Effect of Obesity on Prognosis After Early-Stage Breast Cancer

Department of Oncology, Odense University Hospital, Sdr Blvd 29, DK-5000 Odense, Denmark.
Journal of Clinical Oncology (Impact Factor: 17.88). 01/2011; 29(1):25-31. DOI: 10.1200/JCO.2010.29.7614
Source: PubMed

ABSTRACT This study was performed to characterize the impact of obesity on the risk of breast cancer recurrence and death as a result of breast cancer or other causes in relation to adjuvant treatment.
Information on body mass index (BMI) at diagnosis was available for 18,967 (35%) of 53,816 women treated for early-stage breast cancer in Denmark between 1977 and 2006 with complete follow-up for first events (locoregional recurrences and distant metastases) up to 10 years and for death up to 30 years. Information was available on prognostic factors and adjuvant treatment for all patients. Univariate analyses were used to compare the associations of known prognostic factors and risks of recurrence or death according to BMI categories. Cox proportional hazards regression models were used to assess the influence of BMI after adjusting for other factors.
Patients with a BMI of 30 kg/m(2) or more were older and had more advanced disease at diagnosis compared with patients with a BMI below 25 kg/m(2) (P < .001). When data were adjusted for disease characteristics, the risk of developing distant metastases after 10 years was significantly increased by 46%, and the risk of dying as a result of breast cancer after 30 years was significantly increased by 38% for patients with a BMI of 30 kg/m(2) or more. BMI had no influence on the risk of locoregional recurrences. Both chemotherapy and endocrine therapy seemed to be less effective after 10 or more years for patients with BMIs greater than 30 kg/m(2).
Obesity is an independent prognostic factor for developing distant metastases and for death as a result of breast cancer; the effects of adjuvant therapy seem to be lost more rapidly in patients with breast cancer and obesity.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The aim of this study was to determine whether a higher body mass index (BMI) in penile cancer patients is associated with more advanced penile cancer stage at the time of treatment and cancer survival. Methods: We evaluated 433 penile cancer patients treated between 2006 and 2012 at our institute and recorded American Joint Committee on Cancer (AJCC) stage, BMI, circumcision, smoking and age. A proportional odds model was used to assess a possible association between BMI and AJCC stage at diagnosis and controlled for circumcision, smoking and age. Five-year disease-specific survival was calculated using the Kaplan-Meier method, with the log-rank test assessing equality of distributions. Results: 433 patients with a mean BMI of 26.8 kg/m(2) were analyzed. No statistically significant association between BMI and AJCC stage was found (odds ratio 1.01 per 1 kg/m(2) increase in BMI, 95% confidence interval 0.97-1.05, p = 0.63). Differences in disease-specific survival were not observed based on the different BMI classes. Conclusions: No association between BMI of penile cancer patients and their disease stage at the time of treatment was observed. Thus, BMI at penile cancer treatment does not affect prognosis. © 2015 S. Karger AG, Basel.
    Urologia Internationalis 01/2015; DOI:10.1159/000367927 · 1.15 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Invasive breast cancers are now commonly classified using gene expression into biologically and clinically distinct tumor subtypes. However, the role of obesity in breast tumor gene expression and intrinsic subtype is unknown. Methods Early-stage breast cancer (BC) patients (n = 1,676) were sampled from two prospective cohorts. The PAM50 qRT-PCR assay was used to: a) assess tumor gene expression levels for ESR1, PGR, ERBB2, and 10 proliferation genes and b) classify tumors into intrinsic subtype (Luminal A, Luminal B, Basal-like, HER2-enriched, Normal-like). Body mass index (BMI) around BC diagnosis (kg/m2) was categorized as: underweight (<18.5), normal (18.5-24), overweight (25–29), mildly obese (30–34), and highly obese (≥35). In a cross-sectional analysis, we evaluated associations of BMI with gene expression using linear regression models, and associations of BMI with non-Luminal A intrinsic subtypes, compared with Luminal A subtype, using multinomial logistic regression. Statistical significance tests were two-sided. Results Highly obese women had tumors with higher expression of proliferation genes compared with normal weight women (adjusted mean difference = 0.44; 95% CI: 0.18, 0.71), yet mildly obese (adjusted mean difference = 0.16; 95% CI: −0.06, 0.38) and overweight (adjusted mean difference = 0.18; 95% CI: −0.01, 0.36) women did not. This association was stronger in postmenopausal women (p for interaction = 0.06). Being highly obese, however, was inversely associated with ESR1 expression (adjusted mean difference = −0.95; 95% CI: −1.47, −0.42) compared with being normal weight, whereas being mildly obese and overweight were not. In addition, women with Basal-like and Luminal B subtypes, relative to those with Luminal A subtype, were more likely to be highly obese, compared with normal-weight. Conclusions ER expression may not increase correspondingly with increasing degree of obesity. Highly obese patients are more likely to have tumor subtypes associated with high proliferation and poorer prognosis. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1263-4) contains supplementary material, which is available to authorized users.
    BMC Cancer 12/2015; 15(1). DOI:10.1186/s12885-015-1263-4 · 3.32 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is limited knowledge about the biological basis of racial/ethnic disparities in breast cancer outcomes. Aberrations in IGF signaling induced by obesity and other factors may contribute to these disparities. This study examines the expression profiles of the insulin-like growth factor (IGF)-axis proteins and the association with breast cancer survival across a multiethnic population. We examined the expression profiles of the IGF1, IGF1R, IGFBP2 (IGF-binding proteins), and IGFBP3 proteins in breast tumor tissue and their relationships with all-cause and breast cancer-specific survival up to 17 years postdiagnosis in a multiethnic series of 358 patients in Hawaii, USA. Native Hawaiians, Caucasians, and Japanese were compared. Covariates included demographic and clinical factors and ER/PR/HER2 (estrogen receptor/progesterone receptor/human epidermal growth factor receptor-2) status. In Native Hawaiian patients, IGFBP2 and IGFBP3 expression were each independently associated with overall and breast cancer mortality (IGFB2: HRmort = 10.96, 95% CI: 2.18–55.19 and HRmort = 35.75, 95% CI: 3.64–350.95, respectively; IGFBP3: HRmort = 5.16, 95% CI: 1.27–20.94 and HRmort = 8.60, 95% CI: 1.84–40.15, respectively). IGF1R expression was also positively associated with all-cause mortality in Native Hawaiians. No association of IGF-axis protein expression and survival was observed in Japanese or Caucasian patients. The interaction of race/ethnicity and IGFBP3 expression on mortality risk was significant. IGF-axis proteins may have variable influence on breast cancer progression across different racial/ethnic groups. Expression of binding proteins and receptors in breast tumors may influence survival in breast cancer patients by inducing aberrations in IGF signaling and/or through IGF-independent mechanisms. Additional studies to evaluate the role of the IGF-axis in breast cancer are critical to improve targeted breast cancer treatment strategies.
    Cancer Medicine 12/2014; DOI:10.1002/cam4.375