Breast Cancer Research and Treatment

, Volume 119, Issue 1, pp 145–153 | Cite as

The effect of body mass index on overall and disease-free survival in node-positive breast cancer patients treated with docetaxel and doxorubicin-containing adjuvant chemotherapy: the experience of the BIG 02-98 trial

  • Evandro de Azambuja
  • Worta McCaskill-Stevens
  • Prudence Francis
  • Emmanuel Quinaux
  • John P. A. Crown
  • Malou Vicente
  • Rosa Giuliani
  • Bo Nordenskjöld
  • Jorge Gutiérez
  • Michael Andersson
  • Mireia Margeli Vila
  • Raimund Jakesz
  • Jan Demol
  • Joanna Dewar
  • Armando Santoro
  • Ana Lluch
  • Steven Olsen
  • Richard D. Gelber
  • Angelo Di Leo
  • Martine Piccart-Gebhart
Clinical trial


Background: Obesity has been shown to be an indicator of poor prognosis for patients with primary breast cancer (BC) regardless of the use of adjuvant systemic therapy. Patients and methods: This is a retrospective analysis of 2,887 node-positive BC patients enrolled in the BIG 02-98 adjuvant study, a randomised phase III trial whose primary objective was to evaluate disease-free survival (DFS) by adding docetaxel to doxorubicin-based chemotherapy. In the current analysis, the effect of body mass index (BMI) on DFS and overall survival (OS) was assessed. BMI was obtained before the first cycle of chemotherapy. Obesity was defined as a BMI ≥ 30 kg/m². Results: In total, 547 (19%) patients were obese at baseline, while 2,340 (81%) patients were non-obese. Estimated 5-year OS was 87.5% for non-obese and 82.9% for obese patients (HR 1.34; P = 0.013). Estimated 5-years DFS was 75.9% for non-obese and 70.0% for obese patients (HR 1.20; P = 0.041). In a multivariate model, obesity remained an independent prognostic factor for OS and DFS. Conclusions: In this study, obesity was associated with poorer outcome in node-positive BC patients. Given the increasing prevalence of obesity worldwide, more research on improving the treatment of obese BC patients is needed.


Breast cancer Obesity BMI Adjuvant chemotherapy Docetaxel Node-positive 


  1. 1.
    Ferlay J, Bray F, Pisani P, Parkin DM (2001) Globocan 2000. Cancer incidence, mortality and prevalence worldwide. Version 1.0. IARC CancerBase No. 5. IARCPress, LyonGoogle Scholar
  2. 2.
    Cancer Facts & Figs 2008 (2008) Graphs and figures. (In Edition 2008)Google Scholar
  3. 3.
    Ferlay J, Autier P, Boniol M et al (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18:581–592CrossRefPubMedGoogle Scholar
  4. 4.
    World Health Organization (2008) Controlling the global obesity epidemic (In Edition 2008)Google Scholar
  5. 5.
    U.S. Obesity Trends 1985-2007 (2008) (In Edition 2008)Google Scholar
  6. 6.
    Caterson ID, Gill TP (2002) Obesity: epidemiology and possible prevention. Best Pract Res Clin Endocrinol Metab 16:595–610CrossRefPubMedGoogle Scholar
  7. 7.
    World Health Organization (2008) Global database on body mass index (In Edition 2008)Google Scholar
  8. 8.
    Dignam JJ, Wieand K, Johnson KA et al (2006) Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. Breast Cancer Res Treat 97:245–254CrossRefPubMedGoogle Scholar
  9. 9.
    Vitolins MZ, Kimmick GG, Case LD (2008). BMI influences prognosis following surgery and adjuvant chemotherapy for lymph node positive breast cancer. Breast J 14(4):357–365CrossRefPubMedGoogle Scholar
  10. 10.
    Ryu SY, Kim CB, Nam CM et al (2001) Is body mass index the prognostic factor in breast cancer?: a meta-analysis. J Korean Med Sci 16:610–614PubMedGoogle Scholar
  11. 11.
    Chlebowski RT, Aiello E, McTiernan A (2002) Weight loss in breast cancer patient management. J Clin Oncol 20:1128–1143CrossRefPubMedGoogle Scholar
  12. 12.
    Loi S, Milne RL, Friedlander ML et al (2005) Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 14:1686–1691CrossRefPubMedGoogle Scholar
  13. 13.
    Colleoni M, Li S, Gelber RD et al (2005) Relation between chemotherapy dose, oestrogen receptor expression, and body-mass index. Lancet 366:1108–1110CrossRefPubMedGoogle Scholar
  14. 14.
    Majed B, Moreau T, Senouci K et al (2008) Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat 111:329–342CrossRefPubMedGoogle Scholar
  15. 15.
    Francis P, Crown J, Di Leo A et al (2008) Adjuvant chemotherapy with sequential or concurrent anthracycline and docetaxel: Breast International Group 02–98 randomized trial. J Natl Cancer Inst 100:121–133CrossRefPubMedGoogle Scholar
  16. 16.
    Roche H, Fumoleau P, Spielmann M et al (2006) Sequential adjuvant epirubicin-based and docetaxel chemotherapy for node-positive breast cancer patients: the FNCLCC PACS 01 Trial. J Clin Oncol 24:5664–5671CrossRefPubMedGoogle Scholar
  17. 17.
    Martin M, Pienkowski T, Mackey J et al (2005) Adjuvant docetaxel for node-positive breast cancer. N Engl J Med 352:2302–2313CrossRefPubMedGoogle Scholar
  18. 18.
    Cox DR (1972) Regression models and life-tables (with discussion). J Royal Stat Sc B 34:187–220Google Scholar
  19. 19.
    Berclaz G, Li S, Price KN et al (2004) Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience. Ann Oncol 15:875–884CrossRefPubMedGoogle Scholar
  20. 20.
    Greenman CG, Jagielski CH, Griggs JJ (2008) Breast cancer adjuvant chemotherapy dosing in obese patients: dissemination of information from clinical trials to clinical practice. Cancer 112:2159–2165CrossRefPubMedGoogle Scholar
  21. 21.
    Litton JK, Gonzalez-Angulo AM, Warneke CL et al (2008) Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer. J Clin Oncol 26:4072–4077CrossRefPubMedGoogle Scholar
  22. 22.
    Lees AW, Jenkins HJ, May CL et al (1989) Risk factors and 10-year breast cancer survival in northern Alberta. Breast Cancer Res Treat 13:143–151CrossRefPubMedGoogle Scholar
  23. 23.
    Hebert JR, Hurley TG, Ma Y (1998) The effect of dietary exposures on recurrence and mortality in early stage breast cancer. Breast Cancer Res Treat 51:17–28CrossRefPubMedGoogle Scholar
  24. 24.
    Maehle BO, Tretli S (1996) Pre-morbid body-mass-index in breast cancer: reversed effect on survival in hormone receptor negative patients. Breast Cancer Res Treat 41:123–130CrossRefPubMedGoogle Scholar
  25. 25.
    Cust AE, Stocks T, Lukanova A et al (2009) The influence of overweight and insulin resistance on breast cancer risk and tumour stage at diagnosis: a prospective study. Breast Cancer Res Treat 113:567–576CrossRefPubMedGoogle Scholar
  26. 26.
    Suzuki R, Orsini N, Saji S et al (2009) Body weight and incidence of breast cancer defined by estrogen and progesterone receptor status-A meta-analysis. Int J Cancer 124:698–712CrossRefPubMedGoogle Scholar
  27. 27.
    Dignam JJ, Wieand K, Johnson KA et al (2003) Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst 95:1467–1476PubMedGoogle Scholar
  28. 28.
    Meyerhardt JA, Niedzwiecki D, Hollis D et al (2008) Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from Cancer and Leukemia Group B 89803. J Clin Oncol 26:4109–4115CrossRefPubMedGoogle Scholar
  29. 29.
    Meyerhardt JA, Catalano PJ, Haller DG et al (2003) Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 98:484–495CrossRefPubMedGoogle Scholar
  30. 30.
    Dignam JJ, Polite BN, Yothers G et al (2006) Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst 98:1647–1654PubMedCrossRefGoogle Scholar
  31. 31.
    Haydon AM, Macinnis RJ, English DR, Giles GG (2006) Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut 55:62–67CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Evandro de Azambuja
    • 1
  • Worta McCaskill-Stevens
    • 2
  • Prudence Francis
    • 3
    • 4
    • 5
  • Emmanuel Quinaux
    • 6
  • John P. A. Crown
    • 7
  • Malou Vicente
    • 8
  • Rosa Giuliani
    • 9
  • Bo Nordenskjöld
    • 10
  • Jorge Gutiérez
    • 11
  • Michael Andersson
    • 12
  • Mireia Margeli Vila
    • 13
  • Raimund Jakesz
    • 14
  • Jan Demol
    • 15
  • Joanna Dewar
    • 16
  • Armando Santoro
    • 17
  • Ana Lluch
    • 18
  • Steven Olsen
    • 19
  • Richard D. Gelber
    • 20
  • Angelo Di Leo
    • 21
  • Martine Piccart-Gebhart
    • 1
  1. 1.Institut Jules Bordet and Université Libre de Bruxelles (U.L.B)BrusselsBelgium
  2. 2.National Cancer Institute, National Institutes of HealthBethesdaUSA
  3. 3.Peter MacCallum Cancer Centre and St Vincent’s Hospital, Australian New Zealand Breast Cancer Trials GroupMelbourneAustralia
  4. 4.Australian New Zealand Breast Cancer Trials GroupNewcastleAustralia
  5. 5.International Breast Cancer Study GroupBernSwitzerland
  6. 6.International Drug Development InstituteLouvain-La-NeuveBelgium
  7. 7.St. Vincent’s HospitalDublinIreland
  8. 8.Br.E.A.S.T. Data CentreBrusselsBelgium
  9. 9.Medical Oncology UnitS. Camillo-Forlanini HospitalRomeItaly
  10. 10.Universitetssjukhuset, OncologyLinköpingSweden
  11. 11.Clinica Las CondesLas Condes, SantiagoChile
  12. 12.Department of Oncology, The Finsen CentreCopenhagen University HospitalRigshospitaletDenmark
  13. 13.Hospital Germans Trias I PujolBadalonaSpain
  14. 14.University of Vienna, General HospitalViennaAustria
  15. 15.Heilig Hart ZiekenhuisRoeselareBelgium
  16. 16.Sir Charles Gairdner HospitalNedlandsWestern Australia
  17. 17.Istituto Clinico HumanitasRozzanoItaly
  18. 18.Hospital Clinico UniversitarioValenciaSpain
  19. 19.Sanofi-aventisParisFrance
  20. 20.Department of Biostatistics and Computational BiologyDana-Farber Cancer InstituteBostonUSA
  21. 21.Sandro Pitigliani Medical Oncology UnitHospital of PratoPratoItaly

Personalised recommendations