Visceral Obesity in Non-Small Cell Lung Cancer

SIMPLE SUMMARY: Body mass index may be an inappropriate metric for obesity in lung cancer as its use obscures the harm that obesity causes, which is noticeable when obesity is instead measured as visceral adiposity. Radiological assessment of visceral adiposity is practicable in lung cancer as patients undergo computerized tomography (CT) routinely, and this allows for the inclusion of visceral obesity as a meaningful variable in lung cancer studies. We used CT data to measure visceral adiposity of 994 non-small cell lung cancer (NSCLC) patients to obtain a profile of visceral obesity in NSCLC and associate it with demographic and tumor characteristics. ABSTRACT: While obesity measured by body mass index (BMI) has been paradoxically associated with reduced risk and better outcome for lung cancer, recent studies suggest that the harm of obesity becomes apparent when measured as visceral adiposity. However, the prevalence of visceral obesity and its associations with demographic and tumor features are not established. We therefore conducted an observational study of visceral obesity in 994 non-small cell lung cancer (NSCLC) patients treated during 2008–2020 at our institution. Routine computerized tomography (CT) images of the patients, obtained within a year of tumor resection or biopsy, were used to measure cross-sectional abdominal fat areas. Important aspects of the measurement approach such as inter-observer variability and time stability were examined. Visceral obesity was semi-quantified as visceral fat index (VFI), the fraction of fat area that was visceral. VFI was found to be higher in males compared to females, and in former compared to current or never smokers. There was no association of VFI with tumor histology or stage. A gene expression-based measure of tumor immunogenicity was negatively associated with VFI but had no bearing with BMI. Visceral obesity is appraisable in routine CT and can be an important correlate in lung cancer studies.