Background: Immune checkpoint inhibitors (ICIs) have revolutionized the management of advanced non-small cell lung cancer (NSCLC). Emerging evidence suggests a potential association between elevated body mass index (BMI) and enhanced ICI efficacy, yet this relationship remains inconclusive and warrants further investigation. This study aims to evaluate the impact of BMI on treatment efficacy and survival outcomes in advanced NSCLC patients treated with first-line ICI therapy. Methods: A retrospective study was conducted at a multi-center registry to evaluate the impact of baseline BMI on overall survival (OS) and progression-free survival (PFS) in patients with stage IV NSCLC who received first-line ICI therapies. Treatment regimens included pembrolizumab or the combination of ipilimumab and nivolumab, administered either as monotherapy or in combination with chemotherapy, at the oncology department between January 2018 and December 2023. BMI was categorized according to the World Health Organization (WHO) classification, and OS and PFS were evaluated using Kaplan–Meier survival analysis and the Cox proportional hazards regression model. Results: Among 346 patients, 12.72% were underweight, 45.38% normal weight, 29.19% overweight, and 12.72% obese. Overweight and obese patients were more likely to receive pembrolizumab (p= 0.039) and less likely to undergo chemotherapy (p= 0.012). No significant differences in median overall survival (OS, log-rank:p= 0.155) or progression-free survival (PFS, log-rank:p= 0.370) were observed across BMI categories. However, differences emerged upon further analysis of PD-L1 levels (OS, log-rank:p= 0.029; PFS, log-rank:p= 0.044), additional chemotherapy (OS, log-rank:p= 0.009; PFS, log-rank:p= 0.021), type of immune checkpoint inhibitor (OS, log-rank:p< 0.001; PFS, log-rank:p< 0.001), and histologic diagnosis (OS, log-rank:p= 0.011; PFS, log-rank:p= 0.003). Conclusions: BMI was not an independent predictor of survival outcomes in advanced NSCLC treated with ICI. Incorporating BMI with other patient-specific factors into personalized immunotherapy strategies highlights the importance of tailored approaches to improve patient care and clinical outcomes.
背景：免疫检查点抑制剂（ICIs）已彻底改变了晚期非小细胞肺癌（NSCLC）的治疗模式。新近证据表明，较高的体重指数（BMI）可能与增强的ICI疗效存在潜在关联，但这一关系尚未明确，有待进一步研究。本研究旨在评估BMI对接受一线ICI治疗的晚期NSCLC患者疗效及生存结局的影响。 方法：本研究基于多中心登记数据开展了一项回顾性研究，旨在评估基线BMI对接受一线ICI治疗的IV期NSCLC患者总生存期（OS）和无进展生存期（PFS）的影响。治疗方案包括帕博利珠单抗或伊匹木单抗联合纳武利尤单抗，可单药使用或联合化疗，于2018年1月至2023年12月期间在肿瘤科实施。BMI根据世界卫生组织（WHO）标准进行分类，并采用Kaplan-Meier生存分析和Cox比例风险回归模型评估OS和PFS。 结果：在346例患者中，12.72%为体重过轻，45.38%为正常体重，29.19%为超重，12.72%为肥胖。超重和肥胖患者更倾向于接受帕博利珠单抗治疗（p=0.039），而接受化疗的可能性较低（p=0.012）。在不同BMI类别之间，中位总生存期（OS，对数秩检验：p=0.155）和无进展生存期（PFS，对数秩检验：p=0.370）未观察到显著差异。然而，在对PD-L1水平（OS，对数秩检验：p=0.029；PFS，对数秩检验：p=0.044）、额外化疗（OS，对数秩检验：p=0.009；PFS，对数秩检验：p=0.021）、免疫检查点抑制剂类型（OS，对数秩检验：p<0.001；PFS，对数秩检验：p<0.001）以及组织学诊断（OS，对数秩检验：p=0.011；PFS，对数秩检验：p=0.003）进行进一步分析时，差异显现。 结论：在接受ICI治疗的晚期NSCLC患者中，BMI并非生存结局的独立预测因子。将BMI与其他患者特异性因素结合，纳入个体化免疫治疗策略，突显了定制化方法对于改善患者护理和临床结局的重要性。
Correlation Between Body Mass Index and Immunotherapy Response in Advanced NSCLC
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