Premorbid Body Mass Index and Mortality in Patients with Lung Cancer: A Systematic Review and Meta-analysis
A partir d'une revue systématique de la littérature (14 études), cette méta-analyse évalue l'association entre une obésité pré-morbide et la mortalité spécifique chez des patients atteints d'un cancer du poumon
Highlights : •Elevated premorbid BMI was associated with reduced lung cancer mortality. •Overweight and obese individuals respectively had 16% and 19% reduced mortality, compared to individuals with normal BMI. •These findings were observed across sexes, smoking status, geographic region, study type, method of ascertaining BMI and study type. 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. Results 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.