J Breast Cancer.  2019 Sep;22(3):399-411. 10.4048/jbc.2019.22.e37.

Weight Gain during Neoadjuvant Chemotherapy is Associated with Worse Outcome among the Patients with Operable Breast Cancer

• Fang Q
• Huang J
• Gan L
• Shen K
• Chen X
• Wu B

• KMID: 2458861
• DOI: http://doi.org/10.4048/jbc.2019.22.e37

Abstract

PURPOSE
This study was aimed at identifying the influence of initial weight and weight change during neoadjuvant chemotherapy (NAC) on pathologic complete response (pCR) and long-term survival in Chinese patients with operable breast cancer.
METHODS
We conducted a retrospective study using data from 409 female patients who received NAC for stage II or III breast cancer and had complete record of body mass index (BMI) before and after NAC. BMI of < 25 kg/m² was categorized as normal weight/underweight (NW/UW); 25.0-29.9 kg/m² was categorized as overweight (OW); ≥30 kg/m² was categorized as obese (OB). BMI change was defined as the difference in BMI between day 1 of the first cycle of NAC and the day before surgery. A BMI gain or loss of > 2 kg/m² following NAC was considered to be significant, else was considered stable. The study end points included pCR rates, disease-free survival (DFS), and overall survival (OS).
RESULTS
The median follow-up time was 43.2 (8.9-93.6) months. The average BMI was 23.40 ± 3.04 kg/m² before NAC and 23.66 ± 3.02 kg/m² after NAC (t = −3.604, p < 0.001). The pCR rate was 25.3% in the NW/UW group and 24.1% in the OW/OB group (p = 0.811), and was similar between the BMI-gain (23.3%) and the BMI-stable/loss (25.1%) groups (p = 0.787). Initial BMI was an independent prognostic factor for DFS (hazard ratio, 1.69; 95% confidence interval [CI], 1.13-2.53; p = 0.011) but not for OS, while BMI-gain was an independent prognostic factor for both DFS (hazard ratio, 2.09; 95% CI, 1.28-3.42; p = 0.003) and OS (hazard ratio, 1.97; 95% CI, 1.04-3.74; p = 0.039).
CONCLUSION
BMI increased after NAC in Chinese breast cancer patients. Initial BMI and BMI change during NAC were not associated with pCR but were reversely associated with survival.

Keyword

Body mass index; Breast neoplasms; Neoadjuvant therapy; Survival

MeSH Terms

Asian Continental Ancestry Group
Body Mass Index
Breast Neoplasms*
Breast*
Disease-Free Survival
Drug Therapy*
Female
Follow-Up Studies
Humans
Neoadjuvant Therapy
Overweight
Polymerase Chain Reaction
Retrospective Studies
Weight Gain*

Figure

• 

  Figure 1 Kaplan-Meier plot of DFS (A) and OS (B) by initial body mass index. DFS = disease-free survival; OS = overall survival; OB = obese; OW = overweight; NW = normal weight; UW = underweight.

• 

  Figure 2 Kaplan-Meier plot of DFS (A) and OS (B) by BMI change. DFS = disease-free survival; OS = overall survival; BMI = body mass index.

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