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abstract:
Association between Body Mass Index and Cancer Survival in a Pooled Analysis of 22 Clinical Trials | Cancer Epidemiology, Biomarkers & Prevention
December 16, 2016
Background: Data are inconsistent on the
association between body mass index (BMI) at time of cancer diagnosis
and prognosis. We used data from 22 clinical treatment trials to examine
the association between BMI and survival across multiple cancer types
and stages.
Methods: Trials with ≥5 years of follow-up were selected. Patients with BMI < 18.5 kg/m2
were excluded. Within a disease, analyses were limited to patients on
similar treatment regimens. Variable cutpoint analysis identified a BMI
cutpoint that maximized differences in survival. Multivariable Cox
regression analyses compared survival between patients with BMI above
versus below the cutpoint, adjusting for age, race, sex, and important
disease-specific clinical prognostic factors.
Results:
A total of 11,724 patients from 22 trials were identified. Fourteen
analyses were performed by disease site and treatment regimen. A
cutpoint of BMI = 25 kg/m2 maximized survival differences. No statistically significant trend across all 14 analyses was observed (mean HR = 0.96; P
= 0.06). In no cancer/treatment combination was elevated BMI associated
with an increased risk of death; for some cancers there was a survival
advantage for higher BMI. In sex-stratified analyses, BMI ≥ 25 kg/m2 was associated with better overall survival among men (HR = 0.82; P = 0.003), but not women (HR = 1.04; P
= 0.86). The association persisted when sex-specific cancers were
excluded, when treatment regimens were restricted to dose based on body
surface area, and when early-stage cancers were excluded.
Conclusion: The association between BMI and survival is not consistent across cancer types and stages.
Impact: Our findings suggest that disease, stage, and gender-specific body size recommendations for cancer survivors may be warranted.
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