Body Mass Index, Chemotherapy-Related Weight Changes, and Disease-Free Survival in Haitian Women With Nonmetastatic Breast Cancer

Abstract

PURPOSE Few studies have explored the relationship between body habitus and breast cancer outcomes in Caribbean women of African ancestry. This study evaluates the association between body mass index (BMI) and disease-free survival (DFS) in a retrospective cohort of 224 female Haitian patients with nonmetastatic breast cancer. PATIENTS AND METHODS BMI was obtained from the medical records and categorized as normal weight (< 25 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). DFS was defined as time from surgical resection to disease recurrence, death, or censoring. Kaplan-Meier survival curves were generated, and the association between BMI and DFS was evaluated using Cox proportional hazard models to control for multiple confounders. Exploratory analyses were conducted on weight changes during adjuvant chemotherapy. RESULTS Eighty-three patients (37.1%) were normal weight, 66 (29.5%) were overweight, and 75 (33.5%) were obese. There were no statistical differences in baseline characteristics or treatments received by BMI group. Twenty-six patients died and 73 had disease recurrence. Median DFS was 41.1 months. Kaplan-Meier estimates showed no significant DFS differences by BMI categories. After controlling for confounders, normal weight patients, when compared with overweight and obese patients, had adjusted hazard ratios of 0.85 (95% CI, 0.49 to 1.49) and 0.90 (95% CI, 0.52 to 1.55), respectively. Overall, mean weight loss of 2% of body weight was noted over the course of adjuvant chemotherapy. Patients who were postmenopausal ( P = .007) and obese ( P = .05) lost more weight than other groups. However, chemotherapy-related weight changes did not have an impact on DFS. CONCLUSION Baseline BMI and weight changes during adjuvant chemotherapy did not have an impact on DFS in this cohort. Future prospective studies in similar Caribbean breast cancer cohorts are needed to verify study findings.

Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta‐analysis

“…Increased risk of breast cancer‐specific mortality was evident for BMI above 29 kg/m 2 ( P nonlinearity = .02; 34 studies, 13 324 deaths; 27 publications) 57,63‐65,75,78,79,82,86,91,93,95,96,98‐103,106,109,110,118,125,126,128,137 (Figures 2 and 3). The curves for breast cancer recurrence ( P nonlinearity = .71; 47 studies, 28 165 events; 37 publications) 40,41,45,48,51,54,55,59,63‐65,68‐70,72,73,79,83,85,89,94,96,102,104,106,110,112,115,116,119,120,123‐125,130,131,133 and second primary breast cancer ( P nonlinearity = .19; nine studies, 2925 events; seven publications) 58,63,64,87,108,132,138 appeared linear (Figures S1 and S2).…”

“…However, few studies were included in some subgroups leading to wide 95% CIs and limiting the ability to assess/explain heterogeneity. Meta‐regression analyses indicated that tumor invasiveness or stage may partly explain the heterogeneity observed for breast cancer recurrence ( I 2 = 54%), with the studies of invasive and in situ breast cancers showing a higher average positive association (five studies/publications) 55,96,110,112,127 compared with studies with only invasive cancers (50 studies, 41 publications), 40,41,43‐46,48,51,54,56,59,63‐66,68‐70,72,74,79,84,85,88,89,92,94,102,104,106,115,116,120‐125,130,131,136 and the studies of metastatic breast cancers showing inverse associations (eight studies, two publications) 70,121 compared with the positive associations observed for early stage disease cases (27 studies/publications) 41,43,44,46,48,51,54,56,59,63,66,68,69,72,74,79,88,89,94,106,116,120,122‐124,127,130 ( P meta‐regression = .02 and .003, respectively). A similar pattern by tumor stage was observed for all‐cause mortality (30 studies, 28 publications on early stage diseases 41,43,44,46,54,63,66‐68,72,78,79,88,89,91,94,95,98,100,111,116,120,123,125‐127,129,130 ; five studies, three publications on metastatic disease 70,81,105 ; P meta‐regression .14; Table 2).…”

“…The curves for breast cancer recurrence (P nonlinearity = .71; 47 studies, 28 165 events; 37 publications) 40,41,45,48,51,54,55,59,[63][64][65][68][69][70]72,73,79,83,85,89,94,96,102,104,106,110,112,115,116,119,120,[123][124][125]130,131,133 and second primary breast cancer (P nonlinearity = .19; nine studies, 2925 events; seven publications) 58,63,64,87,108,132,138 appeared linear (Figures S1 and S2).…”

Effect of postoperative chemotherapy on blood glucose and lipid metabolism in patients with invasive breast cancer

“…Chemotherapy may lead to weight gain in breast cancer patients (15)(16)(17)(18). In contrast, long-course chemotherapy has greater effects on adipokines, insulin, and insulin-like growth factors and thus increases the risk for abnormally elevated blood glucose.…”

Breast Cancer in the Caribbean

“…DeGennaro et al, (2018) [ 32 ] contend the unavailability of Haitian population data to be able to calculate age-adjusted rates for significant analysis. Body mass index (BMI) did not seem to have an impact on disease-free survival among a cohort of Haitian women with BC where 63% were either overweight or obese [ 58 ]. In the cohort studied by O'Neill et al [ 59 ], 98% of persons were employed before illness, while 89% suffered a loss of income due to BC.…”