Body Mass Index (BMI), BMI Change, and Overall Survival in Patients With SCLC and NSCLC: A Pooled Analysis of the International Lung Cancer Consortium

Daniel Shepshelovich, Wei Xu, Lin Lu, Aline Fares, Ping Yang, David Christiani, Jie Zhang, Kouya Shiraishi, Brid M. Ryan, Chu Chen, Ann G. Schwartz, Adonina Tardon, Xifeng Wu, Matthew B. Schabath, M. Dawn Teare, Loic Le Marchand, Zuo Feng Zhang, John K. Field, Hermann Brenner, Nancy DiaoJuntao Xie, Takashi Kohno, Curtis C. Harris, Angela S. Wenzlaff, Guillermo Fernandez-Tardon, Yuanqing Ye, Fiona Taylor, Lynne R. Wilkens, Michael Davies, Yi Liu, Matt J. Barnett, Gary E. Goodman, Hal Morgenstern, Bernd Holleczek, M. Catherine Brown, Geoffrey Liu*, Rayjean J. Hung

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

75 Scopus citations


Introduction: The relationships between morbid obesity, changes in body mass index (BMI) before cancer diagnosis, and lung cancer outcomes by histology (SCLC and NSCLC) have not been well studied. Methods: Individual level data analysis was performed on 25,430 patients with NSCLC and 2787 patients with SCLC from 16 studies of the International Lung Cancer Consortium evaluating the association between various BMI variables and lung cancer overall survival, reported as adjusted hazard ratios (aHRs) from Cox proportional hazards models and adjusted penalized smoothing spline plots. Results: Overall survival of NSCLC had putative U-shaped hazard ratio relationships with BMI based on spline plots: being underweight (BMI < 18.5 kg/m2; aHR = 1.56; 95% confidence interval [CI]:1.43–1.70) or morbidly overweight (BMI > 40 kg/m2; aHR = 1.09; 95% CI: 0.95–1.26) at the time of diagnosis was associated with worse stage-specific prognosis, whereas being overweight (25 kg/m2 ≤ BMI < 30 kg/m2; aHR = 0.89; 95% CI: 0.85–0.95) or obese (30 kg/m2 ≤ BMI ≤ 40 kg/m2; aHR = 0.86; 95% CI: 0.82–0.91) was associated with improved survival. Although not significant, a similar pattern was seen with SCLC. Compared with an increased or stable BMI from the period between young adulthood until date of diagnosis, a decreased BMI was associated with worse outcomes in NSCLC (aHR = 1.24; 95% CI: 1.2–1.3) and SCLC patients (aHR=1.26 (95% CI: 1.0–1.6). Decreased BMI was consistently associated with worse outcome, across clinicodemographic subsets. Conclusions: Both being underweight or morbidly obese at time of diagnosis is associated with lower stage-specific survival in independent assessments of NSCLC and SCLC patients. In addition, a decrease in BMI at lung cancer diagnosis relative to early adulthood is a consistent marker of poor survival.

Original languageEnglish
Pages (from-to)1594-1607
Number of pages14
JournalJournal of Thoracic Oncology
Issue number9
StatePublished - Sep 2019


FundersFunder number
Alan Brown Chair
Center for Cancer Research
Health and Labour Sciences Research
Lusi Wong Fund
National Institutes of HealthR01CA60691, R01CA87895, HHSN261201300011I, P30CA022453
National Institutes of Health
National Cancer InstituteP30CA071789, CA90833, U01-CA063673, DA/CA11386, UM1-CA167462
National Cancer Institute
Posluns Family Foundation
Norges Idrettshøgskole


    • Body mass index
    • Lung cancer
    • Survival


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