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Clinical Trial
. 2015 Sep 18;17(1):129.
doi: 10.1186/s13058-015-0639-3.

The influence of obesity on survival in early, high-risk breast cancer: results from the randomized SUCCESS A trial

Peter Widschwendter  1 , Thomas Wp Friedl  2 , Lukas Schwentner  3 , Nikolaus DeGregorio  4 , Bernadette Jaeger  5 , Amelie Schramm  6 , Inga Bekes  7 , Miriam Deniz  8 , Krisztian Lato  9 , Tobias Weissenbacher  10 , Bernd Kost  11 , Ulrich Andergassen  12 , Julia Jueckstock  13 , Julia Neugebauer  14 , Elisabeth Trapp  15 , Peter A Fasching  16 , Matthias W Beckmann  17 , Andreas Schneeweiss  18 , Ines Schrader  19 , Brigitte Rack  20 , Wolfgang Janni  21 , Christoph Scholz  22
Affiliations
Clinical Trial

The influence of obesity on survival in early, high-risk breast cancer: results from the randomized SUCCESS A trial

Peter Widschwendter et al. Breast Cancer Res. .

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.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier plot of overall survival according to body mass index (BMI) group (underweight/normal: BMI < 25.0 kg/m2; overweight: BMI 25.0–29.9 kg/m2; slightly obese: BMI 30.0–34.9 kg/m2; moderately obese: BMI 35.0–39.9 kg/m2; severely obese: BMI ≥ 40.0 kg/m2)
Fig. 2
Fig. 2
Kaplan–Meier plot of disease-free survival according to body mass index (BMI) group (underweight/normal: BMI < 25.0 kg/m2; overweight: BMI 25.0–29.9 kg/m2; slightly obese: BMI 30.0–34.9 kg/m2; moderately obese: BMI 35.0–39.9 kg/m2; severely obese: BMI ≥ 40.0 kg/m2)
Fig. 3
Fig. 3
Kaplan–Meier plots of overall survival according to body mass index (BMI) group (underweight/normal, overweight, slightly obese, moderately obese, severely obese) in patients with tumor subtypes luminal A like (a), luminal B like (b), human epidermal growth factor receptor 2 (HER2) positive (c), and triple negative (d)
Fig. 4
Fig. 4
Kaplan–Meier plots of disease-free survival according to body mass index (BMI) group (underweight/normal, overweight, slightly obese, moderately obese, severely obese) in patients with tumor subtypes luminal A like (a), luminal B like (b), human epidermal growth factor receptor 2 (HER2) positive (c), and triple negative (d)
See this image and copyright information in PMC

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