Does the “obesity paradox” really exist in lung cancer surgery? —maybe we should recognize what is the “obesity” first

Li, Shuangjiang; Che, Guowei; Liu, Lunxu; Chen, Long-Qi

doi:10.21037/jtd.2019.01.34

Cited by 2 publications

(4 citation statements)

References 35 publications

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“…We also show the prognostic effects of pre‐diagnostic weight loss on NSCLC survival and disease progression, which supports the growing evidence that pre and post diagnosis weight changes might be more reliable prognostic factors for lung cancer survival than weight or BMI at the time of diagnosis 19,48 . The observed effect of BMI at diagnosis might partly be a consequence of the preexisting illness resulting in weight loss and distorting the true relationship between BMI and the risk of death and therefore clinicians should be alerted against misinterpreting the current evidence that obesity might be “good” or “protective” for cancer patients 19,20,49 …”

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

“…19,48 The observed effect of BMI at diagnosis might partly be a consequence of the preexisting illness resulting in weight loss and distorting the true relationship between BMI and the risk of death and therefore clinicians should be alerted against misinterpreting the current evidence that obesity might be "good" or "protective" for cancer patients. 19,20,49 The models included age, sex, study location, marital status, education, history of chronic respiratory disorders, history of chronic diseases, amount of weight loss, tumor histology, tumor stage, the smoking status (for analyses including alcohol variables indicated), and alcohol drinking status (for analyses including smoking variables indicated). All models are stratified by year of enrolment and treatments received post-surgery (chemotherapy, radiotherapy).…”

Section: Characteristicmentioning

confidence: 99%

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Survival and prognostic factors of early‐stage non‐small cell lung cancer in Central and Eastern Europe: A prospective cohort study

et al. 2023

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Background Although early diagnosis and surgical resection of the tumor have been shown to be the most important predictors of lung cancer survival, long‐term survival for surgically‐resected early‐stage lung cancer remains poor. Aims In this prospective study we aimed to investigate the survival and prognostic factors of surgically‐resected early‐stage non‐small cell lung cancer (NSCLC) in Central and Eastern Europe. Methods We recruited 2052 patients with stage I‐IIIA NSCLC from 9 centers in Russia, Poland, Serbia, Czech Republic, and Romania, between 2007–2016 and followed them annually through 2020. Results During follow‐up, there were 1121 deaths (including 730 cancer‐specific deaths). Median survival time was 4.9 years, and the 5‐year overall survival was 49.5%. In the multivariable model, mortality was increased among older individuals (HR for each 10‐year increase: 1.31 [95% CI: 1.21–1.42]), males (HR:1.24 [1.04–1.49]), participants with significant weight loss (HR:1.25 [1.03–1.52]), current smokers (HR:1.30 [1.04–1.62]), alcohol drinkers (HR:1.22 [1.03–1.44]), and those with higher stage tumors (HR stage IIIA vs. I: 5.54 [4.10 – 7.48]). However, education, chronic obstructive pulmonary diseases (COPD), and tumor histology were not associated with risk of death. All baseline indicators of smoking and alcohol drinking showed a dose‐dependent association with the risk of cancer‐specific mortality. This included pack‐years of cigarettes smoked (p‐trend = 0.04), quantity of smoking (p‐trend = 0.008), years of smoking (p‐trend = 0.010), gram‐days of alcohol drank (p‐trend = 0.002), frequency of drinking (p‐trend = 0.006), and years of drinking (p‐trend = 0.016). Conclusion This study shows that the 5‐year survival rate of surgically‐resected stage I‐IIIA NSCLC is still around 50% in Central and Eastern Europe. In addition to non‐modifiable prognostic factors, lifetime patterns of smoking and alcohol drinking affected the risk of death and disease progression in a dose‐dependent manner in this population.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Characteristicmentioning

confidence: 99%

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Survival and prognostic factors of early‐stage non‐small cell lung cancer in Central and Eastern Europe: A prospective cohort study

et al. 2023

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“…Surgical outcomes in obesity-associated cancer demonstrate both the inexistence of obesity-conferred advantages of high BMI, and the association of high BMI with increased surgical complications in breast, gastric, colorectal, hepatic, and pancreatic cancer [ 322 – 325 ]. Only a handful of cancer types (such as such as gastric, pancreatic and lung cancer) associate obesity to lower mortality and increased long-term survival [ 326 – 328 ]. Notwithstanding, as previously stated, literature discrepancies, methodological biases, and obesity-induced alterations in physiologic states (i.e., cachexia, sarcopenia, insulin resistance/sensitivity) may partly explain these results.…”

Section: Obesity and The Obesity Paradox In Cancer Treatmentmentioning

confidence: 99%

The ambiguous role of obesity in oncology by promoting cancer but boosting antitumor immunotherapy

Assumpção

Pasquarelli-do-Nascimento

Duarte

et al. 2022

J Biomed Sci

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Obesity is nowadays considered a pandemic which prevalence’s has been steadily increasingly in western countries. It is a dynamic, complex, and multifactorial disease which propitiates the development of several metabolic and cardiovascular diseases, as well as cancer. Excessive adipose tissue has been causally related to cancer progression and is a preventable risk factor for overall and cancer-specific survival, associated with poor prognosis in cancer patients. The onset of obesity features a state of chronic low-grade inflammation and secretion of a diversity of adipocyte-derived molecules (adipokines, cytokines, hormones), responsible for altering the metabolic, inflammatory, and immune landscape. The crosstalk between adipocytes and tumor cells fuels the tumor microenvironment with pro-inflammatory factors, promoting tissue injury, mutagenesis, invasion, and metastasis. Although classically established as a risk factor for cancer and treatment toxicity, recent evidence suggests mild obesity is related to better outcomes, with obese cancer patients showing better responses to treatment when compared to lean cancer patients. This phenomenon is termed obesity paradox and has been reported in different types and stages of cancer. The mechanisms underlying this paradoxical relationship between obesity and cancer are still not fully described but point to systemic alterations in metabolic fitness and modulation of the tumor microenvironment by obesity-associated molecules. Obesity impacts the response to cancer treatments, such as chemotherapy and immunotherapy, and has been reported as having a positive association with immune checkpoint therapy. In this review, we discuss obesity’s association to inflammation and cancer, also highlighting potential physiological and biological mechanisms underlying this association, hoping to clarify the existence and impact of obesity paradox in cancer development and treatment.

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Does the “obesity paradox” really exist in lung cancer surgery? —maybe we should recognize what is the “obesity” first

Cited by 2 publications

References 35 publications

Survival and prognostic factors of early‐stage non‐small cell lung cancer in Central and Eastern Europe: A prospective cohort study

Survival and prognostic factors of early‐stage non‐small cell lung cancer in Central and Eastern Europe: A prospective cohort study

The ambiguous role of obesity in oncology by promoting cancer but boosting antitumor immunotherapy

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