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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

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Abstract

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.

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Acknowledgments

We thank the patients, physicians, nurses and data managers who participated in BIG 02-98 and the staff at the central offices of the cooperative groups. The following cooperative groups participated: Breast European Adjuvant Studies Team, International Breast Cancer Study Group (including Australian New Zealand Breast Cancer Trials Group), Irish Clinical Oncology Research Group, Grupo Español de Investigacion en Cancer de Mama, Danish Breast Cancer Cooperative Group, Swedish Breast Cancer Group, Austrian Breast and Colorectal Cancer Study Group and Grupo Oncologico Cooperative Chileno De Investigacion. The BIG 02-98 trial was supported by the National Health and Medical Research Council (project grants 100925 and 351164 to Australian New Zealand Breast Cancer Trials Group).

Author information

Authors and Affiliations

  1. Institut Jules Bordet and Université Libre de Bruxelles (U.L.B), Boulevard de Waterloo, 125, 1000, Brussels, Belgium

    Evandro de Azambuja & Martine Piccart-Gebhart

  2. National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Worta McCaskill-Stevens

  3. Peter MacCallum Cancer Centre and St Vincent’s Hospital, Australian New Zealand Breast Cancer Trials Group, Melbourne, VIC, Australia

    Prudence Francis

  4. Australian New Zealand Breast Cancer Trials Group, Newcastle, Australia

    Prudence Francis

  5. International Breast Cancer Study Group, Bern, Switzerland

    Prudence Francis

  6. International Drug Development Institute, Louvain-La-Neuve, Belgium

    Emmanuel Quinaux

  7. St. Vincent’s Hospital, Dublin, Ireland

    John P. A. Crown

  8. Br.E.A.S.T. Data Centre, Brussels, Belgium

    Malou Vicente

  9. Medical Oncology Unit, S. Camillo-Forlanini Hospital, Rome, Italy

    Rosa Giuliani

  10. Universitetssjukhuset, Oncology, Linköping, Sweden

    Bo Nordenskjöld

  11. Clinica Las Condes, Las Condes, Santiago, Chile

    Jorge Gutiérez

  12. Department of Oncology, The Finsen Centre, Copenhagen University Hospital, Rigshospitalet, Denmark

    Michael Andersson

  13. Hospital Germans Trias I Pujol, Badalona, Spain

    Mireia Margeli Vila

  14. University of Vienna, General Hospital, Vienna, Austria

    Raimund Jakesz

  15. Heilig Hart Ziekenhuis, Roeselare, Belgium

    Jan Demol

  16. Sir Charles Gairdner Hospital, Nedlands, Western Australia

    Joanna Dewar

  17. Istituto Clinico Humanitas, Rozzano, Italy

    Armando Santoro

  18. Hospital Clinico Universitario, Valencia, Spain

    Ana Lluch

  19. Sanofi-aventis, Paris, France

    Steven Olsen

  20. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    Richard D. Gelber

  21. Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Piazza dell’Ospedale, Prato, Italy

    Angelo Di Leo

Authors
  1. Evandro de Azambuja
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  2. Worta McCaskill-Stevens
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  3. Prudence Francis
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  4. Emmanuel Quinaux
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  5. John P. A. Crown
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  6. Malou Vicente
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  7. Rosa Giuliani
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  8. Bo Nordenskjöld
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  9. Jorge Gutiérez
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  10. Michael Andersson
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  11. Mireia Margeli Vila
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  12. Raimund Jakesz
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  13. Jan Demol
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  14. Joanna Dewar
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  15. Armando Santoro
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  16. Ana Lluch
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  17. Steven Olsen
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  18. Richard D. Gelber
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  19. Angelo Di Leo
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  20. Martine Piccart-Gebhart
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Corresponding author

Correspondence to Martine Piccart-Gebhart.

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On behalf of the BIG 02-98 Study Team.

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de Azambuja, E., McCaskill-Stevens, W., Francis, P. et al. 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. Breast Cancer Res Treat 119, 145–153 (2010). https://doi.org/10.1007/s10549-009-0512-0

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