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Review
. 2021 Sep 10;7(1):119.
doi: 10.1038/s41523-021-00325-6.

Overweight and prognosis in triple-negative breast cancer patients: a systematic review and meta-analysis

Sixten Harborg  1   2 , Robert Zachariae  3   4 , Julia Olsen  3 , Maja Johannsen  4 , Deirdre Cronin-Fenton  5 , Henrik Bøggild  6 , Signe Borgquist  3   7
Affiliations
Review

Overweight and prognosis in triple-negative breast cancer patients: a systematic review and meta-analysis

Sixten Harborg et al. NPJ Breast Cancer. .

Abstract

We conducted a systematic review and meta-analysis investigating the association between overweight and outcome in triple-negative breast cancer (TNBC) patients. We searched PubMed and Embase using variations of the search terms triple-negative breast cancer (population), overweight and/or obesity (exposure), and prognosis (outcome). Based on the World Health Organization guidelines for defining overweight, we included longitudinal observational studies, which utilized survival statistics with hazard ratios (HRs) in our analysis. The included studies measured body mass index at the time of diagnosis of TNBC and reported disease-free survival and/or overall survival. Study quality was assessed with the Newcastle-Ottawa Scale and study data were extracted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist, independently by two authors. Random-effects models were used to combine the effect sizes (HRs), and the results were evaluated and adjusted for possible publication bias. Thirteen studies of 8,944 TNBC patients were included. The meta-analysis showed that overweight was associated with both shorter disease-free survival (HR = 1.26; 95%CI: 1.09-1.46) and shorter overall survival (HR = 1.29; 95%CI: 1.11c1.51) compared to normal-weight. Additionally, our Bayesian meta-analyses suggest that overweight individuals are 7.4 and 9.9 times more likely to have shorter disease-free survival and overall survival, respectively. In conclusion, the available data suggest that overweight is associated with shorter disease-free and overall survival among TNBC patients. The results should be interpreted with caution due to possible publication bias.

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Conflict of interest statement

S.B. has received travel and accommodations expenses and speaker´s fee from Pfizer and Roche. None of this had any role in the design, data collection, analysis, or preparation of the manuscript. R.Z. own stocks in and have received lecture fees from Novo Nordisk. All remaining authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1. PRISMA Flow Diagram of selected studies.
* PRSIMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Fig. 2
Fig. 2. Meta-analysis of observational studies comparing disease-free survival in overweight and normal-weight.
* Disease-free survival was defined as time from breast cancer diagnosis to first breast cancer event or death.
Fig. 3
Fig. 3. Meta-analysis of observational studies comparing overall survival in overweight and normal-weight.
* Overall survival was defined as time from breast cancer diagnosis to death of any cause.
Fig. 4
Fig. 4. Funnel plot assessing the presence of publication bias in the disease-free survival analyses.
* The Duval and Tweedie trim-and-fill method was used to adjust for publication bias.
Fig. 5
Fig. 5. Funnel plot assessing the presence of publication bias in the overall survival analyses.
* The Duval and Tweedie trim-and-fill method was used to adjust for publication bias.
See this image and copyright information in PMC

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