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

  • Epidemiology
  • Published:
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Abstract

Background

Obesity may negatively affect survival in breast cancer (BC), but studies are conflicting, and associations may vary by tumor subtypes and race/ethnicity groups.

Methods

In a retrospective review, we identified 273 women with invasive BC administered Adriamycin/Taxane-based neoadjuvant chemotherapy from 2004 to 2016 with body mass index (BMI) data at diagnosis. Obesity was defined as BMI ≥30. Associations between obesity and event-free survival (EFS), using STEEP events, and overall survival (OS), using all-cause mortality, were assessed overall and stratified by tumor subtype [[Hormone Receptor Positive (HR+)/HER2−, HER2+, and Triple-Negative Breast Cancer (TNBC])] in our diverse population.

Results

Median follow-up was 32.6 months (range 5.7–137.8 months). Overall, obesity was associated with worse EFS (HR 1.71, 95% CI 1.03–2.84, p = 0.04) and a trend towards worse OS (p = 0.13). In HR+/HER2− disease (n = 135), there was an interaction between obesity and hormonal therapy with respect to OS but not EFS. In those receiving tamoxifen (n = 33), obesity was associated with worse OS (HR 9.27, 95% CI 0.96–89.3, p = 0.05). In those receiving an aromatase inhibitor (n = 89), there was no association between obesity and OS. In TNBC (n = 44), obesity was associated with worse EFS (HR 2.62, 95% CI 1.03–6.66, p = 0.04) and a trend towards worse OS (p = 0.06). In HER2+ disease (n = 94), obesity was associated with a trend towards worse EFS (HR 3.37, 95% CI 0.97–11.72, p = 0.06) but not OS. Race/ethnicity was not associated with survival in any subtype, and there were no interactions with obesity on survival.

Conclusions

Obesity may negatively impact survival, with differences among tumor subtypes.

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Abbreviations

BMI:

Body mass index

NAC:

Neoadjuvant chemotherapy

HR+:

Hormone receptor positive

TNBC:

Triple-negative breast cancer

pCR:

Pathologic complete response

EFS:

Event-free survival

OS:

Overall survival

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Funding

This study was funded by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number KL2 TR000081.

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Authors and Affiliations

  1. Department of Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA

    Ying L. Liu

  2. Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA

    Anurag Saraf, Benjamin Catanese & Eileen P. Connolly

  3. Department of Biostatistics, Columbia University School of Medicine, New York, NY, USA

    Shing M. Lee & Yuan Zhang

  4. Department of Medical Oncology, New York Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Ave, Rm 10-1071, New York, NY, 10032, USA

    Kevin Kalinsky

Authors
  1. Ying L. Liu
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  2. Anurag Saraf
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  4. Shing M. Lee
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  5. Yuan Zhang
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  6. Eileen P. Connolly
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  7. Kevin Kalinsky
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Corresponding author

Correspondence to Kevin Kalinsky.

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Conflict of interest

Author EC has received funding from Merck and has served as a consultant for Eisai. Author KK has served as a consultant for Lilly, Biotheranostics, Amgen, Eisai, and Novartis. All other authors have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Liu, Y.L., Saraf, A., Catanese, B. et al. Obesity and survival in the neoadjuvant breast cancer setting: role of tumor subtype in an ethnically diverse population. Breast Cancer Res Treat 167, 277–288 (2018). https://doi.org/10.1007/s10549-017-4507-y

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  • DOI: https://doi.org/10.1007/s10549-017-4507-y

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