Overweight and obesity as poor prognostic factors in locally advanced breast cancer patients

Abstract

Obesity and overweight are established risk factors for the development of breast cancer. They are also associated with poor prognosis for higher risk of disease recurrence and lower overall survival (OS). The aim of this study was to evaluate the influence of overweight and obesity in OS in patients with locally advanced breast cancer (LABC) treated with neoadjuvant chemotherapy. This is a retrospective analysis that included 819 patients diagnosed with LABC between January 2004 and December 2008. The patients were treated with neoadjuvant chemotherapy (NAT) based on anthracyclines, taxanes, or both, followed by surgery. For comparison, patients were divided into the normal weight (NW) group or the overweight/obesity (OW/OB) group. The prevalence of overweight/obesity was 74 %. General characteristics of the patients, including age, tumor size, clinical stage, nuclear grade, hormone receptors, and HER2 expression, were similar between both groups. At a median follow-up of 28 months, we found a statistically significant difference in OS between the two groups, achieving a 91.5 % in NW patients versus 85.9 % in the OW/OB group (P = 0.050). Cox multivariate analysis demonstrated that obesity was an independent factor for poor prognosis, with a hazard ratio of 1.79 (95 % CI (Confidence Interval) 1.09-2.96; P = 0.022). This is the first Mexican study that confirms the role of OW/OB as a risk factor for poor outcome among patients with LABC. Obesity in our country is a public health problem and requires strong preventive intervention strategies for its control, especially among patients diagnosed with breast cancer.

Obesity as a prognostic factor in breast cancer women

“…14 The BIG 02-98 showed that 19% of the patients were obese. 17 A Brazilian study by Sampaio et al 36 and a Mexican study by Arce-Salinas et al 37 presented data on the proportion of obesity and overweight of 70% and 74%, respectively, in women with breast cancer, slightly larger but comparable to the current study.…”

“…38 The 5-year overall survival of 79% in this study was equivalent to the results of age-standardized population-based survival studies 2 and hospital-based in Brazil. [27][28][29][30][31][32][33][34][35][36][37][38][39] The population-based study demonstrated that age-standardized 5-year survival for breast cancer in 34 countries was around 80% and in Brazil in 2009 it was 87%. 2 Yet in populationbased studies such as that of Coleman et al 40 data from the city of Campinas, São Paulo, Brazil, showed a 5-year survival of only 40%.…”

Impact of body fat distribution on neoadjuvant chemotherapy outcomes in advanced breast cancer patients

“…Thus, the impact of obesity on NAC chemosensitivity remains controversial. On the other hand, studies have consistently shown that obese patients have a significantly worse survival outcome after NAC [1,3,29,30]. Together, these studies indicate that obesity has a greater impact on survival outcomes after NAC than NAC chemosensitivity.…”

Incidence of high body mass index in critically ill cancer patients

“…Recently, González et al (37) reported that ambulatory patients with cancer and sarcopenia (low rate of fat-free mass) have a higher risk of death. The few reports that include oncologic patients suggest that obesity is a factor to consider in the response to oncologic treatment, and in the progression and resolution of oncologic disease over the medium or long term (40)(41)(42). In our institution, there are no statistics regarding the incidence of overweight and obesity in oncologic patients.…”