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objectives We aimed to assess the association between premorbid obesity, measured using body mass index (BMI) and lung cancer-related mortality, through a systematic review and meta-analysis. Materials and Methods Observational studies reporting statistical measures of association between premorbid BMI categories and lung cancer-related mortality were included in our study. We estimated hazard ratios (aHR) with 95% confidence intervals (CI), comparing lung cancer-related mortality across BMI categories. The main outcome measure was lung cancer-related mortality in obese (BMI ≥ 30 kg/m2) and overweight participants (BMI 25.0–29.9 kg/m2), compared with normal BMI participants. Results We included 14 studies (including 2 pooled cohort studies) comprising 3,008,137 cancer-free participants at inception, reporting 28,592 lung cancer-related deaths. On meta-analysis, we observed a significantly lower lung cancer-related mortality in overweight (aHR, 0.76; 95% CI, 0.68–0.85) and obese (aHR, 0.68, 95% CI; 0.57–0.81) participants as compared to participants with normal BMI, with considerable heterogeneity; after excluding one study with large effect size, a more conservative and consistent association was observed between BMI and lung cancer-related mortality (overweight vs. normal BMI: aHR, 0.84; 95% CI, 0.79–0.90; obese vs. normal BMI: aHR, 0.81; 95% CI, 0.75–0.87), with moderate heterogeneity. Were similar in men vs. women, non-smokers vs. smokers, and Western vs Asia-Pacific populations. Conclusions Based on meta-analysis, we observed an independent protective association between premorbid obesity and lung cancer-related mortality. This association was observed across sex, smoking status and geographic region. Further studies are needed to prospectively study this association.

Original languageEnglish (US)
Pages (from-to)49-59
Number of pages11
JournalLung Cancer
Volume102
DOIs
StatePublished - Dec 1 2016

Fingerprint

Meta-Analysis
Lung Neoplasms
Body Mass Index
Mortality
Confidence Intervals
Western Asia
Obesity
Observational Studies
Cohort Studies
Smoking
Outcome Assessment (Health Care)
Population

Keywords

  • Body mass index
  • Lung cancer
  • Mortality
  • Obesity
  • Overweight
  • Premorbid
  • Prognosis

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Premorbid body mass index and mortality in patients with lung cancer : A systematic review and meta-analysis. / Gupta, Arjun; Majumder, Kaustav; Arora, Nivedita; Mayo, Helen G.; Singh, Preet Paul; Beg, Muhammad S.; Hughes, Randall; Singh, Siddharth; Johnson, David H.

In: Lung Cancer, Vol. 102, 01.12.2016, p. 49-59.

Research output: Contribution to journalArticle

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abstract = "Objectives We aimed to assess the association between premorbid obesity, measured using body mass index (BMI) and lung cancer-related mortality, through a systematic review and meta-analysis. Materials and Methods Observational studies reporting statistical measures of association between premorbid BMI categories and lung cancer-related mortality were included in our study. We estimated hazard ratios (aHR) with 95{\%} confidence intervals (CI), comparing lung cancer-related mortality across BMI categories. The main outcome measure was lung cancer-related mortality in obese (BMI ≥ 30 kg/m2) and overweight participants (BMI 25.0–29.9 kg/m2), compared with normal BMI participants. Results We included 14 studies (including 2 pooled cohort studies) comprising 3,008,137 cancer-free participants at inception, reporting 28,592 lung cancer-related deaths. On meta-analysis, we observed a significantly lower lung cancer-related mortality in overweight (aHR, 0.76; 95{\%} CI, 0.68–0.85) and obese (aHR, 0.68, 95{\%} CI; 0.57–0.81) participants as compared to participants with normal BMI, with considerable heterogeneity; after excluding one study with large effect size, a more conservative and consistent association was observed between BMI and lung cancer-related mortality (overweight vs. normal BMI: aHR, 0.84; 95{\%} CI, 0.79–0.90; obese vs. normal BMI: aHR, 0.81; 95{\%} CI, 0.75–0.87), with moderate heterogeneity. Were similar in men vs. women, non-smokers vs. smokers, and Western vs Asia-Pacific populations. Conclusions Based on meta-analysis, we observed an independent protective association between premorbid obesity and lung cancer-related mortality. This association was observed across sex, smoking status and geographic region. Further studies are needed to prospectively study this association.",
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AU - Mayo, Helen G.

AU - Singh, Preet Paul

AU - Beg, Muhammad S.

AU - Hughes, Randall

AU - Singh, Siddharth

AU - Johnson, David H.

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