Obesity and survival in operable breast cancer patients treated with adjuvant anthracyclines and taxanes according to pathological subtypes: a pooled analysisReport as inadecuate

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Breast Cancer Research

, 15:R105

First Online: 06 November 2013Received: 27 March 2013Accepted: 16 October 2013DOI: 10.1186-bcr3572

Cite this article as: Pajares, B., Pollán, M., Martín, M. et al. Breast Cancer Res 2013 15: R105. doi:10.1186-bcr3572


IntroductionObesity is an unfavorable prognostic factor in breast cancer BC patients regardless of menopausal status and treatment received. However, the association between obesity and survival outcome by pathological subtype requires further clarification.

MethodsWe performed a retrospective analysis including 5,683 operable BC patients enrolled in four randomized clinical trials GEICAM-9906, GEICAM-9805, GEICAM-2003–02, and BCIRG 001 evaluating anthracyclines and taxanes as adjuvant treatments. Our primary aim was to assess the prognostic effect of body mass index BMI on disease recurrence, breast cancer mortality BCM, and overall mortality OM. A secondary aim was to detect differences of such prognostic effects by subtype.

ResultsMultivariate survival analyses adjusting for age, tumor size, nodal status, menopausal status, surgery type, histological grade, hormone receptor status, human epidermal growth factor receptor 2 HER2 status, chemotherapy regimen, and under-treatment showed that obese patients BMI 30.0 to 34.9 had similar prognoses to that of patients with a BMI < 25 reference group in terms of recurrence Hazard Ratio HR = 1.08, 95% Confidence Interval CI = 0.90 to 1.30, BCM HR = 1.02, 0.81 to 1.29, and OM HR = 0.97, 0.78 to 1.19. Patients with severe obesity BMI ≥ 35 had a significantly increased risk of recurrence HR = 1.26, 1.00 to 1.59, P = 0.048, BCM HR = 1.32, 1.00 to 1.74, P = 0.050, and OM HR = 1.35, 1.06 to 1.71, P = 0.016 compared to our reference group. The prognostic effect of severe obesity did not vary by subtype.

ConclusionsSeverely obese patients treated with anthracyclines and taxanes present a worse prognosis regarding recurrence, BCM, and OM than patients with BMI < 25. The magnitude of the harmful effect of BMI on survival-related outcomes was similar across subtypes.

AbbreviationsBCBreast cancer

BCIRGBreast Cancer International Research Group

BCMBreast cancer mortality

BMIBody mass index

CMFCyclophosphamide, methotrexate, fluorouracil


EREstrogen receptor

FACFluorouracil, doxorubicin, cyclophosphamide

FECFluorouracil, epirubicin, and cyclophosphamide

GEICAMSpanish Breast Cancer Research Group

HER2Human epidermal growth factor-2

HRHazard ratio

OMOverall mortality

PRProgesterone receptor

RCTRandomized controlled trial


TACDocetaxel, doxorubicin, cyclophosphamide

TNFTumor necrosis factor.

Electronic supplementary materialThe online version of this article doi:10.1186-bcr3572 contains supplementary material, which is available to authorized users.

Bella Pajares, Marina Pollán contributed equally to this work.

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Author: Bella Pajares - Marina Pollán - Miguel Martín - John R Mackey - Ana Lluch - Joaquín Gavila - Charles Vogel - Manuel Ru

Source: https://link.springer.com/

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