To evaluate the prognostic significance of BMI, glycemic parameters, and insulin levels on survival and response to EGFR-TKI therapy in patients with stage IV lung adenocarcinoma.
Approach:
Study Design: Prospective, observational cohort study of 133 patients with newly diagnosed stage IV LUAD and ECOG performance status 0–1, conducted between 2020 and 2024.
Data Collection: Collected baseline demographics, TNM stage, treatment information, and molecular biomarker data from electronic medical records.
Statistical Analysis: Used Kaplan–Meier and multivariable Cox regression for overall survival assessment, along with propensity score and interaction analyses.
Key Findings:
High BMI, hyperglycemia, hyperinsulinemia, and T2DM were not associated with worse outcomes.
Low BMI (<22.1 kg/m²; P = 0.007, HR 2.56, 95%CI 1.29 - 5.08) and low fasting insulin (≤34 pmol/L; P < 0.001, HR 10.02, 95%CI 2.73–36.8) were independently associated with shorter overall survival.
EGFR–TKI therapy was associated with improved survival (P = 0.02, HR 0.52).
Patients with both low BMI and low insulin derived survival benefit from EGFR–TKI therapy; absence of EGFR–TKI in this subgroup was associated with very poor 3-year OS (35%).
Interpretation:
Low BMI and low fasting insulin identify a metabolically depleted subgroup with poor prognosis in stage IV LUAD, particularly in those not receiving EGFR–TKI therapy.
Limitations:
Study limited to a single institution, which may affect generalizability.
Small sample size for certain analyses, particularly regarding treatment interactions.
Conclusion:
Low BMI and low fasting insulin may improve risk stratification and support early nutritional and exercise-based interventions in stage IV LUAD.
