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Lung cancer
Original research
Protective effect of height on long-term survival of resectable lung cancer: a new feature of the lung cancer paradox
  1. Elisa Daffré1,
  2. Raphaël Porcher2,3,
  3. Antonio Iannelli4,
  4. Mathilde Prieto1,
  5. Laurent Brouchet5,
  6. Pierre Emmanuel Falcoz6,
  7. Françoise Le Pimpec Barthes7,
  8. Pierre Benoit Pages8,
  9. Pascal Alexandre Thomas9,
  10. Marcel Dahan5,
  11. Marco Alifano1
  1. 1 Thoracic Surgery Department, Cochin Hospital, APHP Centre Université de Paris Cité, Paris, France
  2. 2 Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
  3. 3 Center for Clinical Epidemiology, AP-HP, Hôtel Dieu Hospital, Paris, France
  4. 4 Digestive Surgery, CHU Nice, Nice, France
  5. 5 Thoracic Surgery Department, CHU Toulouse, Toulouse, France
  6. 6 Thoracic Surgery Department, University of Stasbourg, Strasbourg, France
  7. 7 Thoracic Surgery Department, HEGP, APHP Centre Université de Paris Cité, Paris, France
  8. 8 Thoracic Surgery Department, Dijon University Hospital, Dijon, France
  9. 9 Thoracic Surgery Department, Aix-Marseille-University, Marseille, France
  1. Correspondence to Professor Marco Alifano, Thoracic Surgery Department, Cochin Hospital, APHP Centre Université de Paris Cité, Paris, France; marco.alifano{at}aphp.fr

Abstract

Introduction Unlike most malignancies, higher body mass index (BMI) is associated with a reduced risk of lung cancer and improved prognosis after surgery. However, it remains controversial whether height, one of determinants of BMI, is associated with survival independently of BMI and other confounders.

Methods We extracted data on all consecutive patients with resectable non-small cell lung cancer included in Epithor, the French Society of Thoracic and Cardiovascular Surgery database, over a 16-year period. Height was analysed as a continuous variable, and then categorised into four or three categories, according to sex-specific quantiles. Cox proportional hazards regression was used to estimate the association of height with survival, adjusted for age, tobacco consumption, forced expiratory volume in one second (FEV1), WHO performance status (WHO PS), American Society of Anesthesiologists (ASA) score, extent of resection, histological type, stage of disease and centre as a random effect, as well as BMI in a further analysis.

Results The study included 61 379 patients. Higher height was significantly associated with better long-term survival after adjustment for other variables (adjusted HR 0.97 per 10 cm higher height, 95% CI 0.95 to 0.99); additional adjustment for BMI resulted in an identical HR. The prognostic impact of height was further confirmed by stratifying by age, ASA class, WHO PS and histological type. When stratifying by BMI class, there was no evidence of a differential association (p=0.93). When stratifying by stage of disease, the prognostic significance of height was maintained for all stages except IIIB-IV.

Conclusions Our study shows that height is an independent prognostic factor of resectable lung cancer.

  • lung cancer
  • thoracic surgery
  • clinical epidemiology

Data availability statement

Data are available on reasonable request. Data are available after formal request to and acceptance by the French Society of Thoracic and Cardiovascular Surgery.

https://doi.org/10.1136/thorax-2023-220443

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    Data availability statement

    Data are available on reasonable request. Data are available after formal request to and acceptance by the French Society of Thoracic and Cardiovascular Surgery.

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    Footnotes

    • Contributors ED: conceptualisation, data curation, investigation, writing—original draft, validation; RP: statistical analysis; AI, MP: conceptualisation, investigation, validation; LB, PEF, FLPB, PBP: data curation, investigation, validation; PAT, MD: funding acquisition, data curation, investigation, validation, underlying data verification; MA: conceptualisation, investigation, methodology, formal analysis, writing—original draft, supervision, validation. MA acts as guarantor.

    • Funding The Epithor project is financially supported by the French Society of Thoracic and Cardiovascular Surgery.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.