Prognostic significance of body mass index in breast cancer patients with hormone receptor-positive tumours after curative surgery

Abstract

Purpose: Obesity has been recognized as a significant risk factor for postmenopausal breast cancer. The aim of this study is to investigate the prognostic significance of body mass index (BMI) in hormone receptor-positive, operable breast cancer. Methods: In this retrospective cohort study, 1,192 consecutive patients with curative resection of primary breast cancer were enrolled. Patients were assigned to two groups according to BMI: normal or underweight (BMI < 23.0 kg/m2) and overweight or obese (BMI ≥23.0 kg/m2). Associations among BMI and clinicopathological characteristics and prognosis of patients were assessed. Results: A high BMI was significantly (P < 0.01) correlated with age, nodal stage, ALNR, ER positivity, PR positivity and menopausal status at diagnosis. Univariate analysis revealed that BMI, pathologic T stage, nodal stage, axillary lymph node ratio (ALNR) and adjuvant radiotherapy history were significantly (P < 0.05) associated with disease-free survival and overall survival, irrespective of tumour hormone receptor status. Multivariate analysis revealed BMI as an independent prognostic factor in all cases and in hormone receptor-positive cases. Conclusion: A high BMI (≥23.0 kg/m^2) is independently associated with poor prognosis in hormone receptor-positive breast cancer.

Prognostic Impact of Progesterone Receptor Status in Chinese Estrogen Receptor Positive Invasive Breast Cancer Patients

“…In our study, we found significant differences in DFS, BCSS, and OS through a multivariate analysis and each of these variables was an independent predictor of PR status, chemotherapy, lymph node metastasis, and factors, which is similar to results of previous studies [22232425]. Kakugawa et al [26] suggested that decreased PR expression might lead to excessive proliferation of glandular cells, which can cause cancer and metastatic lesions.…”

Association between high body mass index and prognosis of patients with early-stage breast cancer: A systematic review and meta-analysis

“…After searching and screening all eligible studies, 20 retrospective cohort studies including 33,836 patients with EBC 14 , 18 , 21 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 were selected; one study 44 was only published in abstract form. Of the 20 retrospective cohort studies included, 12 studies each examined the effects of overweight on DFS and OS, 12 and 15 studies examined the effects of obesity on DFS and OS, respectively, and 16 and 17 studies examined the effects of high BMI on DFS and OS, respectively.…”

“…Of the included 20 retrospective cohort studies, 16 studies 18 , 21 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 43 , 44 , 45 , 46 reported data on DFS, 17 studies 14 , 18 , 21 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 reported OS data, and 14 studies 18 , 21 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 42 , 43 , 44 , 45 reported both endpoints. However, three studies 21 , 30 , 31 reported RFS data, and one study 32 reported EFS data.…”

“…of Patients ( n ) Median follow-up Time (months) Definition of overweight BMI (kg/m 2 ) Definition of obesity BMI (kg/m 2 ) Exposure Primary endpoints Mantel et al., 1959 29 China J Natl Cancer Inst 44 32.6 ≥30 Obesity OS, EFS Tait et al., 2014 35 USA Breast Cancer Research Treatment 448 40.1 25.0, 30.0 ≥30 Overweight Obesity OS, DFS Wells et al., 2014 27 USA Symposium on Systematic Reviews: Beyond the Basics 418 37.2 25.0, 30.0 ≥30 Overweight Obesity OS, RFS Shang et al., 2021 36 China Breast Cancer Research 2888 76.8 25.0, 30.0 ≥30 Overweight Obesity OS, DFS Wang. et al., 2019 37 China Oncology Research and Treatment 3178 58.0 25.0, 30.0 ≥30 Overweight Obesity OS, DFS Xing et al., 2013 38 China Clinical and Investigative Medicine 1192 36.0 ≥23.0 ≥23 Overweight OS, DFS Lin et al., 2021 39 China Journal of Cancer 5000 NA 24.0, 27.0 ≥27 Overweight Obesity OS, DFS Schvartsman et al., 2017 40 ...…”

“…After the pooled analysis of 16 studies, 18 , 21 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 43 , 44 , 45 , 46 the results demonstrated that compared with normal weight, high BMI has an adverse effect on DFS in patients with EBC (HR: 1.16, 95% CI: 1.08–1.26, P < 0.001) [ Figure 4 A]. The results of the pooled analysis of 17 studies 14 , 18 , 21 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 showed that compared with normal weight, high BMI also has an adverse effect on OS in patients with EBC (HR: 1.25, 95% CI: 1.14–1.39, P < 0.001) [ Figure 4 B].…”