Cholesterol and obesity as prognostic factors in breast cancer

A detailed retrospective analysis was undertaken of the effect of perioperative blood transfusion on long-term survival of 113 patients with Dukes' Stages A, B and C1 cancer of the colon and 383 patients with invasive cancer of the breast who were treated in our institution between 1973 and 1978 and followed for 5 to 10 years. In the patients with colon cancer, a significant adverse effect of transfusion on long-term survival was seen. In this group there was a cumulative 5-year overall survival of 48% for the transfused and 74% for the nontransfused patients (P = 0.007, log-rank test). Perioperative blood transfusion was associated with a relative risk of 3.42 for all deaths (P = 0.005) and 4.25 for death due to cancer (P = 0.03), after adjustment for other important variables such as age, sex, stage, location of tumor, surgical procedure, and preoperative hemoglobin level. In contrast, in our study group of patients with breast cancers, who all underwent a modified radical mastectomy, no effect of blood transfusion on long-term survival was seen. Multivariate analysis adjusting for size of tumor, number of positive regional lymph nodes, menopausal status, estrogen receptor status and the addition or absence of chemotherapy, did not show any increased risk in all deaths or death due to cancer associated with blood transfusion. Although no definite explanation is available, our data show that there seems to be a difference in the relationship between perioperative blood transfusion and survival for colon and breast cancer patients.

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“…22 did not discuss the possible relationship between obesity, blood transfusion, and patient survival.…”

Section: $ Cox Regression Analysissupporting

confidence: 81%

Perioperative blood transfusion and cancer prognosis. Different effects of blood transfusion on prognosis of colon and breast cancer patients

Voogt

Velde

Brand

et al. 1987

Cancer

132

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“…Patients above the median weight are more likely to be obese and to have large breasts where small tumours are more difficult to detect than in small breasts and it is well described that the larger the tumour the more likely axillary nodes are to be involved. The reported reduced survival of obese patients may be due to relatively late presentation, however, in some studies the adverse effect of obesity persisted after adjustment for tumour size and axillary node status (Greenberg et al, 1985;Tartter et al, 1981;Boyd et al, 1981 However, in the group of patients with advanced disease in our study there was no relationship between body weight and the probability of response to endocrine therapy.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, these factors are generally associated with a worse prognosis (Papatestas et al, 1986;Abe et al, 1976;Eberlein et al, 1985;Greenberg et al, 1985;Tartter et al, 1981;Newman et al, 1986;Boyd et al, 1981), although one small study did not confirm this effect (Sohrabi et al, 1980). Similarly in mice, obesity and a fat enriched diet increase the incidence and speed of onset of mammary tumours (Waxler et al, 1979).…”

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confidence: 99%

The relationship of body weight to response to endocrine therapy, steroid hormone receptors and survival of patients with advanced cancer of the breast

Williams

Howell²,

Jones³

1988

Br J Cancer

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Summary High body weight is associated with increased production of oestrogens which may influence the clinical behaviour of breast cancer. We have examined the influence of body weight on the response to endocrine therapy, steroid hormone receptor content and survival in 227 women who either presented with or developed advanced cancer of the breast. One hundred and thirty-three (59%) patients presented with operable disease and 94 (41%) with locally advanced tumours. Two hundred (88%) were treated by tamoxifen and 27 (12%) by ovarian ablation.High body weight was correlated with advanced tumour stage (P=0.002) and progesterone receptor (PR) positivity (P=0.01), but not with the presence of oestrogen receptor (ER P=0.21). The association between high body weight and PR positivity was particularly noticeable among ER positive tumours. There was no significant relationship between the nature of the response to therapy and weight (P=0.57). There was no significant difference in survival from the start of endocrine therapy (P=0.95), nor the time to progression of disease (P=0.29) between patients above and below the median weight of 64kg. Among the patients with operable disease, there was no difference in overall survival (P=0.42), relapse free survival (P=0.69), and survival from the start of endocrine therapy (P=0.85) according to body weight.Most epidemiological evidence suggests that high body weight and obesity are correlated with the incidence of breast cancer, particularly in postmenopausal women (Dewaard, 1982). Furthermore, these factors are generally associated with a worse prognosis (Papatestas et al., 1986;Abe et al., 1976;Eberlein et al., 1985;Greenberg et al., 1985;Tartter et al., 1981;Newman et al., 1986;Boyd et al., 1981), although one small study did not confirm this effect (Sohrabi et al., 1980). Similarly in mice, obesity and a fat enriched diet increase the incidence and speed of onset of mammary tumours (Waxler et al., 1979).In postmenopausal women the major source of oestrogens is the conversion of androstenedione, derived from the adrenal gland, to oestrone in body fat by the aromatase system (Cloncope, 1971;MacDonald et al., 1969). The strong correlation between the production of oestrone, the degree of this conversion and indices of obesity (e.g., weight, percentage of ideal weight and weight:height ratio) suggests that the excess production of steroid hormones within body fat which promotes the growth of mammary epithelial cells, may be the mechanism whereby there is an association between body weight and tumour incidence (Rizkallah et al., 1975; McDonald et al., 1978; Kirschner et al., 1982). This is supported by the report of lower levels of sex hormone binding globulin in the obese which may lead to higher levels of free oestrogens (Kirschner et al., 1982).Our working hypothesis for this study was that the greater endogenous production of growth promoting steroids in women of above average weight might override the effects of endocrine treatment and lead to a lower response rate and red...

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“…These results are of special interest since the same CMF chemotherapy regimen, when used in advanced breast cancer populations, does not result in weight increase (21). Higher indices of body weight at the time of mastectomy have been associated with increased risk for breast cancer recurrence in several reports (22)(23)(24)(25)(26). In the current study, the uniformly fatal outcome seen in patients who gained over 10 kg while receiving adjuvant treatment supports the suggestion of Bonomi and co-workers (20) that weight gain during adjuvant chemotherapy administration for Stage II breast cancer may be detrimental.…”

Section: Discussionmentioning

confidence: 99%

Long-term survival following relapse after 5-FU but not CMF adjuvant breast cancer therapy

Chlebowski

Weiner

Reynolds

et al. 1986

Breast Cancer Res Tr

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Beginning in 1974, patients with greater than or equal to 4 nodes positive following mastectomy were randomized to receive either 5-FU i.v. weekly or CMF i.v. every 2 weeks, both given for 12 months. Median follow-up now exceeds 112 months with nine year results below: (table; see text) Early results based on relapse-free survival favored CMF, but more patients currently are alive on the 5-FU arm. As the survival curves cross at 40 months, the 20% survival advantage for 5-FU did not achieve statistical significance. For 34% of patients failing adjuvant 5-FU, use of combination chemotherapy after relapse (commonly with CMFVP or CMF) resulted in long term survival. In contrast, long-term survival for patients failing adjuvant CMF was unusual. Relapse was detected while under weekly observation in a greater proportion of patients on 5-FU (36%) compared to CMF (6%) adjuvant treatment (p less than 0.05), potentially influencing tumor burden at recurrence. Hormonal therapy or radiation therapy as initial therapy after relapse was ineffective, with no long term survivors resulting on either arm. Weight increase on adjuvant chemotherapy was commonly seen, with weight increase greater than 10 kg associated with a poor prognosis. We conclude that initial improvement in relapse-free survival may not predict long term survival in adjuvant breast cancer trials since both the specific adjuvant therapy given pre-relapse as well as the type of salvage therapy given post-relapse may influence ultimate patient outcome.

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Cholesterol and obesity as prognostic factors in breast cancer

Cited by 129 publications

References 13 publications

Perioperative blood transfusion and cancer prognosis. Different effects of blood transfusion on prognosis of colon and breast cancer patients

Perioperative blood transfusion and cancer prognosis. Different effects of blood transfusion on prognosis of colon and breast cancer patients

The relationship of body weight to response to endocrine therapy, steroid hormone receptors and survival of patients with advanced cancer of the breast

Long-term survival following relapse after 5-FU but not CMF adjuvant breast cancer therapy

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