Publication
The influence of obesity on survival in early, high-risk breast cancer: results from the randomized SUCCESS A trial
Journal Paper/Review - Sep 18, 2015
Widschwendter Peter, Jueckstock Julia, Neugebauer Julia, Trapp Elisabeth, Fasching Peter A, Beckmann Matthias W, Schneeweiss Andreas, Schrader Ines, Rack Brigitte, Janni Wolfgang, Andergassen Ulrich, Kost Bernd, Friedl Thomas Wp, Schwentner Lukas, DeGregorio Nikolaus, Jaeger Bernadette, Schramm Amelie, Bekes Inga, Deniz Miriam, Lato Krisztian, Weissenbacher Tobias, Scholz Christoph
Units
PubMed
Doi
Citation
Type
Journal
Publication Date
Issn Electronic
Pages
Brief description/objective
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.