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This article is the author’s final published version in Frontiers in Nutrition, Volume 9, July 2022, Article number 851629.

The published version is available at Copyright © He et al.


Background: The prognostic role of body mass index (BMI) in patients with brain metastases is controversial. We aim to investigate the impact of BMI on prognosis and anti-cancer therapy effectiveness in brain metastases.

Methods: Patients diagnosed with brain metastases between Oct 2010 and July 2019 were followed for mortality through April 2021. The prognostic role of BMI on overall survival was assessed by a restricted cubic spline (RCS) using a flexible model to visualize the relationship between the BMI values and hazard ratios of all-cause mortality, followed by a cox regression model. The disparity of survival outcomes in patients receiving anti-cancer therapies or those did not was evaluated according to the classification of BMI.

Results: A total of 2,466 patients were included in the analysis, including 241 in the underweight (BMI < 18.5 kg/m2) group, 1,503 in the normal weight group (BMI 18.5-23.9 kg/m2), and 722 in the overweight (BMI ≥ 24 kg/m2) group. Relative to the normal weight group, underweight patients were associated with poor prognosis (adjusted HR 1.25, 95% CI 1.07-1.46, p = 0.005). However, those in the overweight group showed similar overall survival when compared to the normal-weight group. Patients with weight loss were associated with a higher risk of mortality compared with patients without significant weight loss. In underweight patients, there was an insignificant difference in survival outcomes whether they received anti-cancer therapies or not.

Conclusion: Underweight and significant weight loss were associated with poor prognosis in brain metastases. Meanwhile, anti-cancer therapies did not significantly improve overall survival in patients with underweight. These findings suggest that improving nutrition to maintain body weight is critical for patients with brain metastases.

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This work is licensed under a Creative Commons Attribution 4.0 License.

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