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RESEARCH PRODUCT

Obesity and survival in operable breast cancer patients treated with adjuvant anthracyclines and taxanes according to pathological subtypes: a pooled analysis

C Rodríguez-martinBella PajaresManuel Ruiz-borregoAna LluchMc CámaraMiguel MartinEva CarrascoMarina PollánAntonio AntónManuel RamosMiguel ÁNgel SeguíJohn R. MackeyTadeusz PienkowskiOlivier TredanCharles L. VogelJoaquín GaviláEmilio AlbaLourdes CalvoÁLvaro Rodríguez-lescure

subject

Índice de Masa CorporalOncologyReceptor ErbB-2medicine.medical_treatmentObesidad:Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Survival Analysis [Medical Subject Headings]Supervivencia sin EnfermedadBody Mass IndexAntineoplastic Combined Chemotherapy ProtocolsMedicineAnthracyclinesYoung adultMedicine(all)Hazard ratioNeoplasias de la MamaPronósticoFemeninoMiddle AgedPrognosisChemotherapy regimenTreatment OutcomeFemaleTaxoidsMastectomyResearch ArticleAdultmedicine.medical_specialtyAnálisis de Supervivencia:Analytical Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::Body Constitution::Body Weights and Measures::Body Mass Index [Medical Subject Headings]Breast NeoplasmsDisease-Free SurvivalYoung AdultBreast cancerInternal medicineAdjuvant therapyHumansObesity:Analytical Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Disease-Free Survival [Medical Subject Headings]:Diseases::Neoplasms::Neoplasms by Site::Breast Neoplasms [Medical Subject Headings]AgedGynecologyDose-Response Relationship Drugbusiness.industry:Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Antineoplastic Agents [Medical Subject Headings]Retrospective cohort studyAntineoplásicosmedicine.disease:Diseases::Nutritional and Metabolic Diseases::Nutrition Disorders::Overnutrition::Obesity [Medical Subject Headings]:Check Tags::Female [Medical Subject Headings]Multivariate Analysis:Analytical Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis [Medical Subject Headings]Neoplasm Recurrence LocalbusinessBody mass index

description

Obesity is an unfavorable prognostic factor in breast cancer (BC) patients regardless of menopausal status and treatment received. However, the association between obesity and survival outcome by pathological subtype requires further clarification. METHODS: We performed a retrospective analysis including 5,683 operable BC patients enrolled in four randomized clinical trials (GEICAM/9906, GEICAM/9805, GEICAM/2003-02, and BCIRG 001) evaluating anthracyclines and taxanes as adjuvant treatments. Our primary aim was to assess the prognostic effect of body mass index (BMI) on disease recurrence, breast cancer mortality (BCM), and overall mortality (OM). A secondary aim was to detect differences of such prognostic effects by subtype. RESULTS: Multivariate survival analyses adjusting for age, tumor size, nodal status, menopausal status, surgery type, histological grade, hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, chemotherapy regimen, and under-treatment showed that obese patients (BMI 30.0 to 34.9) had similar prognoses to that of patients with a BMI < 25 (reference group) in terms of recurrence (Hazard Ratio [HR] = 1.08, 95% Confidence Interval [CI] = 0.90 to 1.30), BCM (HR = 1.02, 0.81 to 1.29), and OM (HR = 0.97, 0.78 to 1.19). Patients with severe obesity (BMI ≥ 35) had a significantly increased risk of recurrence (HR = 1.26, 1.00 to 1.59, P = 0.048), BCM (HR = 1.32, 1.00 to 1.74, P = 0.050), and OM (HR = 1.35, 1.06 to 1.71, P = 0.016) compared to our reference group. The prognostic effect of severe obesity did not vary by subtype. CONCLUSIONS: Severely obese patients treated with anthracyclines and taxanes present a worse prognosis regarding recurrence, BCM, and OM than patients with BMI < 25. The magnitude of the harmful effect of BMI on survival-related outcomes was similar across subtypes. This work was supported by the Spanish Breast Cancer Research Group (Grupo Español de Investigación de Cáncer de Mama) (GEICAM). No funding was received for the data analyses or the writing of this manuscript. Clinical trials GEICAM/9805 and BCIRG 001 were funded by Sanofi Aventis. GEICAM/9906 and GEICAM/2003-02 were partially funded by Bristol-Myers Squibb. These funding bodies were not involved in the collection and interpretation of the data or in the decision to publish. EA and MM were also supported by FEDER (RECTICC-RD12/0036/0076). We thank all the participating patients, clinicians, GEICAM and local research staff. We thank Hosanna Soler Vila, PhD, who provided medical writing services on behalf of GEICAM. Sí

yearjournalcountryeditionlanguage
2013-11-06
http://hdl.handle.net/10550/44500