BMI and Pathologic Complete Response to Neoadjuvant Chemotherapy in Breast Cancer: A Study and Meta-Analysis

Erbes, Thalia; Stickeler, Elmar; Rücker, Gerta; Buroh, Sabine; Asberger, Jasmin; Dany, N; Thornton, Sophia; Iborra, Séverine; Hirschfeld, Marc; Gitsch, G.; Mayer, Sebastian

doi:10.1016/j.clbc.2016.02.018

Cited by 24 publications

(27 citation statements)

References 43 publications

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“…We also found a statistically significant association between high stromal TILs infiltration and low BMI, which is not surprising if we take into account data showing higher pCR rates after neo-adjuvant chemotherapy in lower mean BMI patients [58][59][60][61][62] . While in luminal/ER-positive BC subtypes numerous studies have identified an increased mortality risk in obese women [63][64][65][66] , BMI in TNBC is considered a confounding factor, as no direct relation has been established between BMI itself and recurrence-free survival (RFS) or OS in TNBC [67][68][69] .…”

Section: Discussionsupporting

confidence: 74%

Insights for the application of TILs and AR in the treatment of TNBC in routine clinical practice

Losurdo

Sanctis

Fernandes

et al. 2020

Sci Rep

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Triple negative breast cancer (TNBC), usually presenting with a very aggressive phenotype, is a heterogeneous entity. We aim to discuss new biomarkers, suitable for prognostic and predictive purposes. We retrospectively collected clinical variables and immunohistochemical characteristics of early TNBCs, specifically focusing on the prognostic and predictive significance of tumor infiltrating lymphocytes (TILs) and androgen receptor (AR) expression, assessing their correlation with clinical variables. Among 159 patients, TILs were significantly higher in younger patients and with lower BMI, and in tumors with higher ki-67 and greater nodal involvement; conversely, AR was significantly higher in older patients and in tumors with lower ki-67. Interestingly and in line with literature, both TILs level and ARs expression were lower within metastatic sites, in patients who developed distant metastases, compared to those found in the primary site. Small (pT1) and node negative tumors were highly represented and no correlation of either TILs or AR with prognosis could be observed. Our findings support the use of stromal TILs to identify a more aggressive, but chemo-sensitive phenotype, mostly represented in younger women, while AR may identify a less aggressive, slow-growing luminal TNBC subtype, more common among older patients. TILs and AR are worth implementing in routine clinical practice to refine prognosis even if, in our case series, we couldn’t identify a significant correlation of the two variables with either disease-free and overall survival.

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Section: Discussionsupporting

confidence: 74%

Insights for the application of TILs and AR in the treatment of TNBC in routine clinical practice

Losurdo

Sanctis

Fernandes

et al. 2020

Sci Rep

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“…15 Although, a metanalysis based on eight major trials found no association between BMI measure and tumor sensitivity. 16 Postmenopausal status is a known cause of changes in body fat distribution, mainly increasing visceral fat tissue. 17,18 In our study population, postmenopausal status was significantly associated with overweight, high VFA and fatty liver compared to premenopausal women.…”

Section: Discussionmentioning

confidence: 99%

<p>Predictive Role Of Body Composition Parameters In Operable Breast Cancer Patients Treated With Neoadjuvant Chemotherapy</p>

Omarini¹,

Palumbo

Pecchi³

et al. 2019

CMAR

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Background: Fat tissue is strongly involved in BC tumorigenesis inducing insulin resistance, chronic inflammation and hormonal changes. Computed tomography (CT) imaging instead of body mass index (BMI) gives a reliable measure of skeletal muscle mass and body fat distribution. The impact of body composition parameters (BCPs) on chemosensitivity is still debated. We examined the associations between BCPs and tumor response to neoadjuvant chemotherapy (NC) in patients treated for operable breast cancer (BC). Methods: A retrospective review of BC patients treated with NC in Modena Cancer Center between 2005 and 2017 was performed. BCPs, such as subcutaneous fat area (SFA), visceral fat area (VFA), lumbar skeletal muscle index (LSMI) and liver-to-spleen (L/S) ratio were calculated by Advance workstation (General Electric), software ADW server 3.2 or 4.7. BMI and BCPs were correlated with pathological complete response (pCR) and survival outcomes. Results: 407 patients were included in the study: 55% with BMI < 25 and 45% with BMI ≥ 25. 137 of them had pre-treatment CT scan imagines. Overweight was significantly associated with postmenopausal status and older age. Hormonal receptor positive BC was more frequent in overweight patients (p<0.05). Postmenopausal women had higher VFA, fatty liver disease and obesity compared to premenopausal patients. No association between BMI classes and tumor response was detected. High VFA and liver steatosis were negative predictive factors for pCR (pCR rate: 36% normal VFA vs 20% high VFA, p= 0.048; no steatosis 32% vs steatosis 13%, p=0.056). Neither BMI classes nor BCPs significantly influenced overall survival and relapse-free survival. Conclusion: Visceral adiposity as well as steatosis were closely involved in chemosensitivity in BC patients treated with NC. Their measures from clinically acquired CT scans provide significant predictive information that outperform BMI value. More research is required to evaluate the relationship among adiposity site and survival outcomes.

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“…Most studies have focused on pathologic complete response (pCR), a surrogate marker for survival in the neoadjuvant setting, 23 and some report that obese patients have lower rates of pCR with a suggestion of worse surival. 24 However, others have shown no differences in pCR or survival between different body mass index (BMI) groups, 21,25 and many of the studies are limited to homogenous, clinical trial populations. The impact of obesity on BC survival in the neoadjuvant setting, and in particular the role of tumor subtype and race/ethnicity, is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Obesity and survival in the neoadjuvant breast cancer setting: role of tumor subtype in an ethnically diverse population

Liu

Saraf

Catanese

et al. 2017

Breast Cancer Res Treat

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BMI and Pathologic Complete Response to Neoadjuvant Chemotherapy in Breast Cancer: A Study and Meta-Analysis

Cited by 24 publications

References 43 publications

Insights for the application of TILs and AR in the treatment of TNBC in routine clinical practice

Insights for the application of TILs and AR in the treatment of TNBC in routine clinical practice

<p>Predictive Role Of Body Composition Parameters In Operable Breast Cancer Patients Treated With Neoadjuvant Chemotherapy</p>

Obesity and survival in the neoadjuvant breast cancer setting: role of tumor subtype in an ethnically diverse population

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