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Scarabosio A, Contessi Negrini F, Pisano G, Beorchia Y, Castriotta L, De Francesco F, Riccio M, Parodi PC, Zingaretti N. Prepectoral Direct-To-Implant One-Stage Reconstruction With ADMs: Safety and Outcome in "Thin Patients". Clin Breast Cancer 2023; 23:e507-e514. [PMID: 37735018 DOI: 10.1016/j.clbc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Prepectoral direct-to-implant reconstruction with acellular dermal matrix (ADM) represents a safe, fast, and successful option in breast reconstruction in a selected cohort of patients. Nowadays, this procedure is considered challenging in thin. Meanwhile, his cohort has not been accurately analyzed yet. METHODS A single institution retrospective cohort study was performed between January 2019 and March 2023 in all women who underwent mastectomy. Biometrical and clinical data were recorded. Also, surgical technique, operating room (OR) time, mastectomy weights, implant choice, and acellular dermal matrix (ADM) types were properly noted. Postoperative complications represented the main topic: these were classified into early and late ones based on onset time. At least 12-month follow-up was required. A comparison between thin and ideal body mass index (BMI) populations was performed. RESULTS Early complications did not seem to differ between the 2 groups with 37.8% and 38.9% of women having at least 1 early complication in thin and ideal-weight women, respectively (P = .919). In univariable regression analysis, compared with women with a BMI of 22.1 to 25.0, women with a BMI ≤ 22.0 were associated with an increased risk of late complications of 2.84 (1.13-7.14). Specifically, thin women appeared to have a 3-fold increased risk (OR = 2.97, 95% CI 1.08-8.18) of ripples/wrinkles compared with women with ideal weight. CONCLUSIONS Prepectoral reconstruction with ADM in thin patients may be considered as safe as in standard BMI patients. Rippling may be more frequent, but, whenever needed, easy to correct with a few sessions of lipo-grafts. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anna Scarabosio
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Filippo Contessi Negrini
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Gaetano Pisano
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Yvonne Beorchia
- Institute of Hygiene and Evaluative Epidemiology, Friuli Centrale University Health Authority, Udine, Italy
| | - Luigi Castriotta
- Institute of Hygiene and Evaluative Epidemiology, Friuli Centrale University Health Authority, Udine, Italy
| | - Francesco De Francesco
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
| | - Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy.
| | - Nicola Zingaretti
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
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Lipsyc-Sharf M, Ballman KV, Campbell JD, Muss HB, Perez EA, Shulman LN, Carey LA, Partridge AH, Warner ET. Age, Body Mass Index, Tumor Subtype, and Racial and Ethnic Disparities in Breast Cancer Survival. JAMA Netw Open 2023; 6:e2339584. [PMID: 37878313 PMCID: PMC10600583 DOI: 10.1001/jamanetworkopen.2023.39584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/11/2023] [Indexed: 10/26/2023] Open
Abstract
Importance Black women in the United States have higher breast cancer (BC) mortality rates than White women. The combined role of multiple factors, including body mass index (BMI), age, and tumor subtype, remains unclear. Objective To assess the association of race and ethnicity with survival among clinical trial participants with early-stage BC (eBC) according to tumor subtype, age, and BMI. Design, Setting, and Participants This cohort study analyzed survival data, as of November 12, 2021, from participants enrolled between 1997 and 2010 in 4 randomized adjuvant chemotherapy trials: Cancer and Leukemia Group B (CALGB) 9741, 49907, and 40101 as well as North Central Cancer Treatment Group (NCCTG) N9831, legacy groups of the Alliance of Clinical Trials in Oncology. Median follow-up was 9.8 years. Exposures Non-Hispanic Black and Hispanic participants were compared with non-Hispanic White participants within subgroups of subtype (hormone receptor positive [HR+]/ERBB2 [formerly HER2] negative [ERBB2-], ERBB2+, and HR-/ERBB2-), age (<50, 50 to <65, and ≥65 years), and BMI (<18.5, 18.5 to <25.0, 25.0 to <30.0, and ≥30.0). Main Outcomes and Measures Recurrence-free survival (RFS) and overall survival (OS). Results Of 9479 participants, 436 (4.4%) were Hispanic, 871 (8.8%) non-Hispanic Black, and 7889 (79.5%) non-Hispanic White. The median (range) age was 52 (19.0-89.7) years. Among participants with HR+/ERBB2- tumors, non-Hispanic Black individuals had worse RFS (hazard ratio [HR], 1.49; 95% CI, 1.04-2.12; 5-year RFS, 88.5% vs 93.2%) than non-Hispanic White individuals, although the global test for association of race and ethnicity with RFS was not significant within any tumor subtype. There were no OS differences by race and ethnicity in any subtype. Race and ethnicity were associated with OS in young participants (age <50 years; global P = .008); young non-Hispanic Black participants (HR, 1.34; 95% CI, 1.04-1.71; 5-year OS, 86.6% vs 92.0%) and Hispanic participants (HR, 1.62; 95% CI, 1.16-2.29; 5-year OS, 86.2% vs 92.0%) had worse OS than young non-Hispanic White participants. Race and ethnicity were associated with RFS in participants with BMIs of 25 to less than 30, with non-Hispanic Black participants having worse RFS (HR, 1.81; 95% CI, 1.23-2.68; 5-year RFS, 83.2% vs 87.3%) than non-Hispanic White participants. Conclusions and Relevance In this cohort study, racial and ethnic survival disparities were identified in patients with eBC receiving standardized initial care, and potentially at-risk subgroups, for whom focused interventions may improve outcomes, were found.
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Affiliation(s)
- Marla Lipsyc-Sharf
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- David Geffen School of Medicine at UCLA/Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Karla V. Ballman
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Jordan D. Campbell
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Hyman B. Muss
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
| | | | | | - Lisa A. Carey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Erica T. Warner
- Clinical Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston
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Chan DS, Vieira R, Abar L, Aune D, Balducci K, Cariolou M, Greenwood DC, Markozannes G, Nanu N, Becerra‐Tomás N, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:572-599. [PMID: 36279884 PMCID: PMC10092239 DOI: 10.1002/ijc.34322] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/29/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.
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Affiliation(s)
- Doris S.M. Chan
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Katia Balducci
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Margarita Cariolou
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Nutrition, Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
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Pang Y, Wei Y, Kartsonaki C. Associations of adiposity and weight change with recurrence and survival in breast cancer patients: a systematic review and meta-analysis. Breast Cancer 2022; 29:575-588. [PMID: 35579841 PMCID: PMC9226105 DOI: 10.1007/s12282-022-01355-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adiposity and weight change among patients with breast cancer are associated with mortality, but there is limited evidence on the associations with distant recurrence or other causes of death or on central adiposity. Moreover, the relationship with breast cancer subtypes and by menopause status is unclear. METHODS We conducted a systematic review and meta-analysis of prospective studies of breast cancer patients investigating the associations of general and central adiposity (body mass index [BMI] and waist circumference [WC], respectively), before and after diagnosis, and weight change, with all-cause mortality, breast cancer-specific mortality (BCSM), and recurrence. RESULTS 173 studies (519,544 patients, 60,249 deaths overall, and 25,751 breast cancer deaths) were included. For BMI < 1 year post diagnosis, compared with normal weight women, the summary relative risk (RR) for obese women was 1.21 (1.15-1.27) for all-cause mortality, 1.22 (1.13-1.32) for BCSM, 1.12 (1.06-1.18) for recurrence, and 1.19 (1.11-1.28) for distant recurrence. Obesity was associated with all-cause mortality and BCSM in patients with ER+ or HER2+ tumors, whereas no clear association was observed in patients with triple-negative tumors. Similar associations were observed by menopausal status. Stronger associations were observed in East Asians than Europeans. Central adiposity was associated with all-cause mortality, while large weight gain was associated with all-cause mortality, BCSM, and recurrence. CONCLUSION Higher adiposity is associated with all-cause mortality, BCSM, recurrence, and distant recurrence in breast cancer patients, with similar associations by menopausal status and some evidence of heterogeneity by subtypes. Weight gain is also associated with recurrence and survival among breast cancer patients.
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Affiliation(s)
- Yuanjie Pang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Yuxia Wei
- Institute of Environmental Medicine, Karolinska Institutet, C6 Institutet för miljömedicin, 17177, Stockholm, Sweden
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Roosevelt Drive, Oxford, UK.
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, Oxford, OX3 7LF, UK.
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Grandal B, Aljehani A, Dumas E, Daoud E, Jochum F, Gougis P, Hotton J, Lemoine A, Michel S, Laas E, Laé M, Pierga JY, Alaoui Ismaili K, Lerebours F, Reyal F, Hamy AS. No Impact of Seasonality of Diagnoses on Baseline Tumor Immune Infiltration, Response to Treatment, and Prognosis in BC Patients Treated with NAC. Cancers (Basel) 2022; 14:cancers14133080. [PMID: 35804852 PMCID: PMC9264787 DOI: 10.3390/cancers14133080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary High tumor-infiltrating lymphocyte (TIL) levels are associated with an increased response to neoadjuvant chemotherapy (NAC) in breast cancer (BC). The seasonal fluctuation of TILs in breast cancer is poorly documented. In this study, we compared pre- and post-treatment immune infiltration, the treatment response as assessed by means of pathological complete response (pCR) rates, and survival according to the seasonality of BC diagnoses in a clinical cohort of patients treated with NAC. We found no association between seasonality and baseline TIL levels or pCR rates. We found that post-NAC stromal lymphocyte infiltration was lower when cancer was diagnosed in the summer, especially in the subgroup of patients with TNBC. Our data do not support the hypothesis that the seasonality of diagnoses has a major impact on the natural history of BC treated with NAC. Abstract Breast cancer (BC) is the most common cancer in women worldwide. Neoadjuvant chemotherapy (NAC) makes it possible to monitor in vivo response to treatment. Several studies have investigated the impact of the seasons on the incidence and detection of BC, on tumor composition, and on the prognosis of BC. However, no evidence is available on their association with immune infiltration and the response to treatment. The objective of this study was to analyze pre- and post-NAC immune infiltration as assessed by TIL levels, the response to treatment as assessed by pathological complete response (pCR) rates, and oncological outcomes as assessed by relapse-free survival (RFS) or overall survival (OS) according to the seasonality of BC diagnoses in a clinical cohort of patients treated with neoadjuvant chemotherapy. Out of 1199 patients, the repartition of the season at BC diagnosis showed that 27.2% were diagnosed in fall, 25.4% in winter, 24% in spring, and 23.4% in summer. Baseline patient and tumor characteristics, including notable pre-NAC TIL levels, were not significantly different in terms of the season of BC diagnosis. Similarly, the pCR rates were not different. No association for oncological outcome was identified. Our data do not support the idea that the seasonality of diagnoses has a major impact on the natural history of BC treated with NAC.
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Affiliation(s)
- Beatriz Grandal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.D.); (E.D.); (F.J.); (P.G.); (S.M.); (E.L.); (A.S.H.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France;
| | - Ashwaq Aljehani
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France;
- Department of Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11564, Saudi Arabia
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.D.); (E.D.); (F.J.); (P.G.); (S.M.); (E.L.); (A.S.H.)
| | - Eric Daoud
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.D.); (E.D.); (F.J.); (P.G.); (S.M.); (E.L.); (A.S.H.)
| | - Floriane Jochum
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.D.); (E.D.); (F.J.); (P.G.); (S.M.); (E.L.); (A.S.H.)
| | - Paul Gougis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.D.); (E.D.); (F.J.); (P.G.); (S.M.); (E.L.); (A.S.H.)
| | - Judicaël Hotton
- Department of Surgical Oncology, Institut Godinot, Université de Lorraine, 51100 Reims, France;
| | - Amélie Lemoine
- Department of Medical Oncology, Institut Godinot, Université de Lorraine, 51100 Reims, France;
| | - Sophie Michel
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.D.); (E.D.); (F.J.); (P.G.); (S.M.); (E.L.); (A.S.H.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France;
| | - Enora Laas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.D.); (E.D.); (F.J.); (P.G.); (S.M.); (E.L.); (A.S.H.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France;
| | - Marick Laé
- Henri Becquerel Cancer Center, Department of Pathology, INSERM U1245, UniRouen Normandy University, 76130 Rouen, France;
- Department of Pathology, Institut Curie, University Paris, 75231 Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, University Paris, 75231 Paris, France; (J.-Y.P.); (K.A.I.); (F.L.)
| | - Khaoula Alaoui Ismaili
- Department of Medical Oncology, Institut Curie, University Paris, 75231 Paris, France; (J.-Y.P.); (K.A.I.); (F.L.)
| | - Florence Lerebours
- Department of Medical Oncology, Institut Curie, University Paris, 75231 Paris, France; (J.-Y.P.); (K.A.I.); (F.L.)
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.D.); (E.D.); (F.J.); (P.G.); (S.M.); (E.L.); (A.S.H.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France;
- Correspondence: ; Tel.: +33-144-324-660 or +33-615-271-980
| | - Anne Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (B.G.); (E.D.); (E.D.); (F.J.); (P.G.); (S.M.); (E.L.); (A.S.H.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France;
- Department of Medical Oncology, Institut Curie, University Paris, 75231 Paris, France; (J.-Y.P.); (K.A.I.); (F.L.)
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Evidence-based tailored nutrition educational intervention improves adherence to dietary guidelines, anthropometric measures and serum metabolic biomarkers in early-stage breast cancer patients: A prospective interventional study. Breast 2021; 60:6-14. [PMID: 34454324 PMCID: PMC8399332 DOI: 10.1016/j.breast.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The impact of the adherence to dietary guidelines of early-stage breast cancer (EBC) patients on body composition changes during treatment is not entirely defined. This study aimed to evaluate the role of an evidence-based nutrition educational intervention, according to adherence to dietary guidelines, in EBC patients. METHODS This prospective study included EBC patients, candidates for neoadjuvant/adjuvant therapy. Patients received an evidence-based tailored nutrition educational intervention. The adherence to dietary guidelines, anthropometric and dietary assessments, and blood glucose and lipid profile tests were evaluated at baseline and after a 12-months nutritional intervention. RESULTS Two hundred and forty-three patients were enrolled. At baseline, 38.3% and 23.9% of patients were overweight and obese, weight gain ≥5% (compared to 6-months before enrollment) and central obesity were observed in 47.3% and 52.7% of patients, respectively. Adherence to dietary guidelines was low (median Med-Diet score: 6 [IQR 4-8]). After the nutritional intervention (median follow-up: 22 months [range 12-45]), adherence to dietary guidelines significantly increased (median Med-Diet score: 12 [IQR 8-13]), p < 0.0001). High adherence to dietary guidelines (defines as Med-Diet score ≥10) significantly correlated with: 1) overall weight loss ≥5% (21.8% vs. 2.5%, p = 0.003); 2) median BMI drop (from 25.6 kg/m2 to 24.4 kg/m2, p = 0.003); 3) lower prevalence of central obesity (38.2% vs. 7.2%, p = 0.01); 4) improvement in blood glucose levels and lipid profile. CONCLUSION This study suggests that an evidence-based tailored nutrition educational intervention during treatment for EBC significantly increases overall adherence to dietary guidelines, and it improves both anthropometric measures and serum metabolic biomarkers in patients with high adherence.
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Kim SW, Chun M, Jung YS, Oh YT, Noh OK, Cho O. Impact of Body Mass Index on Local Recurrence according to Intrinsic Subtype Approximation in Korean Women with Early Stage Invasive Breast Cancer Receiving Contemporary Treatments. J Cancer 2021; 12:4648-4654. [PMID: 34149928 PMCID: PMC8210550 DOI: 10.7150/jca.59064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/19/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose: We investigated the prognostic impact of body mass index (BMI) on local recurrence (LR) according to intrinsic subtype in Korean women with early stage, invasive breast cancer. Materials and methods: We included 907 patients with pathological stage T1-2 and N0-1 breast cancer who underwent curative surgery between 2007 and 2012. Systemic treatments were administered in 876 patients (96.6%). In total, 701 patients (77.3%) received radiotherapy. Intrinsic subtypes were determined using immunohistochemical staining results. Results: During the median follow-up period of 72 months, LR as the first failure occurred in 29 patients, including 24 patients with isolated LR. The 5-year cumulative incidence rate of LR was 3.2% among all patients. In the luminal A subtype, a BMI of <18.5 kg/m2 was an independent risk factor for LR, as determined by a competing-risk regression model (relative risk, 3.33; p = 0.041). Severely obese patients (BMI >30 kg/m2) with the triple negative subtype had an increased risk of LR (relative risk, 3.81; p = 0.048). Conclusion: The present study identified traditionally underestimated risk groups for LR. BMI may diversely influence the rate of LR across intrinsic subtypes in Korean patients with breast cancer.
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Affiliation(s)
- Sang-Won Kim
- Department of Radiation Oncology, Konyang University College of Medicine, Daejeon, Republic of Korea.,Myunggok Medical Research Institute, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yong Sik Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Oyeon Cho
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
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Mejri N, El Benna H, Rachdi H, Labidi S, Benna M, Daoud N, Hamdi Y, Abdelhak S, Boussen H. Reproductive Risk Factors of Inflammatory Breast Cancer according to Luminal, HER2-Overexpressing, and Triple-Negative Subtypes: A Case Comparison Study. Oncol Res Treat 2020; 43:204-210. [DOI: 10.1159/000506691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 02/19/2020] [Indexed: 11/19/2022]
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9
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Chen B, Lai J, Guo L, Dai D, Chen R, Wei G, Liao N. Adverse effects of being underweight on young female breast cancer patients with lymph node metastases. J Cancer 2020; 11:1976-1984. [PMID: 32194809 PMCID: PMC7052872 DOI: 10.7150/jca.38567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/14/2019] [Indexed: 12/22/2022] Open
Abstract
Background: This study aimed to examine the effect of underweight in breast cancer. Methods: We performed a retrospective analysis of 3891 female patients diagnosed with primary breast cancer (I-IV stages). Body mass index (BMI) defined by World Health Organization criteria as follow: Underweight (UW; BMI<18.5 kg/m2), normal weight (NW; BMI =18.5-24.9 kg/m2) and overweight or obese (OW; BMI≥25 kg/m2). We performed to evaluate the association between low BMI and clinical outcome in different age (18-40 years and over 40 years) breast cancer. Results: In our study, about 7% patients suffer from being underweight and 25% patients suffer from being overweight. Underweight is more prominent in young age group. Although no relationship was found between the recurrence rate and being underweight (HR 1.467(95 % CI 0.940-2.291), P=0.092 for disease-free survival), multivariate regression analysis confirmed that low BMI was an independent overall survival (OS) prognostic factor in young patients (HR 1.610(95 % CI 1.028-2.523), P=0.037 for OS). Further analysis showed the prognostic significance of underweight only seen in young patients with axillary lymph node metastasis or III-IV stage patients. Conclusions: Our results demonstrate the prognostic importance of low BMI in young breast cancer patients (under 40 years old) with lymph node metastases. The role of low BMI in breast cancer might depend on patients' age and clinical stage.
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Affiliation(s)
- Bo Chen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jianguo Lai
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Liping Guo
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Danian Dai
- Department of Gynecology and Obstetrics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, China.,Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, China
| | - Rong Chen
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guangnan Wei
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ning Liao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Patel V, James M, Frampton C, Robinson B, Davey V, Timmings L. Body Mass Index and Outcomes in Breast Cancer Treated With Breast Conservation. Int J Radiat Oncol Biol Phys 2019; 106:369-376. [PMID: 31678226 DOI: 10.1016/j.ijrobp.2019.09.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Obesity is increasing in incidence in New Zealand. Maintaining locoregional control after breast cancer surgery is important, as this can improve overall survival. Although obesity has been associated with poorer survival in breast cancer, the correlation with locoregional control is less well evaluated and was the subject of this evaluation. METHODS AND MATERIALS We used the New Zealand breast cancer registry to identify patients treated with breast conservation with body mass index (BMI) recorded. We retrieved patient demographic, tumor characteristic, and treatment-related information. We assessed local and locoregional control outcomes in addition to breast cancer and overall survival outcomes. RESULTS Patients (2513) were identified. The median follow-up was 5.25 years. Of these patients, 38% were obese with a BMI of ≥30 kg/m2, 32% were overweight with a BMI of 25.0 to 29.9 kg/m2, and 29% were either normal or underweight with a BMI of ≤24.9 kg/m2. Most patients were postmenopausal (65%). The median tumor size was 16.0 mm (0.2-80 mm) and the majority were grade 2 or 3 tumors (45% and 33%). The majority (66%) were pathologically node negative and lymphovascular invasion was seen in 24%. There were 81% with estrogen receptor positivity and 358 (14.2%) were Her-2 positive. Local relapse free survival at 5 years was 91.5% (95% confidence interval [CI], 90.3-92.7) and at 10 years was 78.5% (95% CI, 75.9-81.1). Local relapse free rate at 5 years was 96.8% (95% CI, 96.0-97.6) and 10 years was 93.9% (95% CI, 92.5-95.3). We did not find BMI to be associated with local or locoregional relapse, disease free, breast cancer specific, or overall survival. CONCLUSIONS Obesity was not associated with inferior locoregional control or survival outcomes. This supports the practice of continuing to offer breast conserving treatment to women regardless of BMI.
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Affiliation(s)
- Vikash Patel
- Canterbury Regional Cancer and Blood Service, Christchurch Hospital, Christchurch, New Zealand, Radiation Oncology Department, Auckland City Hospital, Auckland, New Zealand.
| | - Melissa James
- Canterbury Regional Cancer and Blood Service, Christchurch Hospital, Christchurch, New Zealand, University of Otago Christchurch, Department of Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Chris Frampton
- University of Otago Christchurch, Department of Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Bridget Robinson
- Canterbury Regional Cancer and Blood Service, Christchurch Hospital, Christchurch, New Zealand, University of Otago Christchurch, Department of Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Valerie Davey
- Christchurch Breast Cancer Patient Register, Department of General Surgery, Christchurch, New Zealand
| | - Lucy Timmings
- University of Otago Christchurch, Department of Medicine, Christchurch Hospital, Christchurch, New Zealand
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11
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Ginzac A, Thivat É, Mouret-Reynier MA, Dubray-Longeras P, Van Praagh I, Passildas J, Abrial C, Kwiatkowski F, Boirie Y, Duclos M, Morio B, Gadea É, Durando X. Weight Evolution During Endocrine Therapy for Breast Cancer in Postmenopausal Patients: Effect of Initial Fat Mass Percentage and Previous Adjuvant Treatments. Clin Breast Cancer 2018; 18:e1093-e1102. [PMID: 30417829 DOI: 10.1016/j.clbc.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/11/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Weight changes during adjuvant treatment for early-stage breast cancer has been associated with a poor prognosis. The long-term evolution of body composition during adjuvant treatment for breast cancer, in particular, endocrine therapy, is not well known, and new data on this topic are required. The present study assessed the evolution of weight and body composition among 33 postmenopausal breast cancer patients receiving endocrine therapy after standard adjuvant chemotherapy that included taxanes. PATIENTS AND METHODS Dual-energy x-ray absorptiometry was used to measure the fat and lean body mass. Body water was assessed using multifrequency bioelectrical impedance analysis. The Hospital Anxiety and Depression questionnaire and the short version of the International Physical Activity Questionnaire were also administered. RESULTS During endocrine therapy, 5 of the 33 patients (15.2%) lost weight and 12 (36.4%) gained weight. The overall average gain was 2.0 ± 5.5 kg (P = .04). During this period, the fat mass, lean body mass, and body water increased. The factors linked to fat mass gain included an excess fat mass (≥ 36%) before treatment and weight loss during chemotherapy. In the overall period of adjuvant cancer treatment, 30% of the population gained > 5% of their initial weight. The average gain was the same as that during the endocrine therapy period (2.0 ± 5.4 kg; P = .031) and was characterized by an increase in total lean body mass, mainly localized in the trunk region. CONCLUSION Endocrine therapy appears as a pivotal period in weight and body composition management. Overfat and obese patients and those who lose weight during chemotherapy were more subject to weight and fat mass gain during endocrine therapy.
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Affiliation(s)
- Angeline Ginzac
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France.
| | - Émilie Thivat
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - Marie-Ange Mouret-Reynier
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | | | | | - Judith Passildas
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - Catherine Abrial
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - Fabrice Kwiatkowski
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - Yves Boirie
- Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1019, Unité de nutrition Humaine, Centre de Recherche en Nutrition Humaine Auvergne, Clermont-Ferrand, France
| | - Martine Duclos
- Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1019, Unité de nutrition Humaine, Centre de Recherche en Nutrition Humaine Auvergne, Clermont-Ferrand, France; CHU Clermont-Ferrand, Service de Médecine du Sport et des Explorations Fonctionnelles, Centre de Recherche en Nutrition Humaine, Institut National de la Recherche Agronomique, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Béatrice Morio
- Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1397, Laboratoire CarMeN, Université Lyon 1, Lyon, France
| | - Émilie Gadea
- Centre Hospitalier Emile Roux, le Puy en Velay, France
| | - Xavier Durando
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
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Vetterlein MW, Gild P, Kluth LA, Seisen T, Gierth M, Fritsche HM, Burger M, Protzel C, Hakenberg OW, von Landenberg N, Roghmann F, Noldus J, Nuhn P, Pycha A, Rink M, Chun FKH, May M, Fisch M, Aziz A. Peri-operative allogeneic blood transfusion does not adversely affect oncological outcomes after radical cystectomy for urinary bladder cancer: a propensity score-weighted European multicentre study. BJU Int 2017; 121:101-110. [DOI: 10.1111/bju.14012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Malte W. Vetterlein
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Philipp Gild
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Luis A. Kluth
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Thomas Seisen
- Department of Urology; Pitié-Salpêtrière Hospital; Pierre and Marie Curie University; Paris France
| | - Michael Gierth
- Department of Urology; Caritas St. Josef Medical Centre; University of Regensburg; Regensburg Germany
| | - Hans-Martin Fritsche
- Department of Urology; Caritas St. Josef Medical Centre; University of Regensburg; Regensburg Germany
| | - Maximilian Burger
- Department of Urology; Caritas St. Josef Medical Centre; University of Regensburg; Regensburg Germany
| | - Chris Protzel
- Department of Urology; University Medical Centre Rostock; Rostock Germany
| | | | | | - Florian Roghmann
- Department of Urology; Marien Hospital Herne; Ruhr-University Bochum; Herne Germany
| | - Joachim Noldus
- Department of Urology; Marien Hospital Herne; Ruhr-University Bochum; Herne Germany
| | - Philipp Nuhn
- Department of Urology; Mannheim Medical Centre; University of Heidelberg; Mannheim Germany
| | - Armin Pycha
- Department of Urology; Central Hospital of Bolzano; Bolzano Italy
- Centre for Urology and Nephrology; Faculty of Medicine; Sigmund Freud University Vienna, Vienna Austria
| | - Michael Rink
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Felix K.-H. Chun
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Matthias May
- Department of Urology; St. Elisabeth Medical Centre; Straubing Germany
| | - Margit Fisch
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Atiqullah Aziz
- Department of Urology; University Medical Centre Rostock; Rostock Germany
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Lee J, Hong BS, Ryu HS, Lee HB, Lee M, Park IA, Kim J, Han W, Noh DY, Moon HG. Transition into inflammatory cancer-associated adipocytes in breast cancer microenvironment requires microRNA regulatory mechanism. PLoS One 2017; 12:e0174126. [PMID: 28333977 PMCID: PMC5363867 DOI: 10.1371/journal.pone.0174126] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/05/2017] [Indexed: 01/25/2023] Open
Abstract
The role of adipocytes in cancer microenvironment has gained focus during the recent years. However, the characteristics of the cancer-associated adipocytes (CAA) in human breast cancer tissues and the underlying regulatory mechanism are not clearly understood. We reviewed pathology specimens of breast cancer patients to understand the morphologic characteristics of CAA, and profiled the mRNA and miRNA expression of CAA by using indirect co-culture system in vitro. The CAAs in human breast cancers showed heterogeneous topographic relationship with breast cancer cells within the breast microenvironment. The CAAs exhibited the characteristics of de-differentiation determined by their microscopic appearance and the expression levels of adipogenic markers. Additionally, the 3T3-L1 adipocytes indirectly co-cultured with breast cancer cells showed up-regulation of inflammation-related genes including Il6 and Ptx3. The up-regulation of IL6 in CAA was further observed in human breast cancer tissues. miRNA array of indirectly co-cultured 3T3-L1 cells showed increased expression of mmu-miR-5112 which may target Cpeb1. Cpeb1 is a negative regulator of Il6. The suppressive role of mmu-miR-5112 was confirmed by dual luciferase reporter assay, and mmu-miR-5112-treated adipocytes showed up-regulation of Il6. The transition of adipocytes into more inflammatory CAA resulted in proliferation-promoting effect in ER positive breast cancer cells such as MCF7 and ZR-75-1 but not in ER negative cells. In this study, we have determined the de-differentiated and inflammatory natures of CAA in breast cancer microenvironment. Additionally, we propose a miRNA-based regulatory mechanism underlying the process of acquiring inflammatory phenotypes in CAA.
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Affiliation(s)
- Jiwoo Lee
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
| | - Bok Sil Hong
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Han-Byoel Lee
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minju Lee
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
| | - In Ae Park
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jisun Kim
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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14
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Warren LEG, Ligibel JA, Chen YH, Truong L, Catalano PJ, Bellon JR. Body Mass Index and Locoregional Recurrence in Women with Early-Stage Breast Cancer. Ann Surg Oncol 2016; 23:3870-3879. [DOI: 10.1245/s10434-016-5437-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Indexed: 01/10/2023]
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Jeon YW, Kang SH, Park MH, Lim W, Cho SH, Suh YJ. Relationship between body mass index and the expression of hormone receptors or human epidermal growth factor receptor 2 with respect to breast cancer survival. BMC Cancer 2015; 15:865. [PMID: 26546331 PMCID: PMC4636815 DOI: 10.1186/s12885-015-1879-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/30/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The association between body mass index (BMI) at the time of breast cancer diagnosis and the prognosis of breast cancer patients remains controversial. Furthermore, the association between BMI and prognosis with respect to different breast cancer subtypes is not clearly defined. METHODS We analyzed data from 41,021 invasive breast cancer patients between January 1988 and February 2008 from the Korean Breast Cancer Registry (KBCR) database. Overall survival (OS) and breast cancer-specific survival (BCSS) were analyzed using the Kaplan-Meier method and Cox's proportional hazard regression model among all patients and specific breast cancer subtypes with respect to BMI categories. RESULTS A U-shaped association between BMI and mortality was observed in the total cohort. Underweight and obese individuals exhibited worse OS (hazard ratio, 1.23 [95 % confidence interval {CI}, 1.05 to 1.44] and 1.29 [1.13 to 1.48], respectively) and BCSS (1.26 [1.03 to 1.54] and 1.21 [1.02 to 1.43], respectively) than normal-weight individuals. In the estrogen receptor (ER) and/or progesterone receptor (PR)+/human epidermal growth factor receptor 2 (HER2) - subgroup, obese individuals exhibited worse OS (1.48 [1.18 to 1.85]) and BCSS (1.31 [1.13 to 1.52]) than normal-weight individuals. Conversely, in the ER and PR-/HER2+ subgroup, underweight individuals exhibited worse OS (1.68 [1.12 to 2.47]) and BCSS (1.79 [1.11 to 2.90]) than normal-weight individuals. CONCLUSIONS We observed a U-shaped relationship between BMI at diagnosis and poor OS and BCSS among all breast cancer patients. However, obesity in the ER and/or PR+/HER2- subgroup and underweight in the ER and PR-/HER2+ subgroup were poor prognostic factors. Therefore, BMI at diagnosis and breast cancer subtype should be considered simultaneously in various treatment decision processes and surveillance schedules.
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Affiliation(s)
- Ye Won Jeon
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University, 93 Joongboo-Daero Paldal-gu, Suwon, 442-723, Kyunggi-do, Republic of Korea.
| | - Su Hwan Kang
- Department of Surgery, Yeungnam University College of Medicine, 170 Hyunchung-ro, Nam-gu, Deagu, 705-703, Republic of Korea.
| | - Min Ho Park
- Department of Surgery, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 501-746, Republic of Korea.
| | - Woosung Lim
- Department of Surgery, Ewha Womans University, Mokdong hospital, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 158-710, Republic of Korea.
| | - Se Heun Cho
- Department of Surgery, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 602-715, Republic of Korea.
| | - Young Jin Suh
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University, 93 Joongboo-Daero Paldal-gu, Suwon, 442-723, Kyunggi-do, Republic of Korea.
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16
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Is obesity always a risk factor for all breast cancer patients? c-erbB2 expression is significantly lower in obese patients with early stage breast cancer. Clin Transl Oncol 2012; 14:923-30. [PMID: 22855166 DOI: 10.1007/s12094-012-0878-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/12/2012] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the relationship between body mass index and lipid profiles with breast cancer prognosis together with the relationship of these parametres with known breast cancer prognostic indices including c-erbB2 expression. PATIENTS AND METHODS Four hundred and thirty-three patients diagnosed with breast cancer at Ankara University, Faculty of Medicine, Department of Medical Oncology made up the study population. The primary endpoints were relapse and death. Body mass index at the time of diagnosis, lipid levels at the time of diagnosis, estrogen receptor status, progesterone receptor status, c-erbB2 expression, tumor grade, patient age, axillary lymph node involvement level, tumor stage, menopausal status and surgery details were taken into account. RESULTS The mean body mass indices were similar in the remission, relapse and mortality groups. Patients with body mass indices higher than 30 kg/m² had a lower incidence of c-erbB2 expression when compared to patients with body mass indices < 18.5 kg/m(2) (19 vs. 50 %, p = 0.009). Survival analysis revealed that patients with body mass indices < 18.5 kg/m(2) had significantly shorter disease free survivals when compared to patients with body mass indices between 25 and 29.9 kg/m(2). Mean serum lipid levels were similar in the remission, relapse and mortality groups. A trend toward relapse was shown in patients with total cholesterol > 240 mg/dl, but this was statistically insignificant. Survival analysis revealed that patients with triglyceride levels lower than 150 mg/dl had a statistically significant longer disease-free survival when compared to the other groups. Again a trend towards shorter overall survival was seen in patients with total cholesterol > 240 mg/dl, but this relationship was also statistically insignificant. CONCLUSION Most large previous studies reported adverse breast cancer outcome with obesity. However in our study, patients with lower body weight had a shorter disease-free survival. This could be explained by the low number of patients in this study, genetic profile of the patient population, possible weight changes after treatment and the inverse relationship between body mass index and c-erbB2 expression.
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Shen GP, Xu FH, He F, Ruan HL, Cui C, Chen LZ, Zeng YX, Jia WH. Pretreatment lifestyle behaviors as survival predictors for patients with nasopharyngeal carcinoma. PLoS One 2012; 7:e36515. [PMID: 22590554 PMCID: PMC3348163 DOI: 10.1371/journal.pone.0036515] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 04/02/2012] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Lifestyle behaviors have been widely reported to influence the survival of patients with head and neck cancer. However, the relationship between pretreatment lifestyle behaviors and survival among patients with nasopharyngeal carcinoma (NPC) is unclear. METHODS A prospective cohort study was designed to determine the relationship between lifestyle behaviors and survival in 1,533 NPC patients recruited from October 2005 to October 2007. Pretreatment lifestyle behaviors (such as body-mass index [BMI], smoking, alcohol, diet) of the patients were investigated. Univariate and multivariate proportional-hazards models were used to assess the impact of lifestyle behaviors on patient survival. RESULTS Smoking was a predictor of survival; both current smokers (hazard ratio [HR] = 1.88; 95% CI, 1.33 to 2.65) and heavy smokers (≥ 25 Pack-years; HR = 1.84; 95% CI, 1.30 to 2.60) showed associations with poor survival. Higher BMI was significantly associated with a lower risk of death (P(trend) = 0.002). Compared with under/normal-weight patients (BMI less than 22.99 kg/m(2)), the multivariate HR for survival was 0.66 (95% CI, 0.48 to 0.90) and 0.47 (95% CI, 0.23 to 0.97) for overweight and obese patients, respectively. No alcohol intake and high fruit intake were associated with favorable survival in the univariate analysis but lost significance in the multivariate model. CONCLUSION Our findings indicate that pretreatment lifestyle behaviors, especially smoking status and BMI, as easily available data, provide prognostic value for survival in NPC patients.
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Affiliation(s)
- Guo-Ping Shen
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Feng-Hua Xu
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Fen He
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Department of Radiation Oncology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hong-Lian Ruan
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Cui Cui
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Li-Zhen Chen
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yi-Xin Zeng
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Wei-Hua Jia
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
- * E-mail:
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18
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Niraula S, Ocana A, Ennis M, Goodwin PJ. Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis. Breast Cancer Res Treat 2012; 134:769-81. [DOI: 10.1007/s10549-012-2073-x] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 04/16/2012] [Indexed: 01/22/2023]
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Abstract
Although obesity is a well-known risk factor for several cancers, its role on cancer survival is poorly understood. We conducted a systematic literature review to assess the current evidence evaluating the impact of body adiposity on the prognosis of the three most common obesity-related cancers: prostate, colorectal, and breast. We included 33 studies of breast cancer, six studies of prostate cancer, and eight studies of colo-rectal cancer. We note that the evidence overrepresents breast cancer survivorship research and is sparse for prostate and colorectal cancers. Overall, most studies support a relationship between body adiposity and site-specific mortality or cancer progression. However, most of the research was not specifically designed to study these outcomes and, therefore, several methodological issues should be considered before integrating their results to draw conclusions. Further research is urgently warranted to assess the long-term impact of obesity among the growing population of cancer survivors.
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Affiliation(s)
- Niyati Parekh
- Department of Nutrition, Food Studies and Public Health, New York University, New York, NY 10003, USA
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Ewertz M, Jensen MB, Gunnarsdóttir KÁ, Højris I, Jakobsen EH, Nielsen D, Stenbygaard LE, Tange UB, Cold S. Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 2010; 29:25-31. [PMID: 21115856 DOI: 10.1200/jco.2010.29.7614] [Citation(s) in RCA: 400] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE 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. PATIENTS AND METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Marianne Ewertz
- Department of Oncology, Odense University Hospital, Sdr Blvd 29, DK-5000 Odense, Denmark.
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Thivat E, Thérondel S, Lapirot O, Abrial C, Gimbergues P, Gadéa E, Planchat E, Kwiatkowski F, Mouret-Reynier MA, Chollet P, Durando X. Weight change during chemotherapy changes the prognosis in non metastatic breast cancer for the worse. BMC Cancer 2010; 10:648. [PMID: 21108799 PMCID: PMC3006393 DOI: 10.1186/1471-2407-10-648] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 11/25/2010] [Indexed: 12/02/2022] Open
Abstract
Background Weight change during chemotherapy is reported to be associated with a worse prognosis in breast cancer patients, both with weight gain and weight loss. However, most studies were conducted prior to the common use of anthracycline-base chemotherapy and on North American populations with a mean BMI classified as overweight. Our study was aimed to evaluate the prognostic value of weight change during anthracycline-based chemotherapy on non metastatic breast cancer (European population) with a long term follow-up. Methods Patients included 111 women diagnosed with early stage breast cancer and locally advanced breast cancer who have been treated by anthracycline-based chemotherapy regimen between 1976 and 1989. The relative percent weight variation (WV) between baseline and postchemotherapy treatment was calculated and categorized into either weight change (WV > 5%) or stable (WV < 5%). The median follow-up was 20.4 years [19.4 - 27.6]. Cox proportional hazard models were used to evaluate any potential association of weight change and known prognostic factors with the time to recurrence and overall survival. Results Baseline BMI was 24.4 kg/m2 [17.1 - 40.5]. During chemotherapy treatment, 31% of patients presented a notable weight variation which was greater than 5% of their initial weight. In multivariate analyses, weight change (> 5%) was positively associated with an increased risk of both recurrence (RR 2.28; 95% CI: 1.29-4.03) and death (RR 2.11; 95% CI: 1.21-3.66). Conclusions Our results suggest that weight change during breast-cancer chemotherapy treatment may be related to poorer prognosis with higher reccurence and higher mortality in comparison to women who maintained their weight.
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Affiliation(s)
- Emilie Thivat
- Division of Clinical Research, Centre Jean Perrin, Clermont-Ferrand, F-63011 France.
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Chen X, Lu W, Zheng W, Gu K, Chen Z, Zheng Y, Shu XO. Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat 2010; 122:823-33. [PMID: 20058068 DOI: 10.1007/s10549-009-0708-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 12/21/2009] [Indexed: 12/22/2022]
Abstract
The authors evaluated the prognostic effects of obesity and weight change after breast cancer diagnosis. A total of 5042 breast cancer patients aged 20-75 were identified through the population-based Shanghai Cancer Registry approximately 6 months after cancer diagnosis and recruited into the study between 2002 and 2006. Participants were followed by in-person interviews supplemented by record linkage with the Shanghai Vital Statistics Registry database. Anthropometric measurements were taken, and information on sociodemographic, clinical, and lifestyle factors was collected through in-person interviews. During the median follow-up of 46 months, 442 deaths and 534 relapses/breast cancer-specific deaths were documented. Women with body mass index (BMI) > or = 30 at diagnosis had higher mortality than women with 18.5 < or = BMI < 25; the multivariate-adjusted hazard ratios (HRs) were 1.55 (95% confidence interval (95% CI): 1.10-2.17) for total mortality and 1.44 (95% CI: 1.02-2.03) for relapse/disease-specific mortality. Similar results were found for pre- and post-diagnostic obesity. Women who gained > or = 5 kg or lost >1 kg had higher mortality than those who maintained their weight. No association was observed between waist-to-hip ratio and mortality. Our study suggests that obesity and weight change after diagnosis are inversely associated with breast cancer prognosis. Weight control is important among women with breast cancer.
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Affiliation(s)
- Xiaoli Chen
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37203-1738, USA
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Moon HG, Han W, Noh DY. Underweight and breast cancer recurrence and death: a report from the Korean Breast Cancer Society. J Clin Oncol 2009; 27:5899-905. [PMID: 19805676 DOI: 10.1200/jco.2009.22.4436] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE The association between body mass index and breast cancer outcome is controversial. Furthermore, the impact of underweight on breast cancer recurrence and death has not been adequately addressed. PATIENTS AND METHODS We investigated this issue using a large nationwide database of 24,698 Korean breast cancer patients. The association between body weight status and breast cancer recurrence was further explored using a single-institution database containing information on 4,345 patients. RESULTS The results from the nationwide database showed significantly lower overall survival (OS) and breast cancer-specific survival (BCSS) in underweight patients compared with survival in patients of normal weight after adjusting for known prognostic factors such as age, tumor size, lymph node metastasis, hormone receptor status, histologic grade, and lymphovascular invasion (hazard ratio [HR], 1.48; 95% CI, 1.15 to 1.90 for OS; HR, 1.49; 95% CI, 1.15 to 1.93 for BCSS), which were not observed in obese patients. In an analysis of recurrence data from the single institution, underweight women had a significantly higher risk of both distant metastasis and local recurrence of breast cancer (HR, 1.93; 95% CI, 1.04 to 3.58 and HR, 5.13; 95% CI, 2.66 to 9.90, respectively). CONCLUSION Our study suggests that underweight should be considered to be a high risk factor for death and recurrence after breast cancer surgery, especially in Asian breast cancer patients.
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Affiliation(s)
- Hyeong-Gon Moon
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang Institute of Health Sciences, Jinju, Korea
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Eralp Y, Smith TL, Altundağ K, Kau SW, Litton J, Valero V, Buzdar A, Hortobagyi GN, Arun B. Clinical features associated with a favorable outcome following neoadjuvant chemotherapy in women with localized breast cancer aged 35 years or younger. J Cancer Res Clin Oncol 2008; 135:141-8. [DOI: 10.1007/s00432-008-0428-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 05/26/2008] [Indexed: 12/13/2022]
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Influence of body mass index on prognosis in gynecological malignancies. Cancer Causes Control 2008; 19:909-16. [DOI: 10.1007/s10552-008-9152-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2007] [Accepted: 03/21/2008] [Indexed: 10/22/2022]
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Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat 2007; 111:329-42. [PMID: 17939036 DOI: 10.1007/s10549-007-9785-3] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 10/05/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Breast cancer and obesity represent important public health issues in most western countries. A number of studies found a negative prognosis effect of obesity or excess of weight in woman breast cancer. However, to date, this issue remains controversial. The objectives of this study were to confirm the prognosis role of obesity on a large cohort of patients and to investigate a potential independent effect. MATERIALS AND METHODS We constituted a cohort of 14,709 patients who were recruited and treated at the Curie Institute (Paris) from 1981 to 1999. These patients were followed prospectively for a first unilateral invasive breast cancer without distant metastasis. Obesity was defined by a Body Mass Index (BMI) above 30 kg/m(2) according to the World Health Organization recommendations. RESULTS Obese patients (8%) presented more extended tumors at diagnosis time suggesting a delayed breast cancer diagnosis. However, obesity appeared as a negative prognosis factor for several events in respectively univariate and multivariate survival analysis: metastasis recurrence (HR = 1.32[1.19-1.48]; HR = 1.12[1.00-1.26]), disease free interval (1.20[1.08-1.32]; 1.10[0.99-1.22]), overall survival (1.43[1.28-1.60]; 1.12[0.99-1.25]) and second primary cancer outcome (1.57[1.19-2.07]; 1.43[1.09-1.89]). Even if obese patients presented more advanced tumors at diagnosis time, multivariate analysis showed that there was a relevant independent effect. Other BMI codings, distinguishing overweight patients or using BMI as a continuous variable, showed a consistent correlation between BMI's value and prognosis effect. Interaction analysis revealed a more important obesity effect in the presence of tumor estrogen receptors and among limited extent tumors. CONCLUSIONS This survey confirms the prognosis role of obesity on one of the largest cohort by investigating several prognosis events. While independent obesity effect linked to hormonal disorders appeared consistent as obesity's mechanism, we stress that obesity prognosis effect was also related to breast cancer presentation at diagnosis time.
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Abstract
Obesity has a complicated relationship to both breast cancer risk and the clinical behaviour of the established disease. It is suggested that obesity is associated with both an increased risk of developing breast cancer risk and worse prognosis after disease onset. In post-menopausal women, various measures of obesity such as body mass index, weight, weight gain and waist : hip ratio have all been positively associated with risk of developing breast cancer. In most but not all case-control and prospective cohort studies, an inverse relationship has been found between weight and breast cancer among pre-menopausal women. Some data suggest that adult weight gain and central obesity increase the risk of pre-menopausal breast cancer. Obesity at the time of diagnosis is thought to be significant as a poor prognostic factor. Obesity is associated with adverse outcomes in both pre- and post-menopausal women with breast cancer. Many cancer survivors seek ways to minimize the risk of recurrence and death because of breast cancer. Despite complex and at times controversial data, enough evidence is available at present to suggest that weight management should be a part of the strategy to prevent the occurrence, recurrence and death because of breast cancer. In this review the effect of obesity on the prognosis of breast cancer is examined in detail.
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Silha JV, Krsek M, Sucharda P, Murphy LJ. Angiogenic factors are elevated in overweight and obese individuals. Int J Obes (Lond) 2006; 29:1308-14. [PMID: 15953938 DOI: 10.1038/sj.ijo.0802987] [Citation(s) in RCA: 232] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adipose tissue produces both vascular growth factors and inhibitors. Since obesity is associated with expansion of the capillary bed in regional adipose depots the balance between these factors may favor angiogenesis. OBJECTIVE To investigate the relationship between body mass index and serum concentrations of vascular growth factors in human subjects. METHODS Vascular endothelial growth factor (VEGF), VEGF-C, VEGF-D, soluble VEGF receptor-2 (sVEGFr2), hepatocyte growth factor (HGF), angiopoietin-2, angiogenin and endostatin concentrations were measured in serum collected from 58 lean (24 males, 34 female, mean BMI, 22.2+/-0.3) and 42 overweight and obese (16 males and 26 females, mean BMI, 33.5+/-1.2) subjects after an overnight fast. RESULTS Sexual dimorphism was apparent in the serum concentrations of VEGF-C, VEFG-D and angiopoietin-2 with significantly higher levels in female compared to male subject. VEGF, VEGF-C, VEGF-D, soluble VEGF receptor-2, angiopoietin-2, angiogenin and endostatin but not HGF were significantly elevated in overweight and obese subjects. Positive correlations between BMI and the serum concentrations of VEGF-C, VEGF-D, sVEGF-R2, angiopoietin-2, angiogenin and endostatin were observed even after adjustment for gender and age. CONCLUSIONS Increased levels of vascular growth factors as well as the angiogenesis inhibitor endostatin are present in overweight and obese subjects and may contribute to previously documented increased risk of metastatic disease in obese subjects with cancer.
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Affiliation(s)
- J V Silha
- Department of Physiology, University of Manitoba, Winnipeg, Canada
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Tao MH, Shu XO, Ruan ZX, Gao YT, Zheng W. Association of overweight with breast cancer survival. Am J Epidemiol 2006; 163:101-7. [PMID: 16339054 DOI: 10.1093/aje/kwj017] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The authors investigated the association between overweight at the time of or soon after cancer diagnosis and survival in a cohort of 1,455 breast cancer patients aged 25-64 years. The patients were recruited into the Shanghai Breast Cancer Study (Shanghai, China), a population-based case-control study, between August 1996 and March 1998. The median follow-up time for this cohort was 5.1 years (1996-2002) after breast cancer diagnosis, and 240 deaths were identified. Being overweight at cancer diagnosis or soon afterward, as measured by body mass index (BMI; weight (kg)/height (m)(2)), was associated with poorer overall survival and disease-free survival. Five-year survival rates were 86.5%, 83.8%, and 80.1% for subjects whose BMIs were <23.0, 23.0-24.9, and >or=25.0, respectively (p = 0.02); the corresponding 5-year disease-free survival rates were 81.9%, 78.1%, and 76.6% (p = 0.05). The inverse association between BMI and survival persisted after adjustment for age at diagnosis and other known prognostic factors for breast cancer, including disease stage. The authors found neither waist:hip ratio nor waist circumference to be independently associated with overall survival or disease-free survival. These results suggest that excess weight may be an independent predictor of breast cancer survival among Chinese women.
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Affiliation(s)
- Meng-Hua Tao
- Department of Medicine, Center for Health Services Research, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN 37232-8300, USA
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Abercrombie HC, Giese-Davis J, Sephton S, Epel ES, Turner-Cobb JM, Spiegel D. Flattened cortisol rhythms in metastatic breast cancer patients. Psychoneuroendocrinology 2004; 29:1082-92. [PMID: 15219660 DOI: 10.1016/j.psyneuen.2003.11.003] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2003] [Revised: 11/07/2003] [Accepted: 11/08/2003] [Indexed: 11/20/2022]
Abstract
Allostatic load, the physiological accumulation of the effects of chronic stressors, has been associated with multiple adverse health outcomes. Flattened diurnal cortisol rhythmicity is one of the prototypes of allostatic load, and has been shown to predict shorter survival among women with metastatic breast cancer. The current study compared diurnal cortisol slope in 17 breast cancer patients and 31 controls, and tested associations with variables previously found to be related to cortisol regulation, i.e, abdominal adiposity, perceived stress, social support, and explicit memory. Women with metastatic breast cancer had significantly flatter diurnal cortisol rhythms than did healthy controls. Patients with greater disease severity showed higher mean cortisol levels, smaller waist circumference, and a tendency toward flatter diurnal cortisol rhythms. There were no relations between cortisol slope and psychological or cognitive functioning among patients. In contrast, controls with flatter rhythms showed the expected allostatic load profile of larger waist circumference, poorer performance on explicit memory tasks, lower perceived social support, and a tendency toward higher perceived stress. These findings suggest that the cortisol diurnal slope may have important but different correlates in healthy women versus those with breast cancer.
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Affiliation(s)
- Heather C Abercrombie
- Department of Psychiatry, University of Wisconsin Medical School, 6001 Research Park Blvd., Madison, WI 53719, USA.
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Berclaz G, Li S, Price KN, Coates AS, Castiglione-Gertsch M, Rudenstam CM, Holmberg SB, Lindtner J, Erien D, Collins J, Snyder R, Thürlimann B, Fey MF, Mendiola C, Werner ID, Simoncini E, Crivellari D, Gelber RD, Goldhirsch A. Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience. Ann Oncol 2004; 15:875-84. [PMID: 15151943 DOI: 10.1093/annonc/mdh222] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Current information on the prognostic importance of body mass index (BMI) for patients with early breast cancer is based on a variety of equivocal reports. Few have data on BMI in relationship to systemic treatment. PATIENTS AND METHODS Patients (6792) were randomized to International Breast Cancer Study Group trials from 1978 to 1993, studying chemotherapy and endocrine therapy. BMI was evaluated with eight other factors: menopausal status, nodal status, estrogen receptor status, progesterone receptor status, tumor size, vessel invasion, tumor grade and treatment. BMI was categorized as normal (< or =24.9), intermediate (25.0-29.9) or obese (> or =30.0). RESULTS Patients with normal BMI had significantly longer overall survival (OS) and disease-free survival (DFS) than patients with intermediate or obese BMI in pairwise comparisons adjusted for other factors. Subset analyses showed the same effect in pre- and perimenopausal patients and in those receiving chemotherapy alone. When assessed globally and adjusted for other factors, BMI significantly influenced OS (P = 0.03) but not DFS (P = 0.12). CONCLUSIONS BMI is an independent prognostic factor for OS in patients with breast cancer, especially among pre-/perimenopausal patients treated with chemotherapy without endocrine therapy.
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Affiliation(s)
- G Berclaz
- Department of Obstetrics and Gynecology, Inselspital, Bern, Switzerland.
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Carmichael AR, Bates T. Obesity and breast cancer: a review of the literature. Breast 2004; 13:85-92. [PMID: 15019686 DOI: 10.1016/j.breast.2003.03.001] [Citation(s) in RCA: 232] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2002] [Revised: 03/10/2003] [Accepted: 03/20/2003] [Indexed: 12/31/2022] Open
Abstract
A woman's build, the risk of breast cancer and its subsequent prognosis seem to be related. In most but not all case-control and prospective cohort studies, an inverse relationship has been found between weight and breast cancer among premenopausal women. However, most large epidemiological studies have found that overweight or obese women are at increased risk of developing postmenopausal breast cancer. It is suggested that higher body mass index is associated with a more advanced stage of breast cancer at diagnosis in terms of tumour size but data on lymph node status is not so consistent. All treatment modalities for breast cancer such as surgery, radiotherapy, chemotherapy and hormonal treatment may be adversely affected by the presence of obesity. The overall and disease-free survival is worse in most but not all studies of prognosis of obese pre- and postmenopausal women with breast cancer.
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Affiliation(s)
- A R Carmichael
- The Princess Royal Hospital, Haywards Heath, Sussex, UK.
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Abstract
Obesity has a complicated relationship to both breast cancer risk and the clinical behavior of the established disease. In postmenopausal women, particularly the elderly, various measures of obesity have been positively associated with risk. However, before menopause increased body weight is inversely related to breast cancer risk. In both premenopausal and postmenopausal breast cancer, the mechanisms by which body weight and obesity affect risk have been related to estrogenic activity. Obesity has also been related to advanced disease at diagnosis and with a poor prognosis in both premenopausal and postmenopausal breast cancer. Breast cancer in African-American women, considering its relationship to obesity, exhibits some important differences from those described in white women, although the high prevalence of obesity in African-American women may contribute to the relatively poor prognosis compared with white American women. Despite the emphasis on estrogens to explain the effects of obesity on breast cancer, other factors may prove to be equally or more important, particularly as they relate to expression of an aggressive tumor phenotype. Among these, this review serves to stress insulin, insulin-like growth factor-I, and leptin, and their relationship to angiogenesis, and transcriptional factors.
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Affiliation(s)
- Gina Day Stephenson
- Institute for Cancer Prevention, American Health Foundation Cancer Center, One Dana Road, Valhalla, NY 10595, USA
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Rock CL, Demark-Wahnefried W. Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol 2002; 20:3302-16. [PMID: 12149305 PMCID: PMC1557657 DOI: 10.1200/jco.2002.03.008] [Citation(s) in RCA: 270] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To review and summarize evidence from clinical and epidemiologic studies that have examined the relationship between nutritional factors, survival, and recurrence after the diagnosis of breast cancer. MATERIALS AND METHODS Relevant clinical and epidemiologic studies were identified through a MEDLINE search. References of identified reports also were used to identify additional published articles for critical review. RESULTS Several nutritional factors modify the progression of disease and prognosis after the diagnosis of breast cancer. Overweight or obesity is associated with poorer prognosis in the majority of the studies that have examined this relationship. Treatment-related weight gain also may influence disease-free survival, reduce quality of life, and increase risk for comorbid conditions. Five of 12 studies that examined the relationship between dietary fat and survival found an inverse association, which was not evident on energy adjustment in most of these studies. The majority of the studies that examined intakes of vegetables or nutrients provided by vegetables and fruit found a direct [corrected] relationship with survival. Alcohol intake was not associated with survival in the majority of the studies that examined this relationship. CONCLUSION Much remains to be learned about the role of nutritional factors in survival after the diagnosis of breast cancer. Healthy weight control with an emphasis on exercise to preserve or increase lean muscle mass and a diet that includes nutrient-rich vegetables can be recommended. Diets that have adequate vegetables, fruit, whole grains, and low-fat dairy foods and that are low in saturated fat may help to lower overall disease risk in this population.
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Affiliation(s)
- Cheryl L Rock
- Department of Family and Preventive Medicine, Cancer Prevention and Control Program, Dept. 901, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0901, USA.
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Djuric Z, DiLaura NM, Jenkins I, Darga L, Jen CKL, Mood D, Bradley E, Hryniuk WM. Combining weight-loss counseling with the weight watchers plan for obese breast cancer survivors. OBESITY RESEARCH 2002; 10:657-65. [PMID: 12105288 DOI: 10.1038/oby.2002.89] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective was to develop effective weight-loss methods for women who have had breast cancer, because obesity may result in an adverse prognosis. RESEARCH METHODS AND PROCEDURES This randomized pilot study tested an individualized approach toward weight loss in obese women who have had a diagnosis of breast cancer. An individualized approach was applied either alone or combined with the commercial Weight Watchers program. Forty-eight women (body mass index of 30 to 44 kg/m(2)) were enrolled. RESULTS Weight change after 12 months of intervention was as follows (mean +/- SD): 0.85 +/- 6.0 kg in the control group, -2.6 +/- 5.9 kg in the Weight Watchers group, -8.0 +/- 5.5 kg in the individualized group, and -9.4 +/- 8.6 kg in the comprehensive group that used both individualized counseling and Weight Watchers. Weight loss relative to control was statistically significant in the comprehensive group 3, 6, and 12 months after randomization, whereas weight loss in the individualized group was significant only at 12 months. Weight loss of 10% or more of initial body weight was observed in 6 of 10 women in the comprehensive group at 12 months. In the comprehensive and Weight Watchers-only groups, weight loss was significantly related to frequency of attendance at Weight Watchers meetings, and attendance was more frequent in the comprehensive group. DISCUSSION These data indicate that the most weight loss was achieved when the counseling approach combined both Weight Watchers and individualized contacts. This was effective even though most of the individualized contacts were by telephone.
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Affiliation(s)
- Zora Djuric
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan 48201, USA.
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