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Obesity as an independent risk factor for decreased survival in node-positive high-risk breast cancer

Breast Cancer Research and Treatment volume 151, pages 569–576 (2015)Cite this article

Abstract

Obese breast cancer patients have a higher risk of lymph node metastasis and a poorer prognosis compared to patients with normal weight. For obese women with node-positive breast cancer, an association between body weight and prognosis remains unclear. In this retrospective study, we analyzed patient data from the Phase-III ADEBAR trial, in which high-risk breast cancer patients (pT1–4, pN2–3, pM0) were randomized into a docetaxel-based versus epirubicin-based chemotherapy regimen. Patients were grouped according to their BMI value as underweight/normal weight (BMI < 25 kg/m2; n = 543), overweight (BMI 25–29.9 kg/m2; n = 482) or obese (BMI ≥ 30 kg/m2; n = 285). Overweight and obese patients were older, had larger tumors and were more likely to be postmenopausal at the time of diagnosis compared to underweight/normal-weight patients (all p < 0.001). Multivariate Cox regression analyses adjusting for age and histopathological tumor features showed that obese patients had a significantly shorter disease-free survival (DFS; HR 1.43; 95 % CI 1.11–1.86; p = 0.006) and overall survival (OS; HR 1.56; 95 % CI 1.14–2.14; p = 0.006) than non-obese patients. Subgroup analyses revealed that the differences in DFS and OS were significant for postmenopausal but not for premenopausal patients, and that the survival benefit of non-obese patients was more pronounced in women with hormone-receptor-positive disease. Obesity constitutes an independent, adverse prognostic factor in high-risk node-positive breast cancer patients, in particular for postmenopausal women and women with hormone-receptor-positive disease.

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Conflict of interest

All authors declare that there is no conflict of interest. W. Janni holds a consulting and advisory function at Sanofi-Aventis and Amgen.

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    Authors and Affiliations

    1. Frauenklinik der Universität Ulm, Prittwitzstraße 43, 89075, Ulm, Germany

      Christoph Scholz, Thomas W. P. Friedl & W. Janni

    2. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Ludwig-Maximilians-Universität München – Campus Innenstadt, Maistraße 11, 80337, Munich, Germany

      U. Andergassen, N. Harbeck, H. Sommer, K. Friese & B. Rack

    3. Frauenklinik, Klinikum der Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany

      P. Hepp

    4. Frauenklinik, Klinikum Traunstein, Cuno-Niggl-Straße 3, 83278, Traunstein, Germany

      C. Schindlbeck

    5. Frauenklinik, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Ismaninger Straße 22, 81675, Munich, Germany

      M. Kiechle

    6. Else Kröner-Fresenius-Center for Nutritional Medicine, Technische Universität München, Munich, Germany

      H. Hauner

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    1. Christoph Scholz
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    Correspondence to Christoph Scholz.

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    Christoph Scholz and U. Andergassen have contributed equally.

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    Scholz, C., Andergassen, U., Hepp, P. et al. Obesity as an independent risk factor for decreased survival in node-positive high-risk breast cancer. Breast Cancer Res Treat 151, 569–576 (2015). https://doi.org/10.1007/s10549-015-3422-3

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    • DOI: https://doi.org/10.1007/s10549-015-3422-3

    Keywords

    • Node-positive breast cancer
    • Obesity
    • Outcome