Impact of BMI on the survival outcomes of non-small cell lung cancer patients treated with immune checkpoint inhibitors: a meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of cohort studies assessing prognostic association
PubMed 37872469 · doi:10.1186/s12885-023-11512-y
What was done
A systematic review and meta-analysis evaluated the association between body mass index (BMI) and survival outcomes in non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs). Overall survival (OS) was the primary endpoint and progression-free survival (PFS) was the secondary endpoint. Pooled hazard ratios (HR) were calculated using random- or fixed-effects models based on Cochran's Q and I² heterogeneity tests.
What was found
Nine studies involving 4,602 NSCLC patients were analyzed. The primary comparison between low and high BMI showed no statistically significant difference in PFS (HR 0.885; 95% CI 0.777–1.009, p = 0.068) or OS (HR 0.947; 95% CI 0.789–1.137, p = 0.560). In subgroup analysis comparing overweight and obese patients to normal-weight patients, higher BMI was significantly associated with improved PFS (HR 0.862; 95% CI 0.760–0.978, p = 0.021) and improved OS (HR 0.818; 95% CI 0.741–0.902, p < 0.0001).
Why it matters
These results provide pooled clinical evidence supporting an obesity paradox in NSCLC patients undergoing immunotherapy. BMI may serve as an easily accessible clinical marker to aid prognostic stratification alongside established biomarkers like PD-L1.
Limits
The primary analysis was non-significant, with positive findings emerging only upon subgroup breakdown. Included studies were retrospective and observational, carrying risk of confounding from performance status, cancer cachexia, or specific ICI regimens. BMI does not differentiate between visceral adiposity and lean muscle mass.
Cited by
- supports In lung cancer, patients with obesity/higher BMI have been observed in studies to experience longer survival than normal-weight patients.