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Aggressive estrogen-receptor-positive breast cancer arising in patients with elevated body mass index

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Abstract

Background

Obese women with estrogen receptor (ER)-positive breast cancer may experience worse disease-free and overall survival. We hypothesize that this observation is due to intrinsically aggressive disease and that obesity will be associated with higher histologic grade and Ki67.

Methods

A sequential cohort of women with breast cancer diagnosed over 2 years was assembled from institutional tumor registries. Patient and tumor characteristics were abstracted from medical records; those with non-invasive tumors, or lacking body mass index (BMI), Ki67 or histologic grade data, were excluded. Univariate and multivariate analysis was performed to investigate the relationship between markers of aggressive disease (grade and Ki67) and multiple variables associated with obesity. A subgroup analysis was performed to investigate further whether ER and menopausal status influenced associations between BMI and aggressive phenotypes.

Results

Of the 1007 patients initially identified, 668 (68 %) met the eligibility criteria. In univariate analysis, histologic grade and Ki67 were strongly associated with increased BMI, younger age, and African-American race, but less so with diabetes, hypertension, and hyperlipidemia. Multivariate analysis confirmed that higher histologic grade was associated with increased BMI (p = 0.02), and that increased Ki67 was associated with younger age (p = 0.0003) and African-American race (p = 0.002). Additional analysis found that the association between increased BMI and higher-grade tumors was particularly significant in premenopausal women with ER-positive disease.

Conclusion

This study concludes that increased BMI is associated with aggressive-phenotype breast cancer and may be particularly relevant to ER-positive breast cancer developing in premenopausal African-American women.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Oncology, Sidney Kimmel Comprehensive Cancer Center, Bunting-Blaustein Cancer Research Bldg, Johns Hopkins University, 1650 Orleans St., Rm. 144, Baltimore, MD, 21287-0013, USA

    Cesar Augusto Santa-Maria

  2. Department of Clinical Sciences, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8551, USA

    Jingsheng Yan & Xian-Jin Xie

  3. Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    David Michael Euhus

Authors
  1. Cesar Augusto Santa-Maria
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  2. Jingsheng Yan
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  3. Xian-Jin Xie
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  4. David Michael Euhus
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Corresponding author

Correspondence to Cesar Augusto Santa-Maria.

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Santa-Maria, C.A., Yan, J., Xie, XJ. et al. Aggressive estrogen-receptor-positive breast cancer arising in patients with elevated body mass index. Int J Clin Oncol 20, 317–323 (2015). https://doi.org/10.1007/s10147-014-0712-4

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  • DOI: https://doi.org/10.1007/s10147-014-0712-4

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