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. 2018 Jan;167(1):277-288.
doi: 10.1007/s10549-017-4507-y. Epub 2017 Sep 25.

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

Ying L Liu  1 , Anurag Saraf  2 , Benjamin Catanese  2 , Shing M Lee  3 , Yuan Zhang  3 , Eileen P Connolly  2 , Kevin Kalinsky  4
Affiliations

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

Ying L Liu et al. Breast Cancer Res Treat. 2018 Jan.

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.

Keywords: Breast cancer; Neoadjuvant chemotherapy; Obesity; Race/ethnicity; Survival; Tumor subtype.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1. Kaplan Meier Curves of Obesity with Event-free and Overall Survival
Overall, obesity is associated with worse event-free and a trend towards worse overall survival.
Figure 2
Figure 2. Kaplan-Meier Curves: Hormone Receptor Positive (HR+)/Her2− (Event-free and Overall survival): Stratified by Tamoxifen vs. Aromatase Inhibitor (AI) use
In HR+ women, there is a significant interaction between hormonal therapy and obesity with overall survival (OS), and in women receiving tamoxifen only, but not AIs, obesity is associated with significantly worse OS. There is no significant interaction with event-free survival, although effects are in the same direction.
Figure 3
Figure 3. Kaplan-Meier Curves (Event-free and Overall Survival) Triple Negative Breast Cancer (TNBC)
In TNBC, obesity is associated with worse event-free survival and a trend towards worse overall survival.
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