Obesity is associated with early recurrence on breast cancer patients that achieved pathological complete response to neoadjuvant chemotherapy

Abstract

Pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) is associated with good long-term prognosis in breast cancer (BC) patients. However, some patients still recur and eventually die from this disease. For years, clinical stage at diagnosis has been consistently linked to recurrence and survival in the pCR setting. Herein, we aimed to identify other potential predictors of recurrence and survival in patients that achieved pCR. We performed a retrospective analysis of patients diagnosed between 2011 and 2020 in our center. We calculated overall survival (OS), invasive disease-free survival (IDFS), distant disease-free survival (DDFS), and BC-specific survival (BCSS). Among the 241 patients included into our study 36% were obese (Body Mass Index (BMI) > 29.9 kg/m²) and 47% were stage III. Multivariate analysis confirmed that obesity was a significant risk factor associated with early recurrence and poorer survival in these patients. In summary, obesity and clinical stage predict early recurrence and poorer survival in patients that achieved pCR after NCT. Pending further investigation and based on our findings we speculate that weight management could be beneficial for this subset of patients. To our knowledge, this is the first Latin American report linking obesity and recurrence within this setting.

Figure 1

Stage at diagnosis and BMI status affect survival rates in patients that achieved pathological complete response after neoadjuvant chemotherapy. (A) Overall survival (OS) curves comparing stage I/II versus stage III (LogRank p = 0.0019). (B) OS curves comparing non-obese versus obese (LogRank p = 0.0024). (C) Breast cancer specific survival (BCSS) curves comparing stage I/II versus stage III (LogRank p = 0.0027). (D) BCSS curves comparing non-obese versus obese (LogRank p = 0.037). E. Distant disease-free survival (DDFS) curves comparing stage I/II versus stage III (LogRank p = 0.0015). (F) DDFS curves comparing non-obese versus obese (LogRank p = 0.045). (G) Invasive-disease free survival (IDFS) curves comparing stage I/II versus stage III (LogRank p = 0.0018). (H) IDFS curves comparing non-obese versus obese (LogRank p = 0.019).

Figure 2

Obesity is associated with poorer survival in stage III patients. (A) OS curves comparing non-obese versus obese (LogRank p = 0.0041). (B) BCSS curves comparing non-obese versus obese (LogRank p = 0.018). (C) DDFS curves comparing non-obese versus obese (LogRank p = 0.064). (D) IDFS curves comparing non-obese versus obese (LogRank p = 0.043).