Interaction between body mass index and hormone-receptor status as a prognostic factor in lymph-node-positive breast cancer

Chung, Inyoung; Lee, J.W.; Lee, J.S.; Park, Y.R.; Lee, S.B.; Kim, H.J.; Ko, Beom Seok; Son, Byung Ho; Sk, Ahn

doi:10.1016/s0960-9776(17)30290-4

Cited by 3 publications

(7 citation statements)

References 16 publications

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“…In the course of some malignancies a paradoxical phenomenon has been observed, indicating that obesity may be an oncogenic factor and -at the same time -may constitute a favorable prognostic factor (4,5). The dual and opposite influence of obesity on the course of the same disease has been called the obesity paradox and has been described in some chronic diseases, including cardiovascular (6) and cerebrovascular diseases (7).…”

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confidence: 99%

Influence of Obesity on the Course of Malignant Neoplastic Disease in Patients After Pulmonary Metastasectomy

Rzechonek

Błasiak

Pniewski³

et al. 2018

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Abstract. Background (82.1±83.5 months vs. 43.0±44.4, p<0.01 and 110.7±81.3 months vs. 69.9±52.9 p<0.005, respectively). Survival after pulmonary metastasectomy was 27.2±25.6 months and was longer in obese and overweight patients than in normal weight patients (20.2±18.4 months vs. 29.4±26.5, p<0.05). Conclusion: Being obese or overweight is a favorable prognostic factor in patients after surgical resection of lung metastases of different malignancies.With the increasing epidemic of obesity in the world, the incidence of malignancies related to obesity also increases (1). Obesity-related cancers include breast cancer in postmenopausal women, colon cancer, cancer of the lower esophagus, gastric cancer, liver cancer, gall bladder cancer, pancreatic cancer, uterine cancer, ovarian cancer and renal cancer (2). Obesity is also associated with increased risk of metastases, including lung metastases, in some cancers (3).In the course of some malignancies a paradoxical phenomenon has been observed, indicating that obesity may be an oncogenic factor and -at the same time -may constitute a favorable prognostic factor (4, 5). The dual and opposite influence of obesity on the course of the same disease has been called the obesity paradox and has been described in some chronic diseases, including cardiovascular (6) and cerebrovascular diseases (7). These paradoxical effects of obesity may occur also in patients with metastases, including patients with malignancies not related to obesity. In a recent large-scale study of 4,010 cancer patients in good general condition, with distant metastases, median OS was twice as high in obese patients as in normal weight patients (8). However, there are also reports stating that there is no beneficial effect of obesity on metastatic neoplastic disease (9-11).The problem of the influence of obesity on the course of metastatic malignancies has not yet been unequivocally explained. Especially, there are no studies on the influence of obesity on survival of patients with operable lung metastases. Therefore, this study was undertaken to evaluate the long-term outcome of surgical treatment of obese and non-obese patients who after resection of primary neoplasm had lung metastases removed. Materials and MethodsData from 99 patients who had a resection of lung metastasis from different primary malignancies between 2001 and 2016 were analyzed. The study was retrospective, and the condition for including patients in the study was access to anesthesia documentation containing body weight and height prior to performing pulmonary metastasectomy. Analysis was performed in the groups depending on body mass index (BMI). Underweight was diagnosed when the BMI 197

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confidence: 99%

Influence of Obesity on the Course of Malignant Neoplastic Disease in Patients After Pulmonary Metastasectomy

Rzechonek

Błasiak

Pniewski³

et al. 2018

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“…5,8,10 Chung et al, for example, in a study of 8742 patients found a significant difference in mean tumor size among underweight, normal weight, overweight, and obese patients (1.96 cm vs 2.29 cm vs 2.54 cm vs 2.64 cm, respectively, P < .001). 8 They, however, did not control for potential covariates. Haakinson et al similarly found in their study of 1352 invasive breast cancer patients that obese patients had a larger mean tumor size than those who were nonobese (2.0 cm vs 1.6 cm, P < .001).…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have shown similar results. 5,8,10 Chung et al, for example, in a study of 8742 patients found a significant difference in mean tumor size among underweight, normal weight, overweight, and obese patients (1.96 cm vs 2.29 cm vs 2.54 cm vs 2.64 cm, respectively, P < .001). 8 They, however, did not control for potential covariates.…”

Section: Discussionmentioning

confidence: 96%

“…This finding is consistent with other studies. 4,5,8 For example, Chung et al found that among 8742 patients treated surgically for stage I to III breast cancer, rates of node positivity increased with obesity (34.7% vs 39.8% vs 44.1% vs 42.5% for underweight, normal weight, overweight, and obese breast cancer patients, respectively, P < .001). 8 Haakinson et al similarly found that among 1352 patients with invasive breast cancer, obese patients were more likely to present with node-positive disease than nonobese patients (31% vs 25%, respectively, P = .026).…”

Section: Discussionmentioning

confidence: 99%

“…4,5,8 For example, Chung et al found that among 8742 patients treated surgically for stage I to III breast cancer, rates of node positivity increased with obesity (34.7% vs 39.8% vs 44.1% vs 42.5% for underweight, normal weight, overweight, and obese breast cancer patients, respectively, P < .001). 8 Haakinson et al similarly found that among 1352 patients with invasive breast cancer, obese patients were more likely to present with node-positive disease than nonobese patients (31% vs 25%, respectively, P = .026). 5 While they found the rates of neoadjuvant chemotherapy were the same in both obese and nonobese patients (3%), the potential interaction between neoadjuvant therapy and obesity on lymph node status could make the interpretation of these data more difficult.…”

Section: Discussionmentioning

confidence: 99%

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Do Obese Patients Present With More Advanced Breast Cancer?

Wang

Huang

Chagpar

2020

The American Surgeon™

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Background Obesity is a known risk factor for breast cancer development; however, it is unclear whether obesity is associated with more aggressive disease. We sought to determine the relationship between obesity and tumor characteristics in breast cancer patients. Methods Medical records of invasive breast cancer patients undergoing mastectomy at our institution between January 2010 and April 2018 were reviewed. Patients who had received neoadjuvant therapy were excluded. Patients were separated into obese (body mass index [BMI] ≥ 30 kg/m2) and nonobese (BMI < 30 kg/m2) categories and compared using nonparametric statistical analyses. Results Of the 415 patients in this cohort, 124 (29.9%) were obese. Obese patients were more likely to present with larger tumors (tumor size ≥ 2 cm: 53.2% vs 41.0%, P = .024) and more node-positive disease (46.8% vs 28.9%, P = .001). Controlling for confounders, obesity was independently associated with node-positive disease (odds ratio [OR] = 2.00; 95% CI 1.24-3.21, P = .004), but not with tumor size ≥ 2 cm (OR = 1.38; 95% CI 0.87-2.21, P = .174). Conclusion Obesity is associated with node-positive disease at presentation independent of other factors.

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Clinical verification of body mass index and tumor immune response in patients with breast cancer receiving preoperative chemotherapy

Takada

Kashiwagi

Asano

et al. 2021

Preprint

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Purpose The body mass index (BMI) is commonly used as a simple indicator of obesity; patients with early-stage breast cancer who are obese (OB) per BMI measurements have been shown to have high postoperative recurrence and low survival rates. On the other hand, it has been shown that lymphocytes present in the vicinity of malignant growths that are involved in the tumors’ immune responses influence the efficacy chemotherapy. Therefore, we hypothesized that OB patients with breast cancer have a lower density of tumor-infiltrating lymphocytes (TILs), which may influence the therapeutic effect of preoperative chemotherapy (POC). In this study, we measured pretreatment BMI and TILs in patients with breast cancer who underwent POC, examined the correlations between these two factors, and retrospectively analyzed their therapeutic outcomes and prognoses. Methods The participants in this study were 421 patients with breast cancer who underwent surgical treatment after POC between February 2007 and January 2019. The patient’s height and weight were measured before POC to calculate the BMI (weight [kg] divided by the square of the height [m2]). According to the World Health Organization categorization, patients who weighed under 18.5 kg/m2 were classified as underweight (UW), those ≥ 18.5 kg/m2 and > 25 kg/m2 were considered normal weight (NW), those ≥ 25 kg/m2 and < 30 kg/m2 were overweight (OW), and those ≥ 30 kg/m2 were OB. The TILs were those lymphocytes that infiltrated the tumor stroma according to the definition of the International TILs Working Group 2014. Results The median BMI was 21.9 kg/m2 (range, 14.3–38.5 kg/m2); most patients (244; 64.5%) were NW. Among all 378 patients with breast cancer, the TIL density was significantly lower in OB than in NW and OW patients (vs. NW: p = 0.001; vs. OW: p = 0.003). Furthermore, when examining patients with each breast cancer type individually, the OS of those with TNBC who had low BMIs was significantly poorer than that of their high-BMI counterparts (log rank p = 0.031). Conclusions Our data did not support the hypothesis that obesity affects the tumor immune microenvironment; however, we showed that being UW does affect the tumor immune microenvironment.

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Interaction between body mass index and hormone-receptor status as a prognostic factor in lymph-node-positive breast cancer

Cited by 3 publications

References 16 publications

Influence of Obesity on the Course of Malignant Neoplastic Disease in Patients After Pulmonary Metastasectomy

Influence of Obesity on the Course of Malignant Neoplastic Disease in Patients After Pulmonary Metastasectomy

Do Obese Patients Present With More Advanced Breast Cancer?

Clinical verification of body mass index and tumor immune response in patients with breast cancer receiving preoperative chemotherapy

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