超越身体质量指数:身高和身高标准化体重对肺癌手术总生存率的影响

IF 9.1 1区 医学 Q1 GERIATRICS & GERONTOLOGY
Lorenzo Gherzi, Mathilde Prieto, Antonio Iannelli, Laurent Brouchet, Pierre-Benoit Pagès, Pierre Emmanuel Falcoz, Françoise Le Pimpec Barthes, Pascal Alexandre Thomas, Marcel Dahan, Marco Alifano
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引用次数: 0

摘要

与大多数恶性肿瘤不同,在人群水平上,以较高的身体质量指数(BMI)表示的肥胖增加与肺癌手术后预后改善有关。尽管BMI是用体重除以身高的平方来计算的,但作为BMI的决定因素之一,身高与更好的生存率相关,不受其他混杂因素的影响。体重与生存的关系很难评估,因为在个人层面上,体重与身高密切相关,并不直接反映肥胖。在这项研究中,我们研究了身高和体重对大量接受肺癌前期手术患者总体生存的影响。方法:我们提取了所有连续I-IIIA期非小细胞肺癌患者的数据,这些患者包括在一个16年的全国手术数据集中。对于每个性别,身高按性别特异性四分位数(sH)分类。性别特异性身高标准化体重(sHNW)被定义为个体体重与同性别、同身高个体的平均体重之比,并被分为四分位数。最后,计算sH和sHNW的类别隶属度之和(按四分位数为1 ~ 4),并将结果划分为sH/sHNW四组。Kaplan-Meier法评估总生存期(OS), log-rank法评估差异。建立Cox模型。结果共纳入50653例患者。平均年龄65.61±9.45岁,女性占31.99%。sH预测OS,较高的身高具有保护作用[第二、第三和第四四分位数相对于第一四分位数的粗hr: 0.94 (95% CI 0.91-0.98)、0.89(0.86-0.92)、0.77 (0.74-0.81);p < 0.0001]。sHNW也与OS相关,较低的sHNW类别与较差的结果相关,而较高的sHNW类别具有保护作用[第二、第三和第四四分位数与第一四分位数的粗hr: 0.88(0.85 - 0.92)、0.82(0.79-0.85)、0.85 (0.81-0.88);p < 0.0001]。四类sH/sHNW的预后差异较大,中低、中高、高三类的粗hr分别为0.88(0.84 ~ 0.93)、0.76(0.73 ~ 0.80)、0.70(0.66 ~ 0.74)。5年总生存率为58.65%(56.89 ~ 60.45)、62.96%(62.15 ~ 63.78)、67.71%(67.02 ~ 68.41)、70.12%(68.98 ~ 71.26),分别为低、中低、中高、高组。所有Cox模型均显示,sHNW和sH/sHNW预测生存独立于常见混杂因素。结论:我们的研究表明sHNW和sH/sHNW是可切除肺癌的重要预后因素。这一发现可能具有流行病学和生物学的相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Beyond Body Mass Index: The Impact of Height and Height-Normalised Weight on Overall Survival of Lung Cancer Undergoing Surgery

Beyond Body Mass Index: The Impact of Height and Height-Normalised Weight on Overall Survival of Lung Cancer Undergoing Surgery

Introduction

Unlike most malignancies, increased adiposity, as expressed by a higher body mass index (BMI), is associated with improved prognosis after lung cancer surgery at the population level. Height, one of the determinants of BMI, is associated with better survival, independent of other confounders, even though BMI is calculated as weight divided by height squared. The association of weight with survival is difficult to assess because, at the individual level, weight is closely linked to height and does not directly reflect adiposity. In this study, we examined the impact of height and weight on overall survival in a large population of patients undergoing upfront surgery for lung cancer.

Methods

We extracted data on all consecutive patients with stage I–IIIA non-small cell lung cancer included in a surgical nationwide dataset over a 16-year period. For each sex, height was categorised in sex-specific quartiles (sH). Sex-specific height-normalised weight (sHNW) was defined as the ratio of an individual's weight to the mean weight of individuals of the same sex and height, and it was categorised into quartiles. Finally, the sum of the category membership (ranging from 1 to 4 according to quartiles) of sH and sHNW was calculated, and the results were categorised into four groups of sH/sHNW. Overall survival (OS) was assessed by Kaplan–Meier, and differences evaluated by log-rank. Cox models were built.

Results

The study included 50 653 patients. Mean age was 65.61 ± 9.45 and 31.99% were women. sH predicted OS, taller height being protective [crude HRs of second, third, and fourth quartiles vs. first quartile: 0.94 (95% CI 0.91–0.98), 0.89 (0.86–0.92), 0.77 (0.74–0.81); p < 0.0001]. sHNW was also associated with OS, with lower sHNW category being associated with worse outcome and higher sHNW categories being protective [crude HRs of second, third and fourth quartiles vs. first quartile: 0.88 (0.85–0.92), 0.82 (0.79–0.85), 0.85 (0.81–0.88); p < 0.0001]. The four classes of sH/sHNW showed higher differences in prognosis with respective crude HRs of 0.88 (0.84–0.93), 0.76 (0.73–0.80) and 0.70 (0.66–0.74) in the intermediate lower, intermediate higher and higher class as compared with the lower class. Five-year overall survival rates were 58.65% (56.89–60.45), 62.96% (62.15–63.78), 67.71% (67.02–68.41) and 70.12% (68.98–71.26), in the lower, intermediate lower, intermediate higher and higher class, respectively. All Cox models showed that sHNW and sH/sHNW predicted survival independently from common confounders.

Conclusions

Our study demonstrated that sHNW and sH/sHNW are strong prognostic factors of resectable lung cancer. This finding could have both epidemiologic and biological relevance.

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来源期刊
Journal of Cachexia Sarcopenia and Muscle
Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-
CiteScore
13.30
自引率
12.40%
发文量
234
审稿时长
16 weeks
期刊介绍: The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.
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