Abstract
AIMS: Preoperative body mass index (BMI) has been shown to be an important prognostic factor after lobectomy in patients with lung cancer. However, few studies have investigated the relationship between preoperative BMI and overall mortality in these patients. In this study, we aimed to identify the range of BMI that heralds a favorable prognosis in patients who have undergone lobectomy for lung cancer. METHODS: The association between BMI and overall survival was examined using primary data from an affiliated hospital database and fitted adjusted Cox regression models. The restricted cubic spline (RCS) method was used to report the relationship between preoperative BMI and overall mortality. Fully adjusted models were stratified by and adjusted for sex, age, disease stage, respiratory function, and adjuvant chemotherapy. RESULTS: Of 3307 patients identified to have undergone radical resection of lung cancer between November 2009 and July 2019, 2365 underwent lobectomy and 558 died. BMI had a J-shaped association with overall mortality; we estimated that the overall mortality risk reached a nadir at BMI values of 23.2-29.4, with an inverse association below 23.2 (hazard ratio 0.104 per 5-unit decrease; 95% confidence interval 0.089-0.119), a positive association above 29.4 (hazard ratio 0.022 per 5-unit increase; 95% confidence interval 0.004-0.040), and the lowest mortality at 25.7. CONCLUSION: Preoperative BMI is an important prognostic factor after lobectomy in patients with lung cancer. A BMI of 23.2-29.4 has a prognostic benefit.