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Lung Cancer. 2018 Dec;126:55-63. doi: 10.1016/j.lungcan.2018.07.005. Epub 2018 Jul 5.

Prediagnosis weight loss, a stronger factor than BMI, to predict survival in patients with lung cancer.

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Service de Pneumologie, Centre Hospitalier Regional d'Orléans (CHRO), Hôpital la source, 14 avenue de l'hôpital, 45000 Orléans, France. Electronic address:
Unité transversale de diététique et nutrition, Institut Gustave Roussy, 94 800 Villejuif, France. Electronic address:
Service de Pneumologie, Centre Hospitalier De Niort, 40 avenue Charles de Gaulle BP 70600 - 79021 Niort Cedex, France. Electronic address:
Service de Pneumologie, Centre Hospitalier Int. Elbeuf/Louviers/Val De Reuil, rue du Docteur Villers Saint-Aubin-lès-Elbeuf, 76503 Elbeuf, France. Electronic address:
Service de Pneumologie, Centre Hospitalier De Saint-Quentin, 1 avenue Michel de l'Hospital, 02321 Saint-Quentin Cedex, France. Electronic address:
Service de Pneumologie, GH Nord-Essonne, Hopital Général Longjumeau, 159 rue du Président François Mitterrand, 91160 Longjumeau, France. Electronic address:
Service de Pneumologie, Centre Hospitalier De Saint Nazaire, Cité sanitaire Georges Charpak, 11 bd Georges Charpak, 44606 Saint-Nazaire Cedex, France. Electronic address:
Service de Pneumologie, Centre Hospitalier Haute Saône - Hôpital De Vesoul, 2 Avenue René Heymes, 70000 Vesoul, France. Electronic address:
Paris, France. Electronic address:
Hôpital de Meaux, 6-8 Rue Saint Fiacre, BP 218, 77104 Meaux CEDEX, France. Electronic address:
Service de Pneumologie, Groupe Hospitalier Régional Mulhouse-Sud Alsace (GHRMSA), Hôpital Emile Muller, 20 rue du Dr Laënnec, BP 1370, 68070 Mulhouse, France. Electronic address:



Recent studies have demonstrated that elevated BMI is associated with improved survival in patients with lung cancer. According to the authors, this "obesity paradox" could be a true benefit or a spurious relationship. In this context, data from the French KBP-2010-CPHG cohort (7,051 patients followed up for primary lung cancer diagnosed in 2010 in the respiratory medicine departments of 104 nonacademic hospitals) were analyzed.


Patients were stratified according to BMI at diagnosis using the definition of the French-Speaking Society of Clinical Nutrition and Metabolism (Société Francophone de Nutrition Clinique et Métabolisme). Survival was analyzed using log-rank and a univariate Cox model. Prognostic factors were identified using a multivariate Cox model with backward elimination procedure, and with or without inclusion of prediagnosis weight loss in the model.


Patients were followed for a median 20.2 months. At diagnosis, respectively 12%, 28%, 45%, and 15% of the 6,595 patients with BMI data were obese, overweight, normal-weight, and underweight; 35%, 43%, 57%, and 75% reported prediagnosis weight loss (i.e., weight loss within the 3 months prior to diagnosis). One-year survival (% [95% CI]) was 53% [50%-57%], 50%, [48%-52%], 43%, [42%-45%], and 32% [29%-35%] in obese, overweight, normal-weight, and underweight patients, respectively (p < 0.001). It was particularly low in underweight patients with prediagnosis weight loss: 27% [24-30%]. BMI did not remain an independent prognostic factor associated with survival when prediagnosis weight loss was introduced in the Cox model. Risk of death was increased by 17%, 23%, and 46% in patients with <5 kg, 5-10 kg, or ≥10 kg prediagnosis weight loss, respectively (p < 0.001).


BMI is an easy but crude assessment tool. Other variables should be used to improve management of patients, and understanding of how prediagnosis body size and nutritional status are associated with cancer survival.


Body mass index; France; Lung cancer; Mortality; Weight loss

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