J Breast Cancer.  2012 Dec;15(4):427-433. 10.4048/jbc.2012.15.4.427.

Body Mass Index Is Not Associated with Treatment Outcomes of Breast Cancer Patients Receiving Neoadjuvant Chemotherapy: Korean Data

• Lee KH
• Keam B
• Im SA
• Kim TY
• Han SW
• Oh DY
• Kim JH
• Lee SH
• Han W
• Kim DW
• Kim TY
• Park IA
• Noh DY
• Heo DS
• Bang YJ

• KMID: 2286440
• DOI: http://doi.org/10.4048/jbc.2012.15.4.427

Abstract

PURPOSE
The effects of body mass index on pathologic complete response and survival have not been reported in Korean patients with breast cancer. The purpose of this study was to evaluate the predictive or prognostic value of obesity in breast cancer receiving neoadjuvant chemotherapy.
METHODS
A total of 438 stage II or III breast cancer patients treated with neoadjuvant chemotherapy were enrolled and analyzed retrospectively.
RESULTS
In the study, 319 patients (72.8%) were normal weight, 100 patients (22.8%) were overweight, and 19 patients (4.3%) were obese. Baseline clinicopathologic characteristics were not different among the groups, except for age. There were no differences in pathologic complete response rate between the groups (9.7% in normal weight, 10.0% in overweight, 5.3% in obese; p=0.804). Neither overweight nor obese patients showed a significant difference in relapse-free survival compared to normal weight patients (p=0.523 and p=0.931, respectively). Also, no significant difference in overall survival (p=0.520 and p=0.864, respectively) was observed.
CONCLUSION
Obesity or higher body mass index was not significantly associated with pathologic complete response and survival in Korean patients with breast cancer who received neoadjuvant chemotherapy. Our results suggest that the prognostic impact of body mass index is different from that of Western patients.

Keyword

Breast neoplasms; Neoadjuvant therapy; Obesity; Prognosis

MeSH Terms

Body Mass Index
Breast
Breast Neoplasms
Humans
Neoadjuvant Therapy
Obesity
Overweight
Prognosis

Figure

• 

  Figure 1 (A) Relapse-free survival by body mass index (BMI) categories, and (B) overall survival by BMI categories. NW=normal/underweight; OW=overweight; OB=obese.

Reference

1. Bastarrachea J, Hortobagyi GN, Smith TL, Kau SW, Buzdar AU. Obesity as an adverse prognostic factor for patients receiving adjuvant chemotherapy for breast cancer. Ann Intern Med. 1994. 120:18–25.

2. Carmichael AR. Obesity as a risk factor for development and poor prognosis of breast cancer. BJOG. 2006. 113:1160–1166.

3. Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Madarnas Y, et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol. 2002. 20:42–51.

4. McTiernan A, Rajan KB, Tworoger SS, Irwin M, Bernstein L, Baumgartner R, et al. Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol. 2003. 21:1961–1966.

5. Cui Y, Whiteman MK, Flaws JA, Langenberg P, Tkaczuk KH, Bush TL. Body mass and stage of breast cancer at diagnosis. Int J Cancer. 2002. 98:279–283.

6. Zumoff B, Dasgupta I. Relationship between body weight and the incidence of positive axillary nodes at mastectomy for breast cancer. J Surg Oncol. 1983. 22:217–220.

7. Dignam JJ, Wieand K, Johnson KA, Fisher B, Xu L, Mamounas EP. Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst. 2003. 95:1467–1476.

8. Goodwin PJ, Boyd NF. Body size and breast cancer prognosis: a critical review of the evidence. Breast Cancer Res Treat. 1990. 16:205–214.

9. Dignam JJ, Wieand K, Johnson KA, Raich P, Anderson SJ, Somkin C, et al. Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. Breast Cancer Res Treat. 2006. 97:245–254.

10. Ahn SH, Son BH, Kim SW, Kim SI, Jeong J, Ko SS, et al. Poor outcome of hormone receptor-positive breast cancer at very young age is due to tamoxifen resistance: nationwide survival data in Korea: a report from the Korean Breast Cancer Society. J Clin Oncol. 2007. 25:2360–2368.

11. Yoo KY, Kang D, Park SK, Kim SU, Shin A, Yoon H, et al. Epidemiology of breast cancer in Korea: occurrence, high-risk groups, and prevention. J Korean Med Sci. 2002. 17:1–6.

12. Moon HG, Han W, Noh DY. Underweight and breast cancer recurrence and death: a report from the Korean Breast Cancer Society. J Clin Oncol. 2009. 27:5899–5905.

13. Dawood S, Broglio K, Gonzalez-Angulo AM, Kau SW, Islam R, Hortobagyi GN, et al. Prognostic value of body mass index in locally advanced breast cancer. Clin Cancer Res. 2008. 14:1718–1725.

14. Litton JK, Gonzalez-Angulo AM, Warneke CL, Buzdar AU, Kau SW, Bondy M, et al. Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer. J Clin Oncol. 2008. 26:4072–4077.

15. Keam B, Im SA, Kim HJ, Oh DY, Kim JH, Lee SH, et al. Prognostic impact of clinicopathologic parameters in stage II/III breast cancer treated with neoadjuvant docetaxel and doxorubicin chemotherapy: paradoxical features of the triple negative breast cancer. BMC Cancer. 2007. 7:203.

16. Lee KH, Im SA, Oh DY, Lee SH, Chie EK, Han W, et al. Prognostic significance of bcl-2 expression in stage III breast cancer patients who had received doxorubicin and cyclophosphamide followed by paclitaxel as adjuvant chemotherapy. BMC Cancer. 2007. 7:63.

17. Carey LA, Dees EC, Sawyer L, Gatti L, Moore DT, Collichio F, et al. The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res. 2007. 13:2329–2334.

18. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004. 363:157–163.

19. Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996. 15:361–387.

20. Berclaz G, Li S, Price KN, Coates AS, Castiglione-Gertsch M, Rudenstam CM, et al. Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience. Ann Oncol. 2004. 15:875–884.

21. Chlebowski RT, Aiello E, McTiernan A. Weight loss in breast cancer patient management. J Clin Oncol. 2002. 20:1128–1143.

22. Ryu SY, Kim CB, Nam CM, Park JK, Kim KS, Park J, et al. Is body mass index the prognostic factor in breast cancer? A meta-analysis. J Korean Med Sci. 2001. 16:610–614.

23. Kimura M. Obesity as prognostic factors in breast cancer. Diabetes Res Clin Pract. 1990. 10:Suppl 1. S247–S251.

24. Kyogoku S, Hirohata T, Takeshita S, Nomura Y, Shigematsu T, Horie A. Survival of breast-cancer patients and body size indicators. Int J Cancer. 1990. 46:824–831.

25. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999. 282:1530–1538.

26. Dignam JJ, Mamounas EP. Obesity and breast cancer prognosis: an expanding body of evidence. Ann Oncol. 2004. 15:850–851.

27. Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med. 2003. 163:49–56.

28. Dolle JM, Daling JR, White E, Brinton LA, Doody DR, Porter PL, et al. Risk factors for triple-negative breast cancer in women under the age of 45 years. Cancer Epidemiol Biomarkers Prev. 2009. 18:1157–1166.

29. Liedtke C, Mazouni C, Hess KR, André F, Tordai A, Mejia JA, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 2008. 26:1275–1281.

30. Kanazawa M, Yoshiike N, Osaka T, Numba Y, Zimmet P, Inoue S. Criteria and classification of obesity in Japan and Asia-Oceania. World Rev Nutr Diet. 2005. 94:1–12.