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Olsson LT, Walens A, Hamilton AM, Benefield HC, Fleming JM, Carey LA, Hursting SD, Williams KP, Troester MA. Obesity and Breast Cancer Metastasis across Genomic Subtypes. Cancer Epidemiol Biomarkers Prev 2022; 31:1944-1951. [PMID: 35973227 PMCID: PMC9628732 DOI: 10.1158/1055-9965.epi-22-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/12/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Obese women have higher risk of aggressive breast tumors and distant metastasis. However, obesity has rarely been assessed in association with metastasis in diverse populations. METHODS In the Carolina Breast Cancer Study Phase 3 (2008-2013), waist-to-hip ratio (WHR), body mass index (BMI), and molecular subtype [PAM50 risk-of-recurrence (ROR) score] were assessed. Obesity measures were evaluated in association with metastasis within five years of diagnosis, overall and stratified by race and ROR score. Absolute risk of metastasis and risk differences between strata were calculated using the Kaplan-Meier estimator, adjusted for age, grade, stage, race, and ER status. Relative frequency of metastatic site and multiplicity were estimated in association with obesity using generalized linear models. RESULTS High-WHR was associated with higher risk of metastasis (5-year risk difference, RD, 4.3%; 95% confidence interval, 2.2-6.5). It was also associated with multiple metastases and metastases at all sites except brain. The 5-year risk of metastasis differed by race (11.2% and 6.9% in Black and non-Black, respectively) and ROR score (19.5% vs. 6.6% in high vs. low-to-intermediate ROR-PT). Non-Black women and those with low-to-intermediate ROR scores had similar risk in high- and low-WHR strata. However, among Black women and those with high ROR, risk of metastasis was elevated among high-WHR (RDBlack/non-Black = 4.6%, RDHigh/Low-Int = 3.1%). Patterns of metastasis were similar by BMI. CONCLUSIONS WHR is associated with metastatic risk, particularly among Black women and those with high-risk tumors. IMPACT Understanding how risk factors for metastasis interact may help in tailoring care plans and surveillance among patients with breast cancer.
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Affiliation(s)
- Linnea T Olsson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrea Walens
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alina M Hamilton
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Halei C Benefield
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jodie M Fleming
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Biological and Biomedical Sciences, North Carolina Central University, Durham, NC
| | - Lisa A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen D Hursting
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin P Williams
- Biomanufacturing Research Institute and Technology Enterprise, North Carolina Central University, Durham, NC
- Co-senior authors
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Co-senior authors
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Rothschild HT, Abel MK, Patterson A, Goodman K, Shui A, van Baelen K, Desmedt C, Benz C, Mukhtar RA. Obesity and menopausal status impact the features and molecular phenotype of invasive lobular breast cancer. Breast Cancer Res Treat 2021; 191:451-458. [PMID: 34817747 PMCID: PMC8763723 DOI: 10.1007/s10549-021-06453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/14/2021] [Indexed: 11/09/2022]
Abstract
Purpose We investigated the relationship between obesity, menopausal status, and invasive lobular carcinoma (ILC), the second most common histological subtype of breast cancer. Specifically, we evaluated the association between body mass index (BMI), metabolic syndrome, the 21-gene Oncotype Recurrence Score (Oncotype RS), and pathological features in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor-2-negative ILC. Methods The study cohort included 491 patients from a prospectively maintained institutional database consisting of patients with stage I-III, HR-positive ILC who underwent surgical treatment between 1996 and 2019. Results Contrary to our expectations, we found that lower BMI was significantly associated with having higher Oncotype RS (18.9% versus 4.8%, p = 0.028) in post-menopausal patients, but was not related to tumor characteristics in pre-menopausal patients. Multivariate network analyses suggested a strong relationship between post-menopausal status itself and tumor characteristics, with lesser influence of BMI. Conclusion These findings provide further insight into the recently appreciated heterogeneity within ILC and support the need for further investigation into the drivers of this disease and tailored treatment strategies.
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Affiliation(s)
| | - Mary Kathryn Abel
- School of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Anne Patterson
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, 94143, USA
| | - Kent Goodman
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, 94143, USA
| | - Amy Shui
- Department of Surgery Biostatistics Core, University of California, San Francisco, CA, 94143, USA
| | - Karen van Baelen
- Department of Oncology, Laboratory for Translational Breast Cancer Research, KU Leuven, B-3000, Leuven, Belgium
| | - Christine Desmedt
- Department of Oncology, Laboratory for Translational Breast Cancer Research, KU Leuven, B-3000, Leuven, Belgium
| | | | - Rita A Mukhtar
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, 94143, USA
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Gagnet S, Diorio C, Provencher L, Mbuya-Bienge C, Lapointe J, Morin C, Lemieux J, Nabi H. Identifying Clinicopathological Factors Associated with Oncotype DX ® 21-Gene Recurrence Score: A Real-World Retrospective Cohort Study of Breast Cancer Patients in Quebec City, Canada. J Pers Med 2021; 11:858. [PMID: 34575635 PMCID: PMC8471231 DOI: 10.3390/jpm11090858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/05/2021] [Accepted: 08/26/2021] [Indexed: 12/22/2022] Open
Abstract
Gene expression profiling tests such as the Oncotype DX (ODX) 21-gene recurrence score (RS) assay is increasingly used in clinical practice to predict the risk of recurrence and support treatment planning for early-stage breast cancer (BC). However, this test has some disadvantages such as a high cost and a long turnaround time to get results, which may lead to disparities in access. We aim to identify clinicopathological factors associated with ODX RS in women with early-stage BC. We conducted a retrospective cohort study of women identified in the medical database of the Deschênes-Fabia Breast Disease Center of Quebec City University, Canada. Our sample consists of 425 women diagnosed with early-stage BC who have obtained an ODX RS between January 2011 and April 2015. The ODX RS has been categorized into three levels as originally defined: low (0-17), intermediate (18-30), and high (>30). The mean RS was 17.8 (SD = 9.2). Univariate analyses and multinomial logistic regressions were performed to identify factors associated with intermediate and high RS compared with low RS. A total of 237 (55.8%) patients had low RS, 148 (34.8%) had intermediate RS, and 40 (9.4%) had high RS. Women with progesterone receptor (PR)-negative (ORs ranging from 3.51 to 10.34) and histologic grade II (ORs ranging from 3.16 to 23.04) tumors were consistently more likely to have intermediate or high RS than low RS. Similar patterns of associations were observed when the RS was categorised using redefined thresholds from (i.e., from the TAILORx study or dichotomized). This study provides evidence suggesting that histologic grade and PR status are predictive factors for intermediate or high RS in women with early-stage BC. If these results are confirmed in future studies, considering these clinicopathological factors could spare women the need to get such a test before the beginning of a possible adjuvant therapy. This option could be considered in settings where the cost of testing is an issue.
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Affiliation(s)
- Simon Gagnet
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
| | - Caroline Diorio
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche sur le Cancer, Université Laval, Québec, QC G1V 0A6, Canada
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec-Université Laval, Québec, QC G1S 4L8, Canada;
| | - Louise Provencher
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec-Université Laval, Québec, QC G1S 4L8, Canada;
| | - Cynthia Mbuya-Bienge
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Julie Lapointe
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
| | - Claudya Morin
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec-Université Laval, Québec, QC G1S 4L8, Canada;
| | - Julie Lemieux
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec-Université Laval, Québec, QC G1S 4L8, Canada;
| | - Hermann Nabi
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche sur le Cancer, Université Laval, Québec, QC G1V 0A6, Canada
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