Obesity as an independent risk factor for decreased survival in node-positive high-risk breast cancer

Abstract

Obese breast cancer patients have a higher risk of lymph node metastasis and a poorer prognosis compared to patients with normal weight. For obese women with node-positive breast cancer, an association between body weight and prognosis remains unclear. In this retrospective study, we analyzed patient data from the Phase-III ADEBAR trial, in which high-risk breast cancer patients (pT1-4, pN2-3, pM0) were randomized into a docetaxel-based versus epirubicin-based chemotherapy regimen. Patients were grouped according to their BMI value as underweight/normal weight (BMI < 25 kg/m(2); n = 543), overweight (BMI 25-29.9 kg/m(2); n = 482) or obese (BMI ≥ 30 kg/m(2); n = 285). Overweight and obese patients were older, had larger tumors and were more likely to be postmenopausal at the time of diagnosis compared to underweight/normal-weight patients (all p < 0.001). Multivariate Cox regression analyses adjusting for age and histopathological tumor features showed that obese patients had a significantly shorter disease-free survival (DFS; HR 1.43; 95 % CI 1.11-1.86; p = 0.006) and overall survival (OS; HR 1.56; 95 % CI 1.14-2.14; p = 0.006) than non-obese patients. Subgroup analyses revealed that the differences in DFS and OS were significant for postmenopausal but not for premenopausal patients, and that the survival benefit of non-obese patients was more pronounced in women with hormone-receptor-positive disease. Obesity constitutes an independent, adverse prognostic factor in high-risk node-positive breast cancer patients, in particular for postmenopausal women and women with hormone-receptor-positive disease.

Energy homeostasis genes and survival after breast cancer diagnosis: the Breast Cancer Health Disparities Study

“…Nonetheless, little evidence has thus far been produced to show an association between GHRL polymorphisms and survival in breast cancer patients. However, GHRL polymorphisms have been associated with obesity (3) and recent studies have associated obesity with decreased survival in breast cancer patients (30, 31), particularly in Hispanics with morbid obesity (18) but these results are far from conclusive and are contradicted by other studies (32). …”

Body Mass Index at Diagnosis as a Prognostic Factor for Early-Stage Invasive Breast Cancer after Surgical Resection

“…The study by Scholz et al [17] comprising 1,493 cases of high-risk breast cancer found that obesity was associated with shorter OS among postmenopausal patients; however, among premenopausal women with breast cancer, OS was not significantly related to obesity. Hao et al [16] showed that overweight (BMI > 24 kg/m 2 ) premenopausal women with TNBC had a worse OS compared to those of normal weight, while such association was not detected in postmenopausal women.…”

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

“…In our current retrospective cohort study, additional explanatory variables including tumor grade, lymphovascular invasion and treatment were available for analysis. There has been some controversy to date concerning the relationship between BMI and menopause status in the prognosis of breast cancer [8,10,11]. In our present study, although subgroup analyses by menopause status indicated that obesity was a significant prognostic factor in the premenopausal subgroup for both OS (HR = 1.87, 95% CI = 1.20-2.91) and BCSS (HR = 2.04, 95% CI = 1.28-3.26), the subsequent interaction test revealed no significant interaction between BMI and menopause status in terms of the breast cancer prognosis in any of our subgroups (Tables A and B in S1 File).…”