Association for Academic Surgery
Obesity and Weight Loss at Presentation of Lung Cancer are Associated with Opposite Effects on Survival

https://doi.org/10.1016/j.jss.2011.04.061Get rights and content

Background

Lung cancer is the second most common neoplasm and the leading cause of cancer deaths in the United States. In cancer, weight loss and obesity are associated with reduced survival. However, the effect of obesity or weight loss at presentation on lung cancer survival has not been well studied.

Materials and Methods

Using an extensive cancer dataset, we identified 76,086 patients diagnosed with lung cancer during the period of 1998–2002, of which 14,751 patients presented with obesity and/or weight loss. We examined the relationship between survival and weight loss or obesity at diagnosis using univariate and multivariate analysis.

Results

Median survival time (MST) for all lung cancer patients was 8.7 mo. Patients presenting with weight loss (15.8%) had shorter MST versus those who did not (6.4 versus 9.2 mo, P < 0.001) and patients with weight loss had significantly shortened MST for all stages and histologic subtypes. In contrast, obese patients at presentation (5.4%) had longer MST relative to non-obese patients (13.0 versus 8.6 mo, P < 0.001), which was significant across all stages and histologic subtypes. Multivariate analysis revealed that the absence of weight loss was an independent, positive predictor of improved survival (HR = 0.087, P < 0.001), while the absence of obesity was an independent predictor of worsened survival in lung cancer (HR = 1.16, P < 0.001).

Conclusions

Our results demonstrate an inverse relationship between survival and weight loss at presentation and a potentially protective effect of obesity in lung cancer survival, which could be due to greater physiologic reserves, thereby prolonging life by slowing the progress of cancer cachexia.

Introduction

Among all malignancies, lung cancer is the second most common neoplasm and the leading cause of cancer deaths in the United States [1]. Despite recent advances in treatments, survival remains dismal among patients diagnosed with lung cancer with overall mortality rates of approximately 72% for men and 41% for women for the years 2001–2005 [2]. Numerous studies have examined prognostic factors in lung cancer outcomes, and several studies have included co-morbid conditions in their analysis. However, data specifically examining the impact of obesity and/or weight loss at presentation on survival are scant.

Despite the fact that obesity has become an epidemic globally, the influence obesity has on lung cancer survival has not been well established [3]. There is a great deal of literature displaying the positive relationship obesity has on the incidence of many cancers, but literature on the impact obesity has on the survival of cancer patients is limited [4]. This is especially true when reviewing the literature on the impact obesity has on lung cancer survival. Recently, there has arisen debate in the literature with the role obesity plays on survival in lung cancer patients. Some studies have identified an increased risk of mortality in obese lung cancer patients, while others have shown a decreased risk of mortality in this population 5, 6, 7, 8, 9, 10. Also, there is discussion regarding the causality of smoking status (smokers, ex-smokers, lifelong non-smokers) on the relationship between obesity and lung cancer survival 4, 10, 11.

In an attempt to understand outcomes for lung cancer patients and potentially to improve survival, we examined a population-based registry to identify prognostic factors important in the treatment outcomes for patients with lung cancer. Due to the unresolved debate in the literature, our main focus was on the role obesity and the absence of weight loss at presentation has on lung cancer survival.

Section snippets

Materials and Methods

The University of Miami Institutional Review Board and the State of Florida Department of Health Institutional Review Board both approved this study. We studied data from Florida’s large, population-based cancer registry, the Florida Cancer Data System (FCDS), to identify all incident cases of lung carcinoma diagnosed between the years of 1998 and 2002. This dataset was further enhanced with data linked to Florida’s Agency for Health Care Administration (AHCA) dataset. The AHCA maintains two

Results

Patient demographics and clinical variables are summarized in Table 1. The cohort was divided near evenly among men (55.6%) and women (44.4%). The majority of the patients were Caucasian (93.2%), non-Hispanic (94.3%), and over the age of 70 y (51.5%). Over half of the patients (57.1%) were identified according to the US Census data as living in a community where 10% or less of the residents were at or below Florida’s poverty level.

Among the reported co-morbid conditions, 15.4% of patients were

Discussion

It has been extensively documented in the literature that obesity has a positive relationship with the incidence of numerous cancers and negatively impacts survival among cancer patients 4, 13, 14. However, details regarding individual sites of cancers and their relation to mortality are less available. Associations of obesity with an increased risk of mortality have been noted for various cancers, including endometrial, kidney, gallbladder, esophageal, and post-menopausal breast cancer 4, 8, 14

Acknowledgments

This work was supported by grants to TAZ from the National Cancer Institute (R01CA122596), the American Cancer Society (RSG TBE-111831), by individual allocation from an ACS Institutional Grant to the University of Miami, the National Institute for General Medical Sciences (R01GM092758), and by the Papanicoulau Corps for Cancer Research, the Women’s Cancer Association of the University of Miami, the Wendy Will Case Cancer Fund, and the Department of Defense Breast Cancer Research Program (BCRP)

References (34)

  • M.C. Cheung et al.

    Defining the role of surgery for primary gastrointestinal tract melanoma

    J Gastrointest Surg

    (2008)
  • E.A. Perez et al.

    Current incidence and outcomes of gastrointestinal mesenchymal tumors including gastrointestinal stromal tumors

    J Am Coll Surg

    (2006)
  • A. Jemal et al.

    Cancer statistics, 2008

    CA Cancer J Clin

    (2008)
  • A. Jemal et al.

    Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control

    J Natl Cancer Inst

    (2008)
  • S.T. Stewart et al.

    Forecasting the effects of obesity and smoking on U.S. life expectancy

    N Engl J Med

    (2009)
  • E.E. Calle et al.

    Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults

    N Engl J Med

    (2003)
  • H. Kollarova et al.

    Is obesity a preventive factor for lung cancer?

    Neoplasma

    (2008)
  • Cited by (85)

    • Exploiting the obesity-associated immune microenvironment for cancer therapeutics

      2022, Pharmacology and Therapeutics
      Citation Excerpt :

      Despite the compelling epidemiological data linking obesity and cancer, high body mass index (BMI) does not always have a negative effect on patients – a phenomenon known as the “obesity paradox”. In several cancer types, it has been shown that elevated BMI is associated with reduced mortality following cancer diagnosis compared to normal BMI (Amptoulach, Gross, & Kalaitzakis, 2015; Brunner et al., 2013; Gupta et al., 2016; Hakimi et al., 2013; Leung et al., 2010; Parker et al., 2006; Schlesinger et al., 2014; Tsang et al., 2016; Yang et al., 2011). Notably, renal cancer patients with high BMI exhibit improved cancer-specific survival (Choi et al., 2013; Hakimi et al., 2013), despite that obesity is an established risk factor for renal cancer incidence (Renehan, Tyson, Egger, Heller, & Zwahlen, 2008).

    View all citing articles on Scopus
    View full text