Obesity is an independent prognostic factor of decreased pathological complete response to neoadjuvant chemotherapy in breast cancer patients

Autor: Yavuz Ozisik, Gökmen Umut Erdem, Deniz Yuce, Ozturk Ates, Kadri Altundag, Aydin Aytekin, Ali R Sever, Suleyman Sahin, Taner Babacan, Fatih Karatas
Rok vydání: 2016
Předmět:
0301 basic medicine
Adult
medicine.medical_specialty
Turkey
medicine.medical_treatment
Subgroup analysis
Breast Neoplasms
Kaplan-Meier Estimate
Overweight
Gastroenterology
Disease-Free Survival
Body Mass Index
03 medical and health sciences
0302 clinical medicine
Breast cancer
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Obesity
Neoadjuvant therapy
Neoplasm Staging
Retrospective Studies
Gynecology
Proportional hazards model
business.industry
Retrospective cohort study
General Medicine
Middle Aged
medicine.disease
Prognosis
Neoadjuvant Therapy
030104 developmental biology
Logistic Models
Treatment Outcome
Chemotherapy
Adjuvant
030220 oncology & carcinogenesis
Multivariate Analysis
Surgery
Female
medicine.symptom
Underweight
Neoplasm Recurrence
Local
business
Body mass index
Zdroj: Breast (Edinburgh, Scotland). 32
ISSN: 1532-3080
Popis: Purpose The relation between higher body mass index (BMI) and pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer (BC) is a controversial issue according to the data of Western and Asian patients. The aim of this study is to evaluate BMI and pCR to NAC and discuss the importance of pCR outcomes in Turkish BC patients as a bridging country between Europe and Asia. Patients and methods Of the 4423 BC patients diagnosed between the years 1994 and 2015 in Hacettepe University Cancer Institute, 295 female patients with stage II and III BC were enrolled in the study. Three different group divisions were done according to patients' BMI as normal or underweight (N/U) patients (BMI 2 ), overweight (OW) patients (BMI = 25–29.9 kg/m 2 ) and obese (OB) patients (BMI ≥30 kg/m 2 ). BC subtypes were defined as luminal-like (ER/PR-positive and HER2-negative), HER2/luminal (ER/PR-positive and HER2-positive), HER2-type (ER/PR-negative and HER2-positive), and triple-negative (TNBC; ER/PR- and HER2-negative). The analysis of overall survival (OS) and recurrence-free survival (RFS) was performed according to Kaplan–Meier method. The Log-rank test was used to compare the subgroup analysis and logistic regression analysis to determine the independent prognostic factors. Results In this study, a total number of 93 (31.5%) patients were N/U, 107 (36.3%) patients were OW and 95 (32.2%) patients were OB. Among groups, except for the age, no baseline clinicopathological differences were found. In 70 (23.7%) patients, pCR was achieved. pCR rates in N/U, OW and OB were 31.2%, 22.4%, and 17.9% respectively, showing a considerable trend towards significance (P = 0.09 in chi-square test). In the multivariate logistic regression analysis, obesity was an independent adverse prognostic feature on pCR to NAC compared to N/U patients (OR, 0.34; 95% CI, 0.13 to 0.85, P = 0.02). The recurrence rates were slightly increased with the increase of BMI (N/U = 24.7%, OW = 29.0% and OB = 40%; P = 0.06 respectively). Median RFS was significantly higher in N/U group compared to OB patients (150 vs. 76 months respectively, P = 0.03) and was also higher in pCR group compared to non-pCR patients (151 vs. 77 months P = 0.004). Median OS was significantly higher in N/U patients compared to OB patients (N/U = not reached, OW = 211 and OB = 114 months; P = 0.01) and was also higher in pCR group compared to non-pCR patients (not reached vs. 211 months P = 0.04). In Cox regression analysis; pCR, histopathological grade and TNBC were found as independent prognostic factors on OS (HR, 0.29; 95% CI, 0.11 to 0.79, P = 0.015, HR, 2.09; 95% CI, 1.14 to 3.83, P = 0.017, HR, 1.95; 95% CI, 1.01 to 3.77, P = 0.046, respectively). Conclusion It was observed that obesity was an important independent prognostic factor which has an adverse effect on pCR. Moreover it causes decreasing RFS and OS in BC patients who had received NAC. The probability of inefficient treatment in obese patients should be considered.
Databáze: OpenAIRE
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