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Impact of change in body mass index during neoadjuvant chemotherapy and survival among breast cancer subtypes

  • Epidemiology
  • Published:
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Abstract

Purpose

We hypothesized that an increase in BMI category during neoadjuvant chemotherapy (NAC) would be associated with pathological complete response (pCR) rate and worse survival outcomes in primary breast cancer patients.

Methods

We reviewed the records of 4029 patients with stage I–III breast cancer who had undergone NAC and definitive surgery at our institution between May 1, 1990 and April 30, 2013. BMI values at baseline and after NAC were recorded, and the corresponding BMI category was assessed with the WHO classification. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan–Meier method, and multivariate Cox regression models were used to estimate the effect of covariates of interest on OS and RFS.

Results

The median follow-up period was 3.95 years. A change in BMI category from normal to obese during NAC was independently associated with shorter OS duration than was maintaining a normal weight [hazard ratio (HR) 1.637; 95%CI 1.066–2.514; p = 0.0242]. Kaplan–Meier curves among breast cancer subtypes showed differences, and a decrease in BMI led to better RFS and OS rates in obese patients with HR+/HER2− disease; those who maintained BMI also showed better prognosis for triple-negative breast cancer (TNBC). We saw no association between BMI change and pCR rate.

Conclusion

Our data suggest that inability to maintain normal weight during NAC is a predictive marker of poor survival but not pCR. It may be important for patients to maintain a normal weight during NAC.

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Acknowledgements

Tamara Locke in the Department of Scientific Publications at The University of Texas MD Anderson Cancer Center provided scientific editing services.

Funding

This study was funded by a My Oncology Dream award from the Japan Cancer Society, the Ichiro Kanehara Foundation for the Promotion of Medical Science and Medical Care, the National Institutes of Health through MD Anderson’s Cancer Center Support Grant P30CA016672, and a grant from the State of Texas Rare and Aggressive Breast Cancer Research Program.

Author information

Author notes

  1. Takahiro Kogawa and Takeo Fujii have contributed equally to this study.

Authors and Affiliations

  1. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1354, Houston, TX, 77030, USA

    Takahiro Kogawa, Takeo Fujii, Tamer M. Fouad, Kenichi Harano, Hiroko Masuda, Toshiaki Iwase, Young Sam Park, Bora Lim, Debu Tripathy, Jennifer K. Litton & Naoto T. Ueno

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Diane D. Liu

  3. Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Chad Barnett

  4. Department of Medical Oncology, The National Cancer Institute, Cairo University, Cairo, Egypt

    Tamer M. Fouad

Authors
  1. Takahiro Kogawa
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  2. Takeo Fujii
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  3. Tamer M. Fouad
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  4. Diane D. Liu
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  5. Kenichi Harano
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  6. Hiroko Masuda
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  7. Toshiaki Iwase
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  8. Chad Barnett
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  9. Young Sam Park
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  10. Bora Lim
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  11. Debu Tripathy
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  12. Jennifer K. Litton
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  13. Naoto T. Ueno
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Corresponding author

Correspondence to Naoto T. Ueno.

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Conflict of interest

Debu Tripathy has received research grants from Novartis and consultant/advisory role from Novartis and Pfizer.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

A waiver of informed consent was authorized by institutional review board because the study was a retrospective chart review involving no diagnostic or therapeutic intervention.

Electronic supplementary material

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10549_2018_4853_MOESM1_ESM.pptx

Supplementary Figures: Supplemental Fig 1. Kaplan-Meier curves illustrating recurrence-free survival (A, B, and C) and overall survival (D, E, and F) according to BMI category change in HR+/HER2– patients. Supplemental Fig 2. Kaplan-Meier curves illustrating recurrence-free survival (A, B, and C) and overall survival (D, E, and F) according to BMI category change in TNBC patients. Supplemental Fig 3. Kaplan-Meier curves illustrating recurrence-free survival (A, B, and C) and overall survival (D, E, and F) according to BMI category change in HR+/HER2+ patients. Supplemental Fig 4. Kaplan-Meier curves illustrating recurrence-free survival (A, B, and C) and overall survival (D, E, and F) according to BMI category change in HR-/HER2+ patients (PPTX 5740 KB)

Supplementary material Tables (DOCX 53 KB)

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Kogawa, T., Fujii, T., Fouad, T.M. et al. Impact of change in body mass index during neoadjuvant chemotherapy and survival among breast cancer subtypes. Breast Cancer Res Treat 171, 501–511 (2018). https://doi.org/10.1007/s10549-018-4853-4

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  • DOI: https://doi.org/10.1007/s10549-018-4853-4

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