Obesity and survival in the neoadjuvant breast cancer setting: role of tumor subtype in an ethnically diverse population.

Breast Cancer Res Treat 2018 01 25;167(1):277-288. Epub 2017 Sep 25.

Department of Medical Oncology, New York Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Ave, Rm 10-1071, New York, NY, 10032, USA.

Background: Obesity may negatively affect survival in breast cancer (BC), but studies are conflicting, and associations may vary by tumor subtypes and race/ethnicity groups.

Methods: In a retrospective review, we identified 273 women with invasive BC administered Adriamycin/Taxane-based neoadjuvant chemotherapy from 2004 to 2016 with body mass index (BMI) data at diagnosis. Obesity was defined as BMI ≥30. Associations between obesity and event-free survival (EFS), using STEEP events, and overall survival (OS), using all-cause mortality, were assessed overall and stratified by tumor subtype [[Hormone Receptor Positive (HR+)/HER2-, HER2+, and Triple-Negative Breast Cancer (TNBC])] in our diverse population.

Results: Median follow-up was 32.6 months (range 5.7-137.8 months). Overall, obesity was associated with worse EFS (HR 1.71, 95% CI 1.03-2.84, p = 0.04) and a trend towards worse OS (p = 0.13). In HR+/HER2- disease (n = 135), there was an interaction between obesity and hormonal therapy with respect to OS but not EFS. In those receiving tamoxifen (n = 33), obesity was associated with worse OS (HR 9.27, 95% CI 0.96-89.3, p = 0.05). In those receiving an aromatase inhibitor (n = 89), there was no association between obesity and OS. In TNBC (n = 44), obesity was associated with worse EFS (HR 2.62, 95% CI 1.03-6.66, p = 0.04) and a trend towards worse OS (p = 0.06). In HER2+ disease (n = 94), obesity was associated with a trend towards worse EFS (HR 3.37, 95% CI 0.97-11.72, p = 0.06) but not OS. Race/ethnicity was not associated with survival in any subtype, and there were no interactions with obesity on survival.

Conclusions: Obesity may negatively impact survival, with differences among tumor subtypes.

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http://link.springer.com/10.1007/s10549-017-4507-y
Publisher Site
http://dx.doi.org/10.1007/s10549-017-4507-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790631PMC
January 2018
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References

(Supplied by CrossRef)
Article in Lancet
K Bhaskaran et al.
Lancet 2014
Article in Obesity Rev
AG Tsai et al.
Obesity Rev 2011
Article in Breast Cancer
WG Gathirua-Mwangi et al.
Breast Cancer 2015
Article in J Clin Oncol
S Jiralerspong et al.
J Clin Oncol 2016
Article in Ann Oncol
DS Chan et al.
Ann Oncol 2014
Article in Breast Cancer Res Treat
S Niraula et al.
Breast Cancer Res Treat 2012
Article in Breast Cancer Res Treat
M Protani et al.
Breast Cancer Res Treat 2010
Article in Endocr Relat Cancer
EH Allott et al.
Endocr Relat Cancer 2015
Article in J Clin Oncol
G Pfeiler et al.
J Clin Oncol 2011
Article in J Clin Oncol
I Sestak et al.
J Clin Oncol 2010
Article in J Natl Cancer Inst
JJ Dignam et al.
J Natl Cancer Inst 2003

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