Overweight and Obesity are Associated with Poorer Survival Among Patients with Advanced Non-Small Cell Lung Cancer Receiving Platinum-Based Chemotherapy

Figures & data

Table 1 Treatment Response and Patients’ Characteristics

Variables	n	%
Sex
Males	124	71.3
Females	50	28.7
Age (years), mean (SD)	58.1 (9.43)
<60 years	98	56.3
≥60 years	76	43.7
Smoking history
Yes	67	38.5
No	107	61.5
Histopathology
Adenocarcinoma	123	70.7
Squamous cell carcinoma	51	29.3
Staging
Stage II/III	39	22.4
Stage IV	135	77.6
Other treatments
Cryotherapy	10	5.7
Palliative radiotherapy	85	48.9
ECOG performance status
0	13	7.5
1	120	69.0
2	41	23.5
Cachexia
Yes	111	63.8
No	63	36.2
Body mass index (kg/m^2), mean (SD)	21.9 (3.58)
Underweight	27	15.5
Normal weight	114	65.5
Overweight/obesity	33	19.0
D-dimer before chemotherapy
<500	35	20.1
≥500	139	79.9

Table 2 Patients’ Characteristics According to the Weight Status

Variables	Underweight (n = 27)	Normal Weight (n = 114)	Overweight/Obesity (n = 33)	P
Sex				0.005
Males	22 (81.5)	86 (75.4)	16 (48.5)
Females	5 (18.5)	28 (24.6)	17 (51.5)
Age (years), mean (SD)				0.792
<60 years	14 (51.9)	64 (56.1)	20 (60.6)
≥60 years	13 (48.1)	50 (43.9)	13 (39.4)
Histopathology				0.39
Adenocarcinoma	22 (81.5)	79 (69.3)	22 (66.7)
Squamous cell carcinoma	5 (18.5)	35 (30.7)	11 (33.3)
Staging				0.119
Stage II/III	3 (11.1)	25 (21.9)	11 (33.3)
Stage IV	24 (88.9)	89 (78.1)	22 (66.7)
ECOG performance status				0.109
0	0 (0)	12 (10.5)	1 (3.0)
1	17 (63.0)	77 (67.5)	26 (78.8)
2	10 (37.0)	25 (22.0)	6 (18.2)
Cachexia				0.474
Yes	16 (59.3)	71 (62.3)	24 (72.7)
No	11 (40.7)	43 (37.7)	9 (27.3)
D-dimer before chemotherapy				0.104
<500	4 (14.8)	20 (17.5)	11 (33.3)
≥500	23 (85.2)	94 (82.5)	22 (66.7)

Note: P values were calculated by chi-square or one-way ANOVA, where appropriate.

Table 3 Association Between Clinical Characteristics and Treatment Response

Variables	CR/PR	SD/PD	Crude		Adjusted*
	n (%)	n (%)	OR (95% CI)	P	OR (95% CI)	P
Sex
Males	52 (71.2)	72 (71.3)	Ref	Ref	Ref	Ref
Females	21 (28.8)	29 (28.7)	1 (0.51; 1.94)	0.994	0.96 (0.43; 2.16)	0.921
Age (years), mean (SD)	58.1 (8.62)	58.1 (10.0)	1 (0.97; 1.03)	0.998	1.00 (0.97; 1.04)	0.945
<60 years	44 (60.3)	54 (53.47)
≥60 years	29 (39.7)	47 (46.53)
Smoking history
Yes	27 (37.0)	40 (39.6)	1.12 (0.60; 2.08)	0.726	1.08 (0.53; 2.21)	0.829
No	46 (63.0)	61 (60.4)	Ref	Ref	Ref	Ref
Histopathology
Adenocarcinoma	52 (71.2)	71 (70.3)	Ref	Ref	Ref	Ref
Squamous cell carcinoma	21 (28.8)	30 (29.7)	1.05 (0.54; 2.03)	0.894	1.16 (0.58; 2.34)	0.671
Staging
Stage II/III	21 (28.8)	18 (17.8)	Ref	Ref	Ref	Ref
Stage IV	52 (71.2)	83 (82.2)	1.86 (0.91; 3.82)	0.088	2.01 (0.88; 4.58)	0.095
ECOG performance status
0	4 (5.5)	9 (8.9)	Ref	Ref	Ref	Ref
1	50 (68.5)	70 (69.3)	0.62 (0.18; 2.13)	0.451	0.52 (0.14; 1.94)	0.331
2	19 (26.0)	22 (21.8)	0.51 (0.14; 1.94)	0.327	0.49 (0.12; 1.95)	0.31
Cachexia
Yes	48 (65.8)	63 (62.4)	0.86 (0.46; 1.62)	0.647	0.80 (0.41; 1.57)	0.514
No	25 (34.2)	38 (37.6)	Ref	Ref	Ref	Ref
Body mass index (kg/m^2), mean (SD)	22.0 (3.75)	21.9 (3.48)
Underweight	13 (17.8)	14 (13.9)	0.70 (0.30; 1.63)	0.411	0.70 (0.29; 1.69)	0.431
Normal weight	45 (61.6)	69 (68.3)	Ref	Ref	Ref	Ref
Overweight/obesity	15 (20.6)	18 (17.8)	0.78 (0.36; 1.71)	0.539	0.94 (0.40; 1.57)	0.88
D-dimer before chemotherapy
<500	17 (23.3)	18 (17.8)	Ref	Ref	Ref	Ref
≥500	56 (76.7)	83 (82.2)	1.4 (0.66; 2.95)	0.375	1.11 (0.49; 2.54)	0.798

Notes: All odds ratios and P values were calculated using logistic regression. *Fully adjusted model.

Abbreviations: CI, confidence interval; CR, complete response; ECOG, Eastern Cooperative Oncology Group; OR, odds ratio; PD, progressive disease; PR, partial response; Ref, reference; SD, stable disease.

Figure 1 Kaplan–Meier graph of survival functions by (A) sex, (B) age, (C) histopathology, (D) staging, (E) treatment response, (F) the presence of cachexia, (G) weight status, (H) weight D-dimer levels at baseline, (I) performance status.

Table 4 Sex and Weight Status Were Associated with 2-Year Mortality Rate

Variables	Crude			Adjusted*
	HR	95% CI	P	HR	95% CI	P
Males (vs females)	1.45	0.99–2.13	0.056	1.77	1.15–2.72	0.009
Age (years)	1	0.98–1.02	0.83	0.99	0.98–1.01	0.587
Stage IV (vs stage II/III)	1.46	0.96–2.22	0.079	1.43	0.90–2.25	0.133
Overweight/ obesity (vs UW/NW)	1.23	0.81–1.87	0.339	1.67	1.04–2.69	0.034
SCC (vs adenocarcinoma)	0.99	0.69–1.43	0.96	0.97	0.66–1.42	0.882
D-dimer ≥500ng/mL (vs D-dimer <500 ng/mL)	1.21	0.80–1.85	0.368	1.23	0.79–1.93	0.358
PS 1–2 (vs PS 0)	1.98	0.97–4.05	0.062	1.78	0.85–3.69	0.121

Notes: Cox proportional hazard was applied. *Fully adjusted model.

Abbreviations: CI, confidence interval; HR, hazard ratio; NW, normal weight; PS, performance status; UW, underweight.