In: Breast Cancer Research, 17 (2015), Nr. 129. pp. 1-11. ISSN 1465-542X

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PDF, English Download (1MB) | Lizenz: The influence of obesity on survival in early, high-risk breast cancer: results from the randomized SUCCESS A trial by Widschwendter, Peter ; Friedl, Thomas WP ; Schwentner, Lukas ; DeGregorio, Nikolaus ; Jäger, Bernadette ; Schramm, Amelie ; Bekes, Inga ; Deniz, Miriam ; Lato, Krisztian ; Weissenbacher, Tobias ; Kost, Bernd ; Andergassen, Ulrich ; Jückstock, Julia ; Neugebauer, Julia ; Trapp, Elisabeth ; Fasching, Peter A. ; Beckmann, Matthias W. ; Schneeweiß, Andreas ; Schrader, Ines ; Rack, Brigitte ; Janni, Wolfgang ; Scholz, Christoph underlies the terms of Creative Commons Attribution 3.0 Germany

Abstract

Introduction: Obese breast cancer patients have worse prognosis than normal weight patients, but the level at which obesity is prognostically unfavorable is unclear. Methods: This retrospective analysis was performed using data from the SUCCESS A trial, in which 3754 patients with high-risk early breast cancer were randomized to anthracycline- and taxane-based chemotherapy with or without gemcitabine. Patients were classified as underweight/normal weight (body mass index (BMI) < 25.0), overweight (BMI 25.0–29.9), slightly obese (BMI 30.0–34.9), moderately obese (BMI 35.0–39.9) and severely obese (BMI ≥ 40.0), and the effect of BMI on disease-free survival (DFS) and overall survival (OS) was evaluated (median follow-up 65 months). In addition, subgroup analyses were conducted to assess the effect of BMI in luminal A-like, luminal B-like, HER2 (human epidermal growth factor 2)-positive and triple-negative tumors. Results: Multivariate analyses revealed an independent prognostic effect of BMI on DFS (p = 0.001) and OS (p = 0.005). Compared with underweight/normal weight patients, severely obese patients had worse DFS (hazard ratio (HR) 2.70, 95 % confidence interval (CI) 1.71–4.28, p < 0.001) and OS (HR 2.79, 95 % CI 1.63–4.77, p < 0.001), while moderately obese, slightly obese and overweight patients did not differ from underweight/normal weight patients with regard to DFS or OS. Subgroup analyses showed a similar significant effect of BMI on DFS and OS in patients with triple-negative breast cancer (TNBC), but not in patients with other tumor subtypes. Conclusions: Severe obesity (BMI ≥ 40) significantly worsens prognosis in early breast cancer patients, particularly for triple-negative tumors. Trial registration: Clinicaltrials.gov NCT02181101. Registered September 2005