ArticleFrontiers in oncology2026
Body mass index and fasting insulin predict survival and EGFR-TKI benefit in Stage IV lung adenocarcinoma.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Corrections and comments
- Erratum issued
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Abstract
Background: Obesity, hyperinsulinemia, and type 2 diabetes mellitus (T2DM) are considered adverse metabolic conditions in cancer, although exceptions like the "obesity paradox" have been reported. Their prognostic significance in advanced lung adenocarcinoma (LUAD), particularly in patients receiving tyrosine kinase inhibitor (TKI) therapy, remains unclear. Methods: We prospectively analyzed 133 consecutive patients with newly diagnosed stage IV LUAD and ECOG performance status 0-1 enrolled between 2020 and 2024. All had ≥3 months of follow-up and T2DM status. BMI was available in 104 patients, glucose and fasting insulin in 46 patients. Primary endpoint was overall survival (OS), assessed using Kaplan-Meier and multivariable Cox regression. Propensity score and interaction analyses evaluated TKI, immune checkpoint inhibitor (ICI), and anti-VEGF therapies. Results: High BMI, hyperglycemia, hyperinsulinemia, and T2DM were not associated with worse outcomes. In contrast, low BMI (<22.1 kg/m²; Conclusions: Low BMI and low fasting insulin identify a metabolically depleted subgroup with poor prognosis in stage IV LUAD, with worse outcomes observed in patients not receiving EGFR-TKI therapy. These parameters may improve risk stratification and support early nutritional and exercise-based interventions.
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