Obesity paradox in patients with non‐small cell lung cancer undergoing immune checkpoint inhibitor therapy

• Published in: Journal of cachexia, sarcopenia and muscle sarcopenia and muscle, 2023-12, Vol.14 (6), p.2898-2907
• Main Authors: Lee, Ji Hyun, Kang, Danbee, Ahn, Jin Seok, Guallar, Eliseo, Cho, Juhee, Lee, Ho Yun
• Format: Article
• Language: English
• Subjects: Abdomen; Body composition; Body fat; Body mass index; Cancer therapies; Carcinoma, Non-Small-Cell Lung - complications; Carcinoma, Non-Small-Cell Lung - drug therapy; Data warehouses; Female; Histology; Humans; Immune checkpoint inhibitors; Immune Checkpoint Inhibitors - therapeutic use; Immunotherapy; Ligands; Lung cancer; Lung neoplasms; Lung Neoplasms - complications; Lung Neoplasms - drug therapy; Male; Medical prognosis; Middle Aged; Musculoskeletal system; Mutation; Non‐small cell lung cancer; Obesity; Obesity - complications; Obesity - drug therapy; Obesity Paradox; Original; Overweight; Patients; Retrospective Studies; Tumors; Tumour biomarkers; Women
• ISSN: 2190-5991; 2190-6009
• DOI: 10.1002/jcsm.13367

Background The obesity paradox in patients with advanced non‐small cell lung cancer receiving immune checkpoint inhibitor therapy has been observed, but its underlying mechanism is not fully understood. We aimed to investigate whether body composition affects the prognostic impact of obesity, as determined by body mass index (BMI), on survival. Methods This retrospective study evaluated the data collected from Asian patients who were treated with immune checkpoint inhibitors for advanced non‐small cell lung cancer between October 2015 and October 2021. We used abdominal cross‐sectional imaging to calculate the skeletal muscle and visceral fat indices (cm2/m2) by dividing the cross‐sectional areas of the skeletal muscle and visceral fat by the height squared. Cox proportional‐hazards regression was performed to determine the correlation between BMI according to the Asia‐Pacific classification, body composition metrics and overall survival. Results We analysed the data of 820 patients (630 men and 190 women, with a mean age of 64.3 years [standard deviation: 10.4 years]) and observed 572 (69.8%) deaths with the 1‐year mortality rate of 0.58 (95% confidence interval, 0.55–0.62). Obese BMI was associated with longer overall survival, independent of clinical covariates (hazard ratio, 0.64; 95% confidence interval: 0.52–0.80). The prognostic value of obese BMI remained after additional adjustments for skeletal muscle index (hazard ratio, 0.68; 95% confidence interval, 0.53–0.87) or visceral fat index (hazard ratio, 0.54; 95% confidence interval: 0.41–0.70). No association was observed between sex and the impact of BMI on overall survival (P‐value for interaction >0.05). Conclusions In Asian patients with advanced non‐small cell lung cancer who received immune checkpoint inhibitors, obese BMI was associated with favourable overall survival independent of skeletal muscle or visceral fat mass.