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Yuan Z, Cheng Y, Han J, Wang D, Dong H, Shi Y, Poulsen KL, Fan X, Zhao J. Association between metabolic overweight/obesity phenotypes and readmission risk in patients with lung cancer: A retrospective cohort study. EClinicalMedicine 2022; 51:101577. [PMID: 35898319 PMCID: PMC9310118 DOI: 10.1016/j.eclinm.2022.101577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Increased body mass index (BMI) and metabolic abnormalities are controversial prognostic factors of lung cancer. However, the relationship between metabolic overweight/obesity phenotypes and hospital readmission in patients with lung cancer is rarely reported. METHODS We established a retrospective cohort using the United States (US) Nationwide Readmissions Database (NRD). We included adult patients diagnosed with lung cancer from January 1, 2018 to November 30, 2018 and excluded patients combined with other cancers, pregnancy, died during hospitalization, low body weight, and those with missing data. The cohort was observed for hospital readmission until December 31, 2018. We defined and distinguished four metabolic overweight/obesity phenotypes: metabolically healthy with normal weight (MHNW), metabolically unhealthy with normal weight (MUNW), metabolically healthy with overweight or obesity (MHO), and metabolically unhealthy with overweight or obesity (MUO). The relationship between metabolic overweight/obesity phenotypes and 30-day readmission risk was assessed by multivariable Cox regression analysis. FINDINGS Of the 115,393 patients included from the NRD 2018 (MHNW [58214, 50.4%], MUNW [44980, 39.0%], MHO [5044, 4.4%], and MUO [7155, 6.2%]), patients with the phenotype MUNW (6531, 14.5%), MHO (771, 15.3%), and MUO (1155, 16.1%) had a higher readmission rate compared to those with MHNW (7901, 13.6%). Compared with patients with the MHNW phenotype, those with the MUNW (hazard ratio [HR], 1.10; 95% CI, 1.06-1.14), MHO (HR, 1.15; 95% CI, 1.07-1.24), and MUO (HR, 1.28; 95% CI, 1.20-1.36) phenotypes had a higher risk of readmission, especially in men, those without surgical intervention, or those aged >60 years. In women, similar results with respect to readmission were observed in people aged >60 years (MUNW [HR, 1.07; 95% CI, 1.01-1.13], MHO [HR, 1.19; 95% CI, 1.06-1.35], and MUO [HR, 1.28; 95% CI, 1.16-1.41]). We also found increased costs for 30-day readmission in patients with MHO (OR, 1.18; 95% CI, 1.07-1.29) and MUO (OR, 1.11; 95% CI, 1.02-1.20). INTERPRETATION Increased BMI and metabolic abnormalities are independently associated with higher readmission risks in patients with lung cancer, whereas increased BMI also increases the readmission costs. Follow-up and intervention method targeting increased BMI and metabolic abnormalities should be considered for patients with lung cancer. FUNDING The National Key Research and Development Program of China (2017YFC1309800).
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Key Words
- BMI, body mass index
- Body mass index
- CI, confidence interval
- HCUP, Healthcare Cost and Utilization Project
- HR, hazard ratio
- ICD-10, International Classification of Diseases, 10th Revision
- LOS, length of stay
- Lung cancer
- MHNW, metabolically healthy with normal weight
- MHO, metabolically healthy with overweight or obesity
- MS, metabolic syndrome
- MUNW, metabolically unhealthy with normal weight
- MUO, metabolically unhealthy with overweight or obesity
- Metabolic abnormality
- NRD, Nationwide Readmissions Database
- OR, odds ratio
- PCS, Procedure Coding System
- Phenotype
- Readmission
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Affiliation(s)
- Zinuo Yuan
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
- Shandong Clinical Research Centre of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Yiping Cheng
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
- Shandong Clinical Research Centre of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Junming Han
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
- Shandong Clinical Research Centre of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Dawei Wang
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
- Shandong Clinical Research Centre of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Hang Dong
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
- Shandong Clinical Research Centre of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Yingzhou Shi
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
- Shandong Clinical Research Centre of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Kyle L. Poulsen
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Centre at Houston, Houston, TX, USA
| | - Xiude Fan
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
- Shandong Clinical Research Centre of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
- Corresponding author at: Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
- Shandong Clinical Research Centre of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
- Corresponding author at: Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
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Zhang X, Liu Y, Shao H, Zheng X. Obesity Paradox in Lung Cancer Prognosis: Evolving Biological Insights and Clinical Implications. J Thorac Oncol 2017; 12:1478-1488. [PMID: 28757418 DOI: 10.1016/j.jtho.2017.07.022] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/18/2017] [Accepted: 07/22/2017] [Indexed: 01/16/2023]
Abstract
The survival rate of lung cancer remains low despite the progress of surgery and chemotherapy. With the increasing comorbidity of obesity in patients with lung cancer, new challenges are emerging in the management of this patient population. A key issue of interest is the prognostic effect of obesity on surgical and chemotherapeutic outcomes in patients with lung cancer, which is fueled by the growing observation of survival benefits in overweight or obese patients. This unexpected inverse relationship between obesity and lung cancer mortality, called the obesity paradox, remains poorly understood. The evolving insights into the heterogeneity of obesity phenotypes and associated biological connections with lung cancer progression in recent years may help explain some of the seemingly paradoxical relationship, and well-designed clinical studies looking at the causal role of obesity-associated molecules are expected. Here, we examine potential biological mechanisms behind the protective effects of obesity in lung cancer. We highlight the need to clarify the clinical implications of this relationship toward an updated intervention strategy in the clinical care of patients with lung cancer and obesity.
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Affiliation(s)
- Xueli Zhang
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Yamin Liu
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Hua Shao
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Xiao Zheng
- School of Pharmacy, China Pharmaceutical University, Nanjing, People's Republic of China.
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