Obesity and Breast Cancer Prognosis: Evidence, Challenges, and Opportunities

Prognostic relation of body mass index on extended aromatase inhibition treatment in postmenopausal patients with estrogen receptor positive breast cancer: A retrospective analysis of the SOLE trial

BACKGROUND

Obesity is associated with a greater risk of developing distant recurrences in patients with estrogen receptor-positive (ER+) breast cancer. This association is however poorly investigated in patients treated with extended endocrine treatment (ET). We therefore evaluated the prognostic role of BMI in the SOLE trial, where postmenopausal patients, after having completed 4-6 years of adjuvant ET, were treated with 5 additional years of continuous or intermittent letrozole.

PATIENTS & METHODS

We considered the 3606 patients with ER+ /HER2- lymph node-positive BC with available BMI from the SOLE trial (NCT00553410). Distant-recurrence free interval (DRFI) was the main endpoint, and breast cancer-free interval (BCFI), disease-free survival (DFS) and overall survival (OS) secondary endpoints. Adjusted risk ratios (RR) for distant metastases were estimated with crude cumulative incidence models.

RESULTS

38.6 % of the patients were underweight or normal weight, 36.5 % overweight and 24.9 % obese. BMI was associated with age, tumor size, number of positive lymph nodes, menopausal status and type of prior ET. In the adjusted analyses, the prognostic value of BMI was dependent on prior ET and extended ET arm (second-order interaction p-value<0.001 for DRFI, BCFI and DFS, but not for OS). For instance, in patients treated with both a selective estrogen receptor modulator and an aromatase inhibitor in the first five years, obesity, as compared to normal-weight, was associated with better (RRDRFI=0.61, 95 %CI: 0.42-0.90) and worse (RRDRFI=2.31, 95 %CI: 1.41-3.78) outcomes in the adjusted models, in patients treated with continuous and intermittent letrozole in the extended ET, respectively.

CONCLUSION

We observed that the prognostic relation of BMI changes according to the type of adjuvant ET and mode of administration of extended AI. This warrants further investigation.

Ethnic enclaves, neighborhood socioeconomic status, and obesity among Hispanic women in Chicago: a latent profile analysis approach

PURPOSE

The prevalence of obesity, a crucial risk factor for breast cancer, is markedly higher among Hispanic women. The interaction between ethnic enclaves and neighborhood socioeconomic status (SES) as a determinant of this disparity warrants further research. We aimed to identify neighborhood profiles based on ethnic enclaves and socioeconomic status to evaluate the association with obesity among Hispanic women in the metropolitan Chicago region.

METHODS

We used a convenience sample of 24,884 Hispanic women over age 40 who obtained breast imaging from the largest healthcare organization in Chicago between 2010 and 2017. We conducted LPA to characterize neighborhood composition based on tract indicators of ethnic enclaves, disadvantage, and affluence. Multivariate linear and multinomial logistic regression models were used to evaluate the association of neighborhood profiles with BMI.

RESULTS

The LPA model identified four latent profiles, labeled based on their most significant characteristic as "middling," "disadvantage" "ethnic enclaves," and "affluent". Close to 50% of women in the disadvantage profile were obese and obese class II. Women in the disadvantage profile had the highest relative risk of being obese II (OR: 2.74 CI 95% 2.23, 3.36), compared to women in the middling profile. Women in the ethnic enclave and affluent profile were positively and negatively associated with obesity, respectively.

DISCUSSION

Using LPA to group individuals according to their combined traits provides empirical evidence to strengthen our understanding of how neighborhoods influence obesity in Hispanic women. The study findings suggest that ethnic enclaves, that are also disadvantage, are associated with obesity in Hispanic women.

Percentage mammographic density or absolute breast density for risk stratification in breast screening: Possible implications for socioeconomic health disparity

ObjectivesObesity levels and mortality from breast cancer are higher in more deprived areas of the UK, despite lower breast cancer incidence. Supplemental imaging for women with dense breasts has been proposed as a potential improvement to screening, but it is not clear how stratification by percentage mammographic density (%MD) would be reflected across socioeconomic groups. This study aims to clarify the associations between breast composition (dense and fatty tissue) and socioeconomic status in a multi-ethnic screening population.MethodsDemographic characteristics were collected for 62,913 participants in a UK breast screening programme (age, ethnicity, Index of Multiple Deprivation (IMD)). Automated mammographic measurements were derived: dense volume (DV), non-dense volume (NDV) and percent density (%MD). Correlations between deprivation and mammographic composition were examined before and after adjustment for age, ethnicity and NDV, using non-dense breast volume as a proxy for body mass index (BMI).ResultsThere was negligible correlation between deprivation and DV (r = 0.017; P < 0.001 in all cases), but NDV increased with increasing deprivation (Pearson r = 0.101). Correlations were weaker in the Asian and Chinese ethnic groups. %MD decreased with deprivation (r = -0.094) and adjustment for ethnicity did not alter the association between %MD and IMD (relative change, most to least deprived quintile IMD: 1.18; 95% confidence interval: 1.16, 1.21).ConclusionsDeprivation-related differences in %MD in the screening population are largely explained by differences in breast fat volume (NDV) which reflects BMI. Women in more deprived areas, where obesity and breast cancer mortality rates are higher, have increased breast adiposity and may miss out on risk-adapted screening if stratification is based solely on %MD or BIRADS classification.

Body mass index and clinical outcomes in breast cancer patients undergoing endocrine therapy: A meta-analysis and Mendelian randomization study

OBJECTIVE

The relationship between breast cancer prognosis, Body Mass Index (BMI), and endocrine therapy outcomes remains inconclusive. This study examines BMI's impact on survival outcomes in breast cancer patients receiving endocrine therapy through Mendelian randomization (MR) and a comprehensive clinical data review.

METHODS

A meta-analysis of clinical studies up to January 2024 investigated the association between obesity and the efficacy and safety of endocrine therapy. Additionally, a two-sample MR approach using genetic variants evaluated the causal effect of BMI on survival in breast cancer patients undergoing endocrine therapy.

RESULTS

Meta-analysis of eight studies (n = 12,673) found that BMI generally does not affect therapy outcomes. However, subgroup analysis showed that overweight patients on anastrozole had shorter disease-free survival (DFS) than normal-weight patients (Hazard Ratio (HR) = 1.21, P = 0.03), increased fatigue (Risk Ratio (RR) = 0.91, P = 0.03), and higher nausea with cyclin-dependent kinase 4/6(CDK4/6)inhibitors (Risk Ratio, RR = 0.69, P < 0.0001). Normal-weight patients on tamoxifen had a greater risk of bone pain (RR = 1.25, P = 0.03). Further MR analysis revealed no causal link between BMI and 5-year or 15-year survival rates in endocrine-treated patients (5-year HR = 0.7923, 95 % Confidence Interval (CI)[0.2053, 3.0581], P = 0.7355; 15-year HR = 0.9793, 95 % CI [0.7121, 1.3469], P = 0.898).

CONCLUSION

Current meta-analysis and MR findings suggest no significant link between BMI and the overall efficacy of endocrine therapy in breast cancer. However, BMI should be considered in anastrozole therapy due to differential effects on DFS and adverse events.

Identification and Management of Medical Comorbidities in Patients With HR+/HER2- Metastatic Breast Cancer Treated With CDK4/6 Inhibitors: Literature Review and Recommendations From Experts in Spain Opinion

Approximately one-third of patients with breast cancer have comorbidities at the time of their diagnosis. Recommendations for managing metastatic breast cancer are usually based on the results of clinical trials, which often limit patients with comorbidities. However, comorbidities greatly influence the quality of life, patient survival rate and treatment choice, particularly in older patients. The objective of this review was to identify clinically relevant comorbidities in patients with metastatic breast cancer, analyze the clinical approach to the treatment of these comorbidities, and propose recommendations from experts. An expert panel of eight medical oncologists identified seven therapeutic areas associated with the most relevant comorbidities in metastatic breast cancer: cardiovascular, gastrointestinal, endocrine/metabolic, renal, geriatric, psychological, and pain related. A clinical specialist from each therapeutic area specific to the relevant comorbidities (n = 8) joined the panel of experts (n = 8) to provide guidance on the appropriate management of these comorbidities. The specific comorbidities analyzed were hypertension, atrial fibrillation, venous thromboembolism, obesity, diabetes mellitus, cancer cachexia, chronic kidney disease, age-related disorders, arthritis, and fibromyalgia. In most cases, patients with metastatic breast cancer and medical comorbidities are polymedicated and/or vulnerable to toxicity. The oncologists provided recommendations on initial assessment and monitoring, follow-up recommendations, and warning signs and symptoms for referral to corresponding specialists based on their experience. The panel of experts also explored clinical scenarios related to each comorbidity and recommended a preferred CDK4/6 inhibitor based on available evidence regarding drug-drug interactions and potential for toxicity.

Race and clinical outcomes in hormone receptor-positive, HER2-negative, node-positive breast cancer in the randomized RxPONDER trial

BACKGROUND

The phase III RxPONDER trial has affected treatment for node-positive (1-3), hormone receptor-positive, HER2-negative breast cancer with a 21-gene recurrence score (RS) less than 26. We investigated how these findings apply to different racial and ethnic groups within the trial.

METHODS

The trial randomly assigned women to endocrine therapy (ET) or to chemotherapy plus ET. The primary clinical outcome was invasive disease-free survival (IDFS), with distant relapse-free survival (DRFS) as a secondary outcome. Multivariable Cox models were used to evaluate the association between race/ethnicity and survival outcomes, adjusting for clinicopathological characteristics, RS, and treatment.

RESULTS

A total of 4048 women with self-reported race/ethnicity were included: Hispanic (15.1%), non-Hispanic Black (NHB) (6.1%), Native American/Pacific Islander (0.8%), Asian (8.0%), and non-Hispanic White (NHW) (70%). No differences in RS distribution, tumor size, or number of positive nodes were observed by race/ethnicity. Relative to NHWs, IDFS was worse for NHB participants (5-year IDFS 91.6% vs 87.1%, HR = 1.37; 95% CI = 1.03 to 1.81) and better for Asians (91.6% vs 93.9%, HR = 0.64; 95% CI = 0.46 to 0.91). Relative to NHW, DRFS was worse for NHB participants (5-year DRFS 95.8% vs 91.0%, HR = 1.65; 95% CI = 1.17 to 2.32) and better for Asians (95.8% vs 96.7%, HR = 0.59; 95% CI = 0.37 to 0.95). Adjusting for clinical characteristics, particularly body mass index, diminished the effect of race on outcomes. Chemotherapy treatment efficacy did not differ by race/ethnicity.

CONCLUSIONS

NHB women had worse clinical outcomes compared with NHWs in the RxPONDER trial despite similar RS and comparable treatment. Our study emphasizes the persistent racial disparities in breast cancer outcomes while highlighting complex interactions among contributing factors.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01272037.

Effects of Nutritional Intervention and Exercise on Anthropometric and Metabolic Parameters in Moroccan Women with Breast Cancer: A Pilot Study

This study examines the effects of a dietary and physical activity intervention on body composition and metabolic parameters in Moroccan women with breast cancer. Conducted as a pilot cohort study, 37 women with breast cancer were recruited between 2017 and 2019 at the Hassan II Regional Hospital Center and the Agadir Regional Oncology Center. Participants completed a 12-month nutrition and physical activity intervention. The mean age was 47.92 ± 8.56 years. At the end of the intervention, participants experienced a mean weight loss of 11%, resulting in a significant reduction in normal weight and obesity rates from 35.14% and 32.43% to 57% and 5%, respectively (p < 0.05). Waist and hip circumferences were reduced by 10%, and there were significant reductions in body fat and visceral fat. Improvements were also seen in metabolic markers, with significant reductions in total cholesterol, LDL-C, blood glucose and HbA1c levels (p < 0.05). Lean mass was preserved and HDL-C showed a significant increase (p < 0.001).

Annual report of National Clinical Database-Breast Cancer Registry in 2021: characteristics categorized by body mass index and menopause status

The Japanese Breast Cancer Society initiated the breast cancer registry in 1975 and migrated the registry to the National Clinical Database-Breast Cancer Registry (NCD-BCR) in 2012. This annual report presents 2021 data on the NCD-BCR. We analyzed data from 98,540 breast cancer (BC) cases registered in 2021. In 2021, 99.4% of BC cases were females with a median age of 61. Most (57.5%) were diagnosed at early stages (Stage 0 or I). Breast-conserving surgery was performed in 42.8% of cases. Sentinel lymph node biopsy was performed in 67.8%, followed by radiotherapy in 71.0% of those post-conserving surgery. Regarding postoperative systemic therapy, 63.1% received endocrine therapy, 28.2% received chemotherapy, and 14.9% received molecular-targeted therapy. ER positivity was observed in 75.2%, HER2 in 13.6%, and Ki67 ≥30% in 29.1% of cases. The median age of premenopausal cases was 46 (interquartile range, 42-49) years and the median BMI was 21.5 (19.7-24.2) kg/m2 whereas the median age of postmenopausal cases was 69 (61-76) years and the median BMI was 23.0 (20.6-25.9) kg/m2. In premenopausal cases, cases with normal BMI were more likely to be found at checkups without subjective symptoms and in the early stage than those with high BMI. The tendency of ER, PgR, HER2, and Ki67 status on BMI differed by menopause status; premenopausal cases with a lower BMI showed higher proportions of ER- and PgR-positive cancer and lower proportions of cancer with high Ki67. These nationwide descriptive statistics would help clinical explanation and further research on breast cancer.

Beneath the Surface: The Emerging Role of Ultra-Processed Foods in Obesity-Related Cancer

PURPOSEOF REVIEW

Ultra-processed foods (UPFs) are becoming more and more important in daily diets around the world; in some cases, they can account for as much as 60% of daily energy intake. Epidemiological evidence suggests that this shift toward high levels of food processing may be partially responsible for the global obesity epidemic and the rise in the prevalence of chronic diseases.

RECENT FINDINGS

Few prospective studies have examined the relationship between UPF consumption and cancer outcomes. According to currently available information, UPFs may increase the risk of cancer due to their obesogenic properties and exposure to substances that can cause cancer, such as certain food additives and pollution from product processing. The complex relationship between obesity and cancer involves factors such as immune dysregulation, altered adipokine and sex hormone levels, abnormal fatty acid metabolism, extracellular matrix remodeling, and chronic inflammation. Addressing cancer risk associated with UPF consumption could involve a multifaceted approach, including consumer behavior modification programs and robust public health regulations aimed at enhancing food environments. Improved knowledge of the potential dual negative impacts of UPFs on the environment and cancer risk is one of the priority areas we identify for future research and policy implications. Various approaches could be used to prevent cancers associated with UPF consumption, such as consumer behavior change programs and stricter public health regulations needed to improve the food environment. This review examines for the first time the potential role of UPFs in cancer risk associated with obesity, exploring underlying biological mechanisms and identifying key areas for future research and policy action, including the dual environmental and health impact of UPFs.

Bisphenol A-induced cancer-associated adipocytes promotes breast carcinogenesis via CXCL12/AKT signaling

Bisphenol A (BPA), a commonly used plastic additive, is believed to cause obesity. As an environmental endocrine disruptor, BPA is closely associated with the onset and progression of BC. However, the molecular mechanisms underlying the promotion of breast cancer by BPA remain unclear. As obesity is a significant risk factor for breast cancer, this study aimed at exploring whether BPA facilitates the progression of breast cancer by inducing obesity. Using the National Health and Nutrition Examination Survey data, a positive correlation was observed between BPA exposure and the risk of sex-specific cancers among US adults with body mass index ≥30, suggesting that obesity may be influenced by urinary BPA. 3T3-L1 cells differentiated into mature adipocytes following treatment with 10-8 M BPA, and subsequent treatment with 4T1-conditioned medium acquired properties associated with cancer-associated adipocytes (CAAs). Network pharmacology suggested that CXCL12 may serve as a key target gene in breast cancer progression. Follow-up PCR analysis revealed high CXCL12 expression in BPA-induced CAAs. Overexpression of CXCL12 promoted epithelial-mesenchymal transition (EMT) and 4T1 cell migration by activating the AKT pathway. In vivo, BPA-induced CAAs accelerated tumor growth compared to a controls xenografted with only 4T1 cells. In tissues from the BPA-CAAs group, the expression of CXCL12, markers associated with CAAs, phosphorylated AKT, N-cadherin, and vimentin was markedly elevated, whereas the expression of E-cadherin was reduced. In conclusion, BPA may induce adipose cells to differentiate into CAA-like cells and subsequently advance breast cancer EMT through the CXCL12/AKT pathway.

Effect of subcutaneous fat on long-term survival after surgery for stage I-III breast cancer as determined by computed tomography

Introduction

Monitoring body composition through Computed Tomography (CT) scans, including muscle and adipose tissue, plays a key role in the prognosis of various cancers. However, abdominal CT is impractical for patients with breast cancer (BC), making chest CT an essential tool for postoperative surveillance. This study aims to evaluate the effect of subcutaneous fat tissue at the 11th thoracic vertebral plane on the postoperative prognosis of BC patients by analyzing chest CT images, providing evidence for postoperative nutritional and rehabilitation guidance.

Methods

We conducted a retrospective analysis of the medical records of 188 BC patients treated and discharged from the Second Affiliated Hospital of Wenzhou Medical University between January 1, 2013, and December 31, 2013. The subcutaneous fat area (SFA) at the 11th thoracic vertebra (T11) was measured using chest CT images, and the subcutaneous fat index (SFI, area/height2) was calculated. Using multivariate Cox proportional hazards models and propensity score matching (PSM), the relationships between the SFI and overall survival (OS), as well as recurrence-free survival (RFS), were assessed. Additionally, Kaplan-Meier survival curves were applied to compare prognostic differences between the groups.

Results

The median follow-up duration was 128 months (range: 27-188 months). Of the 188 patients included in the study, the optimal cutoff value for the SFI was determined to be 49.31 cm²/m². Multivariate analysis indicated that SFI was an independent prognostic factor for both OS (HR 2.50, 95% CI 1.07-5.83, P = 0.034) and RFS (HR 2.04, 95% CI 1.10-3.78, P = 0.024). After PSM, Kaplan-Meier survival curve analysis revealed significant differences in both RFS and OS between the two groups (P = 0.025 and P = 0.018, respectively). All the results showed that the prognosis of BC with more subcutaneous fat was poor.

Discussion

The findings demonstrated that the SFI at T11 was negatively correlated with patient survival. This offers a new perspective on personalized management for BC patients, suggesting that future research should validate these results and investigate combining imaging assessments with lifestyle interventions, such as exercise, nutrition, and diet, to optimize patient outcomes.

Innovative nanodelivery systems for targeted breast cancer therapy: overcoming drug delivery challenges and exploring future perspectives

Cancer chemotherapy is often limited by insufficient drug targeting, which can cause severe adverse effects on healthy tissues. The advent of nanodelivery systems offers a potential solution to this issue. It intricately enhances drug accumulation in tumor regions, while optimizing drug solubility, ensuring colloidal stability, and promoting cellular uptake, significantly improving the precision and efficacy of treatment, opening a gentler yet more effective new path for cancer therapy. This article begins with the pathogenesis of breast cancer and extends to the current treatment methods and their shortcomings, exploring in-depth the targeting therapeutic effects of five innovative nanodelivery technologies used in the treatment of breast cancer in recent years. Finally, it discusses the potential opportunities and challenges that nanodelivery systems may face in future development.

Construction and validation of a nomogram prediction model for the occurrence of complications in patients following robotic radical surgery for gastric cancer

BACKGROUND

In the last two decades, robotic-assisted gastrectomy has become a widely adopted surgical option for gastric cancer (GC) treatment. Despite its popularity, postoperative complications can significantly deteriorate patient quality of life and prognosis. Therefore, identifying risk factors for these complications is crucial for early detection and intervention.

OBJECTIVE

This research is designed to construct and validate a predictive model for assessing the risk of postoperative complications in patients undergoing robotic-assisted radical gastrectomy.

METHODS

A retrospective analysis was conducted on 500 GC patients from Gansu Provincial People's Hospital between December 2016 and October 2023. These patients formed the training cohort. An additional 136 patients from the 940th Hospital of Joint Logistic Support Force, the Chinese People's Liberation Army as the external validation cohort. Patients were categorized into groups with and without complications. Data collected included demographic details, laboratory results, CT quantitative body composition analysis, and clinical information. Variable selection was conducted through Lasso regression, succeeded by multivariable logistic regression to pinpoint independent risk factors. These elements facilitated the construction of a nomogram for prediction. The model's performance underwent internal validation via bootstrap techniques and external validation through a validation cohort. The efficacy of the model was quantified by the area under the receiver operating characteristic (ROC) curve (AUC), evaluated for calibration using calibration curves and the Hosmer-Lemeshow test, and assessed for clinical utility through decision curve analysis (DCA).

RESULTS

Of the 500 patients in the training cohort, 65 experienced complications, a rate of 13%. The validation cohort had a similar complication rate of 13.24% (18 out of 136 patients). Independent risk factors identified included tumor diameter (OR = 1.99, 95% CI = 1.07-3.73), TNM stage III (OR = 2.12, 95% CI = 1.03-4.36), ASA class I (OR = 0.26, 95% CI = 0.13-0.53), ASA class III (OR = 4.75, 95% CI = 2.12-10.62), and visceral fat area (VFA) (OR = 2.52, 95% CI = 1.10-5.79). The nomogram demonstrated good discrimination (AUC = 0.81, 95% CI: 0.76-0.87) in internal validation and (AUC = 0.79, 95% CI: 0.67-0.90) in external validation. Both validations confirmed the model's accurate calibration and significant clinical utility, with net benefits observed at probability thresholds ranging from 2 to 79% and 2-71%.

CONCLUSION

The developed nomogram, based on five independent risk factors-tumor diameter, TNM stage III, ASA class I, ASA class III, and VFA-effectively predicts the risk of complications in patients undergoing robotic-assisted radical gastrectomy, offering a valuable tool for clinical decision-making.

Impact of obesity on outcome in children diagnosed with cancer in Canada: A report from Cancer in Young People in Canada

BACKGROUND

Childhood obesity can result in adverse health outcomes. The objectives of this study were to describe the prevalence of obesity and determine the association between obesity at cancer diagnosis and event-free survival (EFS) and overall survival (OS) in children diagnosed with cancer in Canada.

METHODS

The authors conducted a retrospective cohort study using the Cancer in Young People in Canada database, including all children with newly diagnosed cancer aged 2-18 years across Canada from 2001 to 2020. Obesity was defined as age-adjusted and sex-adjusted body mass index greater than or equal to the 95th percentile. Univariate and multivariable Cox proportional hazards models compared EFS and OS between patients with and without obesity at diagnosis.

RESULTS

In total, 11,291 patients were included, of whom 10.5% were obese at diagnosis. In multivariable models controlling for age, sex, ethnicity, neighborhood income quintile, treatment era, and cancer categories, obesity at diagnosis was independently associated with inferior EFS (adjusted hazard ratio [aHR], 1.16; 95% confidence interval [CI], 1.02-1.32; p = .02) and OS (aHR, 1.29; 95% CI, 1.11-1.49; p = .001). The adverse prognostic impact of obesity was particularly notable for acute lymphoblastic leukemia (ALL) and central nervous system (CNS) tumors. In children with ALL (n = 3458), obesity remained associated with inferior EFS (aHR, 1.55; p = .002) and OS (aHR, 1.75; p = .002) in multivariable analysis. In patients with CNS tumors (n = 2458), obesity was also associated with inferior EFS (aHR, 1.38; p = .008) and OS (aHR, 1.47; p = .004).

CONCLUSIONS

In this population-based study, obesity at cancer diagnosis was independently associated with inferior survival across the entire cohort, and prominently in children with ALL and CNS tumors.

Continental differences in the association between excess body weight and prognosis in triple-negative breast cancer: a meta-analysis

PURPOSE

The association between obesity and triple-negative breast cancer (TNBC) prognosis has been equivocal, with considerable heterogeneity between and within studies. Recent meta-analyses report adverse associations with overall survival (OS) and disease-free survival (DFS) in TNBC. We update this evidence and examine study- and disease-specific sources of heterogeneity.

METHODS

A systematic search of four databases was conducted until February 22, 2023. Random-effects meta-analyses were used to pool hazard ratios (HR) for OS, DFS, and breast cancer-specific mortality (BCSM). Subgroup analyses examined sources of study heterogeneity.

RESULTS

In meta-analyses of included studies (n = 33), significant associations were observed between excess body weight and worse OS (n = 24; HR = 1.20; 95%CI 1.20-1.34), DFS (n = 26; HR = 1.15; 1.05-1.27), and BCSM (n = 9; HR = 1.13; 1.00-1.27). In subgroup meta-analyses, significant inter-study survival differences were observed for study location (OS, DFS), time period of diagnoses (DFS), menopausal status (OS), and body mass index cut points examined (OS). Asian and European studies reported significant associations with OS (HR = 1.31; 1.11-1.54 and HR = 1.38; 1.00-1.89, respectively) and DFS (HR = 1.28; 1.07-1.54 and HR = 1.44; 1.13-1.84, respectively); however, no association was observed between obesity and TNBC prognosis in North American studies (OS: HR = 1.03; 0.89-1.19; DFS: HR = 1.05; 0.95-1.15). Location subgroup differences remained robust after excluding poor-quality studies. Post hoc analysis in the subset of studies reporting predominantly (≥ 70%) White sample showed no statistically significant associations for OS (HR = 1.13; 95%CI 0.96, 1.34), DFS (HR = 1.03; 95%CI 0.86, 1.23), or BCSM (HR = 1.08; 95%CI 0.91, 1.27).

CONCLUSION

This study further confirms that obesity is associated with poor prognosis in TNBC and identified subgroups at higher risk. Ethnic differences in the association between excess body weight and TNBC are reported. Further exploration of study and patient characteristics is needed to properly understand the populations most at risk.

Breast Cancer Survivors' Diet and Physical Activity Preferences and Barriers: How COVID-19 Changed the Intervention Landscape

Background

Existing studies on breast cancer survivors (BCS) have primarily focused on individual aspects of either diet or exercise preferences and barriers. Our study aims to examine BCS' perceptions toward diet and exercise combined. Given the transformative impact of COVID-19, there is a crucial need for insights in the post-pandemic era to address the distinct challenges faced by BCS in maintaining their health and well-being.

Objectives

This exploratory study aims to understand BCS' preferences for and barriers to diet and exercise to inform future intervention development.

Methods

A cross-sectional survey was administered to adults diagnosed with ductal carcinoma in situ or stage I-IV breast cancer (BC) from 2019 to 2021 regarding interest, preferences, and barriers to participating in diet and exercise interventions. Descriptive analysis compared pre-COVID-19 (pre-C) and during-COVID-19 pandemic (during-C) subsets.

Results

There were 224 participants. Over half expressed interest in a BC research study related to diet and exercise. Most preferred receiving consultations in-person with relevant specialists, education or counseling in one-on-one sections, and information from written materials, in-person, or via technology. Barriers were fatigue, family, and work. One hundred and thirty participants completed the survey pre-C, and 94 during-C. Compared with pre-C, during-C participants preferred visual communication tools for information on nutrition and exercise over in-person methods (P < 0.05). In most categories, the percentage of barriers noted during-C was greater than pre-C.

Conclusions

Participants indicated preference for dual-modal diet and exercise interventions. The pandemic impacted participation preferences and barriers, with shifts toward favoring visual communication tools over in-person services and increasing psychosocial and COVID-related barriers. Hybrid care, combining in-person with technology-based delivery, shows promise in enhancing flexibility and accessibility in nutrition and exercise interventions amid the pandemic.

The association of BMI and subclinical myocardial dysfunction in breast cancer patients after single or dual anti-HER2 targeted therapy

BACKGROUND

Anti-HER2 targeted therapy has significantly reduced the recurrence and death of HER2-overexpressing breast cancer patients, but might lead to cardiotoxicity. Some patients with normal myocardial function may suffer from subclinical myocardial dysfunction after anti-HER2 targeted therapy. We sought to evaluate earlier the subclinical myocardial dysfunction in breast cancer patients after single or dual anti-HER2 targeted therapy, and identify the risk factors related to subclinical myocardiotoxicity.

METHODS

In our study, 40 breast cancer patients after single anti-HER2 targeted therapy, and 40 breast cancer patients after dual anti-HER2 targeted therapy were enrolled. Global longitudinal strain (GLS) was measured through echocardiography.

RESULTS

Seven patients in single anti-HER2 therapy group and eight patients in dual anti-HER2 therapy group had GLS lower than - 18%, suggesting subclinical myocardial dysfunction, but no difference between these two groups. Furthermore, we found that increased BMI was associated with reduction of GLS in breast cancer patients after anti-HER2 targeted therapy. Increased BMI (OR 2.683; 95% CI 1.225-5.879) was a risk factor of subclinical cardiotoxicity in dual anti-HER2 targeted therapy group. In addition, the patients with BMI ≥ 25 were more prone to have subclinical myocardial dysfunction in dual anti-HER2 therapy group compared with those with BMI ≥ 25 in single anti-HER2 therapy group.

CONCLUSION

Our results indicate dual anti-HER2 therapy does not increase the risk of subclinical myocardial dysfunction for breast cancer patients, compared with single anti-HER2 therapy. Patients with BMI ≥ 25 are more prone to have subclinical cardiotoxicity after dual anti-HER2 therapy than after single anti-HER2 therapy. Weight reduction should be the major measure to prevent subclinical myocardial dysfunction for these patients.

Who is Focusing on Women's Health: A Bibliometric Analysis of Global Research Trends on Overweight in Female Patients with Gynecologic or Breast Cancer

Objective

Obesity has become a significant public health concern, strongly linked to various diseases, particularly gynecologic and breast cancers. This bibliometric review aims to analyze global research trends on overweight women, particularly those with gynecologic and breast cancers, to identify research hotspots, key contributors, and emerging areas of study.

Methods

A comprehensive bibliometric analysis was conducted using the Web of Science Core Collection (WoSCC) database, covering the period from January 2013 to September 2024. Articles were screened and analyzed using tools such as VOSviewer and Biblioshiny platform, with metrics including publication volume, citation analysis, and co-authorship networks. Key areas of focus were global research trends, leading countries, institutions, authors, journals, and keyword analysis.

Results

A total of 1452 publications were analyzed. Research activity on the association between obesity and gynecologic/breast cancer has steadily increased, with the United States leading in publications and citations, followed by China and Italy. Core journals included Breast Cancer Research and Treatment and Gynecologic Oncology. Key research areas identified through keyword analysis include the relationship between body mass index (BMI) and cancer risk, survival rates in cancer patients, physical activity, and the role of adipose tissue inflammation in tumor progression. Emerging topics include extracellular vesicles and cancer-associated fibroblasts.

Conclusion

Global research on the relationship between obesity and female-specific cancers has shown significant growth. The findings highlight BMI, survival, and physical activity as central themes. Future research should explore the molecular mechanisms linking obesity to cancer and evaluate weight loss interventions for cancer prevention and treatment.

The Group-basEd Telehealth behavioral WEight Loss Program Among Breast Cancer Survivors: A Pilot and Feasibility Study

Objective

Obesity is related to the recurrence of breast cancer. In-person groups or individual telephone counseling currently comprise the behavioral weight loss (BWL) programs tested for cancer survivors. Group support via telehealth may be convenient and provide support from fellow survivors, but feasibility, acceptability, and efficacy testing are needed.

Methods

A single-arm, 6-month BWL program was conducted for female breast cancer survivors with an ECOG performance 0 or 1, BMI > 25 kg/m2, and > 6 months from completion of adjuvant chemotherapy and/or radiation treatment. Participants attended 22 video group sessions over 6 months, completing acceptability ratings, weight measurements, Patient Health Questionnaire (PHQ-9), City of Hope Breast Cancer Quality of Life Scale (QOL), and International Physical Activity Questionnaire. Changes in survey scores and weight (last-observation carried forward) and differences in outcomes by patients' race were computed with paired t-tests, ANCOVAs and Chi-square tests.

Results

Twenty-one (5 Black, 15 White, 1 Asian American; Mean (SD) = 60.7 (11.6) years; BMI 33.1 (5.9) kg/m2) survivors enrolled with 90% retention and 81.3% of sessions attended. Acceptability ratings were high (all > 4 on a five-point scale). Mean (SD) weight loss was 5.9% (5.2%), with 60% losing ≥ 5% of baseline weight; White participants lost 7.5% and Black participants lost 1.9% (p = 0.04). Significant improvements were observed in mood (PHQ-9; p = 0.01) and physical wellbeing QOL (p = 0.01). Physical activity did not change.

Conclusion

This telehealth group BWL program was feasible and acceptable for breast cancer survivors, yielding a clinically significant weight loss. Future studies should test this intervention in larger, more diverse samples.

Trail Registration

ClinicalTrials.gov identifier: NCT04855552, posted April 22, 2021.

Obesity Is an Independent Prognostic Factor That Reduced Pathological Complete Response in Operable Breast Cancer Patients

Background and Objectives: Obesity is a significant risk factor for the development of breast cancer (BC) and associated poorer outcomes. A pathological complete response (pCR) with neoadjuvant chemotherapy (NACT) correlates with improved long-term prognosis in BC patients. In this study, we aimed to investigate the predictive effect of obesity on achieving pCR following NACT. Methods: This single-center retrospective study included patients with operable BC who were treated with NACT. Patients were categorized based on their pre-chemotherapy body mass index (BMI), including non-obese (<30 kg/m2) and obese (≥30 kg/m2) groups, and pathological responses to NACT were compared. Results: A total of 191 female patients were included in this study; of these, 83 (43.4%) were obese and 108 (56.6%) were in the non-obese group. Obesity was more common in postmenopausal patients, and the median age of obese patients was significantly higher compared to non-obese patients. Patients in the obese group demonstrated significantly lower pCR rates compared to the non-obese group (30% vs. 45%, p = 0.03). The histological subtype assessment indicated that only in the HR-positive/HER2-negative patients was the pCR rate significantly lower in the obese group compared to the non-obese group (11% vs. 27%, p = 0.05). According to menopausal assessment, a significant difference in pCR rates was observed only among postmenopausal patients, with rates of 29% in the obese group compared to 52% in the non-obese group (p = 0.03). In logistic regression analysis, obesity (OR: 0.52, 95% CI: 0.28-0.97; p = 0.04) and a low Ki-67 score (HR: 2.7, 95% CI: 1.37-5.53; p = 0.003) were independently associated with a decreased rate of pCR. Conclusions: The impact of obesity on achieving pCR in BC patients undergoing NACT remains controversial. Our study revealed that obesity was an independently significant negative predictive factor for achieving pCR.

Macrophages in tumor cell migration and metastasis

Tumor-associated macrophages (TAMs) are a phenotypically diverse, highly plastic population of cells in the tumor microenvironment (TME) that have long been known to promote cancer progression. In this review, we summarize TAM ontogeny and polarization, and then explore how TAMs enhance tumor cell migration through the TME, thus facilitating metastasis. We also discuss how chemotherapy and host factors including diet, obesity, and race, impact TAM phenotype and cancer progression. In brief, TAMs induce epithelial-mesenchymal transition (EMT) in tumor cells, giving them a migratory phenotype. They promote extracellular matrix (ECM) remodeling, allowing tumor cells to migrate more easily. TAMs also provide chemotactic signals that promote tumor cell directional migration towards blood vessels, and then participate in the signaling cascade at the blood vessel that allows tumor cells to intravasate and disseminate throughout the body. Furthermore, while chemotherapy can repolarize TAMs to induce an anti-tumor response, these cytotoxic drugs can also lead to macrophage-mediated tumor relapse and metastasis. Patient response to chemotherapy may be dependent on patient-specific factors such as diet, obesity, and race, as these factors have been shown to alter macrophage phenotype and affect cancer-related outcomes. More research on how chemotherapy and patient-specific factors impact TAMs and cancer progression is needed to refine treatment strategies for cancer patients.

Single-cell RNA-sequencing reveals a unique landscape of the tumor microenvironment in obesity-associated breast cancer

As two diseases with rapidly increasing incidence, the molecular linkages between obesity and breast cancer (BC) are intriguing. Overall, obesity may be a negative prognostic factor for BC. Single-cell RNA-sequencing (scRNA-seq) was performed on tumor tissues from 6 obese and non-obese BC patients. With 48,033 cells analyzed, we found heterogeneous tumor epithelium and microenvironment in these obese and lean BC patients. Interestingly, the obesity-associated epithelial cells exhibited specific expression signatures which linked tumor growth and hormone metabolism in BC. Notably, one population of obesity-specific macrophage up-regulated the nuclear receptor subfamily 1 group H member 3 (NR1H3), which acted a transcription factor and regulated FABP4 expression through its interaction with the DNA of SREBP1, and further increased the proliferation of tumor cells in BC. Using single-cell signatures, our study illustrate cell diversity and transcriptomic differences in tumors from obese and non-obese BC patients, and sheds light on potential molecular link between lipid metabolism and BC.

Significance of LIF/LIFR Signaling in the Progression of Obesity-Driven Triple-Negative Breast Cancer

American women with obesity have an increased incidence of triple-negative breast cancer (TNBC). The impact of obesity conditions on the tumor microenvironment is suspected to accelerate TNBC progression; however, the specific mechanism(s) remains elusive. This study explores the hypothesis that obesity upregulates leukemia inhibitory factor receptor (LIFR) oncogenic signaling in TNBC and assesses the efficacy of LIFR inhibition with EC359 in blocking TNBC progression. TNBC cell lines were co-cultured with human primary adipocytes, or adipocyte-conditioned medium, and treated with EC359. The effects of adiposity were measured using cell viability, colony formation, and invasion assays. Mechanistic studies utilized RNA-Seq, Western blotting, RT-qPCR, and reporter gene assays. The therapeutic potential of EC359 was tested using xenograft and patient-derived organoid (PDO) models. The results showed that adipose conditions increased TNBC cell proliferation and invasion, and these effects correlated with enhanced LIFR signaling. Accordingly, EC359 treatment reduced cell viability, colony formation, and invasion under adipose conditions and blocked adipose-mediated organoid growth and TNBC xenograft tumor growth. RNA-Seq analysis identified critical pathways modulated by LIF/LIFR signaling in diet-induced obesity mouse models. These findings suggest that adiposity contributes to TNBC progression via the activation of the LIF/LIFR pathway, and LIFR inhibition with EC359 represents a promising therapeutic approach for obesity-associated TNBC.

Mammographic Breast Density at Breast Cancer Diagnosis and Breast Cancer-Specific Survival

Background: Breast density impacts upon breast cancer risk and recurrence, but its influence on breast cancer-specific survival is unclear. This study examines the influence of mammographic breast density (MBD) at diagnosis on breast cancer-specific survival. Methods: The data of 224 patients diagnosed with breast cancer were analyzed. Two area-based MBD measurement tools-AutoDensity and LIBRA-were used to measure MBD via a mammogram of the contralateral breast acquired at the time of diagnosis. These patients were split into two groups based on their percent breast density (PBD): high (PBD ≥ 20%) versus low (PBD < 20%). Breast cancer-specific survival in each of these PBD groups was assessed at a median follow-up of 34 months using Kaplan-Meier analysis and the Cox proportional hazards model. Results: The proportion of women with low PBD who died from breast cancer was significantly higher than that seen with high PBD (p = 0.01). The 5-year breast cancer-specific survival was poorer among women with low PBD than those with high PBD (0.348; 95% CI: 0.13-0.94) vs. 0.87; 95% CI: (0.8-0.96); p < 0.001)]. Women with higher breast density demonstrated longer survival regardless of the method of PBD measurement: LIBRA [log-rank test (Mantel-Cox): 9.4; p = 0.002)]; AutoDensity [log-rank test (Mantel-Cox) 7.6; p = 0.006]. Multivariate analysis also demonstrated that there was a higher risk of breast cancer-related deaths in women with low PBD (adjusted HR: 5.167; 95% CI: 1.974-13.521; p = 0.001). Conclusion: Women with <20% breast density at breast cancer diagnosis demonstrate poor survival regarding the disease. The impact of breast density on survival is not influenced by the method of measurement.

Trem2 deficiency attenuates breast cancer tumor growth in lean, but not obese or weight loss, mice and is associated with alterations of clonal T cell populations

Obesity is an established risk factor for breast cancer development and worsened prognosis; however, the mechanisms for this association - and the potential benefits of weight loss - have not been fully explored. The adipose environment surrounding breast tumors, which is inflamed in obesity, has been implicated in tumor progression. An emerging therapeutic target for cancer is TREM2, a transmembrane receptor of the immunoglobulin superfamily that is expressed on macrophages in adipose tissue and tumors. We utilized genetic loss of function (Trem2 +,+ and Trem2 -/-) models and dietary (lean, obese, and weight loss) intervention approaches to examine impacts on postmenopausal breast cancer. Remarkably, Trem2 deficiency ameliorated tumor growth in lean, but not obese or weight loss mice. Single-cell RNA sequencing, in conjunction with VDJ sequencing of tumor and tumor-adjacent mammary adipose tissue (mATTum-adj) immune cells, revealed that tumors of lean Trem2 -/- mice exhibited a shift in clonal CD8+ T cells from an exhausted to an effector memory state, accompanied with increased clonality of CD4+ Th1 cells, that was not observed in any other diet-genotype group. Notably, identical T cell clonotypes were identified in the tumor and mATTum-adj of the same mouse. Finally, an immune checkpoint study demonstrated that αPD-1 therapy restricted tumor growth in lean and weight loss, but not obese mice. We conclude that weight history is relevant when considering potential efficacy of TREM2 inhibition in postmenopausal breast cancer. This work reveals immunological interactions between tumors and surrounding adipose tissue, highlighting significant differences under obese and weight loss conditions.

SEMA7A as a Novel Prognostic Biomarker and Its Correlation with Immune Infiltrates in Breast Cancer

Background

The role of Semaphorin 7a (SEMA7A) in the initiation and progression of different types of cancerous lesions has been extensively studied. However, the prognostic significance of SEMA7A, specifically in breast cancer (BC), lacks clarity.

Methods

We conducted an evaluation on the relationship between SEMA7A and the prognosis, immune invasion and tumor mutation burden in different types of cancer by analyzing data from The Cancer Genome Atlas database. The present study focused on investigating the expression level, mutation, immune correlation and coexpression of SEMA7A in BC, utilizing various databases such as the University of Alabama at Birmingham Cancer data analysis portal, cBioPortal and tumor immune estimation resource. Survival analysis was carried out using the Kaplan-Meier Plotter. Furthermore, we employed the R software package to generate receiver operating characteristic (ROC) curves and nomograms. Notably, P<0.05 was considered to indicate statistical significance.

Results

Using pancancer analysis, it has been observed that the expression of SEMA7A is elevated in various types of cancer and is strongly correlated with the prognosis of different cancer types. SEMA7A also exhibits a significant association with the tumor mutation burden of diverse types of cancer. Moreover, SEMA7A displays a notable increase in BC cases, and was indicated to have a substantial association with the abundance of immune infiltration. In-depth survival analysis demonstrated that elevated levels of SEMA7A expression are notably linked to shorter overall survival and distant metastasis-free survival among patients with BC. The efficiency of SEMA7A as a reliable prognostic biomarker for BC has been substantiated by the validation of ROC curves and nomograms.

Conclusion

SEMA7A has the potential to function as a prognostic indicator for BC, and its correlation with immune infiltration in BC is significant.

Comparing long-term prognosis following different surgical methods in patients with early stage breast cancer and obesity: a retrospective cohort study in China

OBJECTIVE

Breast-conserving therapy (BCT) includes breast-conserving surgery (BCS) combined with radiation therapy (RT). RT plays a crucial role in improving the prognosis of patients who undergo BCS. However, obesity is a potential risk factor for resistance to radiation. The aim of this study was to evaluate any difference in the long-term prognosis of patients with early stage breast cancer and obesity treated with BCT or total mastectomy (TM).

DESIGN, SETTING AND PARTICIPANTS

This was a retrospective cohort study involving 1125 patients diagnosed with early stage breast cancer and obesity at the Shanghai Cancer Center of Fudan University from 2013 to 2016.

OUTCOME MEASURES

Obesity in the Chinese population was defined as a body mass index ≥28 kg/m2. Surgical options included BCT and TM. The primary survival outcomes were overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). Inverse probability of treatment weighting (IPTW) was used to control for the impact of confounding factors on prognosis.

RESULTS

The median follow-up times in the BCT group and TM group without postoperative RT were 51.1 months (IQR of 40.6-68.1 months) and 61.8 months (IQR of 46.5-76.7 months), respectively. After IPTW, the baseline data were balanced. Compared with those in the TM cohort, patients in the whole IPTW cohort in the BCT cohort had worse DFS (HR 4.280, 95% CI 2.180 to 8.400; p<0.001), RFS (HR 4.380, 95% CI 2.370 to 8.120; p<0.001) and OS (HR 3.590, 95% CI 1.620 to 7.950; p=0.002).

CONCLUSION

In patients with early stage breast cancer and obesity, TM is associated with better survival outcomes than BCT.

Quality of Life Determinants in Patients with Metastatic Prostate Cancer: Insights from a Cross-Sectional Questionnaire-Based Study

INTRODUCTION

Prostate cancer is one of the most prevalent malignancies affecting men globally, with a significant impact on health-related quality of life (HRQOL). With the recent therapeutic advancements and improvements in survival, there is a need to understand the determinants of HRQOL in metastatic prostate cancer patients to optimize treatment strategies for quality of life as the number of survivors increases. The aim of this study was to identify clinical variables that affect HRQOL and its domains in patients with metastatic prostate cancer.

METHODS

We conducted a cross-sectional questionnaire-based study in patients diagnosed with metastatic prostate cancer at a tertiary cancer center in India. Baseline clinical features, treatment details, and completed Functional Assessment of Cancer Therapy-Prostate (FACT-P), composed of FACT-general (FACT-G) and prostate cancer-specific concerns subscale (PCS) and FACT-P Trial Outcome Index (FACT-P TOI) questionnaires, were collected. The mean total, as well as individual domain scores, were calculated. Additionally, these were stratified by the current treatment being received by patients. Linear regression was used to identify independent factors affecting HRQOL in these patients.

RESULTS

Of the 106 enrolled patients, 84 completed the FACT-P questionnaire and were included in the analysis. The median age was 66 years, and at the time of assessment, 3 patients (3.6%) were receiving androgen deprivation therapy only, 53 patients (63.1%) were on ADT + androgen receptor-targeted agents (ARTAs), and 18 patients (21.4%) patients received ADT + chemotherapy. The mean (±standard deviation) of the FACT-P TOI score was 70.33 (±15.16); the PCS subscale was the most affected, followed by functional well-being. Patients on chemotherapy scored significantly higher on PCS, but the composite scores were not significantly different. Univariable regression identified obesity (body mass index > 25 kg/m2) and duration of first-line treatment as significant predictors of better HRQOL; however, obesity was the only independent predictor in multivariable analysis (β = 8.2; 95% confidence interval, 1.2 to 15.0; p = 0.022). Obesity also independently predicted a better FACT-P and its physical well-being domain score and PCS.

CONCLUSION

Prostate cancer patients experience impaired QoL, especially in the prostate cancer-specific and functional well-being domains. Lower BMI is an independent predictor of poor QoL, and this requires efforts to assess the impact of strategies to manage the nutritional status of patients with metastatic disease on QoL outcomes.

Breast Cancer Risk After Bariatric Surgery and Influence of Insulin Levels: A Nonrandomized Controlled Trial

Importance

Obesity and insulin are risk factors for breast cancer, and retrospective studies suggest bariatric surgery reduces breast cancer risk in women. However, long-term prospective data on breast cancer risk after bariatric surgery and the role of baseline insulin levels are lacking.

Objective

To examine if bariatric surgery is associated with breast cancer incidence in women and if treatment benefit is modified by baseline insulin levels.

Design, Setting, and Participants

The Swedish Obese Subjects (SOS) study was a nonrandomized intervention trial designed to investigate the long-term effects of bariatric surgery on obesity-related mortality and morbidity. Study recruitment took place between 1987 and 2001, and median (IQR) follow-up time was 23.9 years (20.1-27.1) years. The study was conducted at 25 public surgical departments and 480 primary health care centers in Sweden and included 2867 women aged 37 to 60 years and with body mass index 38 or greater (calculated as weight in kilograms divided by height in meters squared).

Intervention

In the surgery group (n = 1420), 260 women underwent gastric banding, 970 vertical banded gastroplasty, and 190 gastric bypass. The remaining contemporaneously matched control individuals (n = 1447) received usual obesity care.

Main Outcome and Measures

Breast cancer, the main outcome of this secondary report, was not a predefined outcome in the SOS study. Breast cancer events were identified in the Swedish National Cancer Registry.

Results

The study population comprised 2867 women with a mean (SD) age of 48.0 (6.2) years. During follow-up, there were 154 breast cancer events, 66 in the surgery group and 88 in the usual care group, and a decreased risk of breast cancer was observed in the bariatric surgery group (hazard ratio [HR], 0.68; 95% CI, 0.49-0.94; P = .019; adjusted HR, 0.72; 95% CI, 0.52-1.01; P = .06). The surgical treatment benefit on breast cancer risk was greater in women with baseline insulin levels above the median 15.8 μIU/L (HR, 0.48; 95% CI, 0.31-0.74; P = .001; adjusted HR, 0.55; 95% CI, 0.35-0.86; P = .008) compared to those below (HR, 0.95; 95% CI, 0.59-1.53; P = .84; adjusted HR, 1.01; 95% CI, 0.61-1.66; P = .97; interaction P = .02).

Conclusions and Relevance

This prospective clinical trial indicated a reduced risk of breast cancer after bariatric surgery in women with obesity. The surgical treatment benefit was predominantly seen in women with hyperinsulinemia.

Trial Registration

ClinicalTrials.gov Identifier: NCT01479452.

Efficacy of adjuvant chemotherapy schedules for breast cancer according to body mass index: results from the phase III GIM2 trial

BACKGROUND

The phase III GIM2 trial showed improved disease-free survival (DFS) and overall survival (OS) with adjuvant dose-dense (DD) as compared with standard-interval (SI) chemotherapy in women with node-positive early-stage breast cancer (BC). This exploratory analysis aimed to investigate the benefit of different schedules according to body mass index (BMI) in this trial.

PATIENTS AND METHODS

This analysis explored the efficacy, in terms of DFS and OS, of different chemotherapy schedules according to BMI. Univariate and multivariable Cox proportional hazard models, adjusted for relevant prognostic factors, were used.

RESULTS

Out of 2091 patients enrolled, 1925 with known baseline BMI were randomized in the DD versus SI comparison and therefore included in this analysis: 31.6% were overweight and 19.3% obese. Overweight and obesity were significantly associated with postmenopausal status, pT >2, and pN >2 tumors. After a median follow-up of 15.0 years (interquartile range 8.4-16.3 years), multivariable Cox survival models demonstrated no association of different BMI categories on DFS [adjusted hazard ratio (adjHR) 0.96, 95% confidence interval (CI) 0.80-1.15 and adjHR 1.11, 95% CI 0.91-1.35 for overweight and obese patients, respectively, compared to patients with normal BMI] or OS (adjHR 0.90, 95% CI 0.71-1.14 and adjHR 1.18, 95% CI 0.92-1.52 for overweight and obese patients, respectively). No significant interaction was found between BMI and treatment schedule in terms of DFS (Pfor interaction = 0.56) or OS (Pfor interaction = 0.19). The survival benefit of DD chemotherapy was observed irrespective of different BMI categories, with a more pronounced benefit for overweight and obese patients.

CONCLUSION

In node-positive BC patients, DD schedule should be considered the preferred schedule irrespective of BMI.

Extracellular vesicles in tumor-adipose tissue crosstalk: key drivers and therapeutic targets in cancer cachexia

Cancer cachexia is a complex metabolic syndrome characterized by unintentional loss of skeletal muscle and body fat. This syndrome is frequently associated with different types of cancer and negatively affects the prognosis and outcome of these patients. It involves a dynamic interplay between tumor cells and adipose tissue, where tumor-derived extracellular vesicles (EVs) play a crucial role in mediating intercellular communication. Tumor cells release EVs containing bioactive molecules such as hormones (adrenomedullin, PTHrP), pro-inflammatory cytokines (IL-6), and miRNAs (miR-1304-3p, miR-204-5p, miR-155, miR-425-3p, miR-146b-5p, miR-92a-3p), which can trigger lipolysis and induce the browning of white adipocytes contributing to a cancer cachexia phenotype. On the other hand, adipocyte-derived EVs can reprogram the metabolism of tumor cells by transporting fatty acids and enzymes involved in fatty acid oxidation, resulting in tumor growth and progression. These vesicles also carry leptin and key miRNAs (miR-155-5p, miR-10a-3p, miR-30a-3p, miR-32a/b, miR-21), thereby supporting tumor cell proliferation, metastasis formation, and therapy resistance. Understanding the intricate network underlying EV-mediated communication between tumor cells and adipocytes can provide critical insights into the mechanisms driving cancer cachexia. This review consolidates current knowledge on the crosstalk between tumor cells and adipose tissue mediated by EVs and offers valuable insights for future research. It also addresses controversial topics in the field and possible therapeutic approaches to manage cancer cachexia and ultimately improve patient outcomes and quality of life.

Exploring the multifaceted role of obesity in breast cancer progression

Obesity is a multifaceted metabolic disorder characterized by excessive accumulation of adipose tissue. It is a well-established risk factor for the development and progression of breast cancer. Adipose tissue, which was once regarded solely as a passive energy storage depot, is now acknowledged as an active endocrine organ producing a plethora of bioactive molecules known as adipokines that contribute to the elevation of proinflammatory cytokines and estrogen production due to enhanced aromatase activity. In the context of breast cancer, the crosstalk between adipocytes and cancer cells within the adipose microenvironment exerts profound effects on tumor initiation, progression, and therapeutic resistance. Moreover, adipocytes can engage in direct interactions with breast cancer cells through physical contact and paracrine signaling, thereby facilitating cancer cell survival and invasion. This review endeavors to summarize the current understanding of the intricate interplay between adipocyte-associated factors and breast cancer progression. Furthermore, by discussing the different aspects of breast cancer that can be adversely affected by obesity, this review aims to shed light on potential avenues for new and novel therapeutic interventions.

Specificities of mammary and periprostatic adipose tissues: A perspective from cancer research

In addition to the major subcutaneous and visceral adipose tissues (AT), other adipose depots are dispersed throughout the body and are found in close interaction with proximal organs such as mammary and periprostatic AT (MAT and PPAT respectively). These ATs have an effect on proximal organ function during physiological processes and diseases such as cancer. We highlighted here some of their most distinctive features in terms of tissular organization and responses to external stimuli and discussed how obesity affects them based on our current knowledge.

Body adipose tissue depots and treatment outcomes for women with breast cancer: A systematic review

BACKGROUND & AIMS

Excessive adipose tissue is associated with poorer prognosis in women with breast cancer (BC). However, several body adiposity depots, such as visceral (VAT), subcutaneous (SAT), intermuscular (IMAT), and gluteofemoral adipose tissues (GFAT) may have heterogeneous metabolic roles and health effects in these patients. This systematic review aims to evaluate the impact of different body adipose tissue depots, assessed via computed tomography (CT), on treatment outcomes for women with BC. We hypothesize that distinct body adipose tissue depots may be associated differently with outcomes in patients with BC.

METHODS

A comprehensive bibliographical search was conducted using PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases (until January 2024). The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

The final sample comprised 23 retrospective studies (n = 12,462), with fourteen presenting good quality. A lack of standardization in CT body adipose tissue depots measurement and outcome presentation precluded quantitative analysis. Furthermore, most included studies had heterogeneous clinical characteristics. Survival and treatment response were the most prevalent outcomes. VAT (n = 19) and SAT (n = 17) were the most frequently evaluated depots and their increase was associated with worse outcomes, mainly in terms of survival. IMAT (n = 4) presented contradictory findings and a higher GFAT (n = 1) was associated with better outcomes.

CONCLUSION

This systematic review found an association between increased VAT and SAT with worse outcomes in patients with BC. However, due to the heterogeneity of the included studies, further research with homogeneous methodologies is necessary to better understand the impact of body adipose tissue depots on treatment outcomes. Such knowledge could lead to improved care for this patient population.

An Integrated Care Approach to Improve Well-Being in Breast Cancer Patients

BACKGROUND

Breast cancer (BC) treatment has recently been revolutionized by the introduction of newer targeted agents, that helped tailoring therapies around the single patient. Along with increased survival rates, a careful evaluation of diet, lifestyle habits, physical activity, emotional and psychological experiences linked to the treatment journey, is now mandatory. However, a true proposal for an omnicomprehensive and "integrative" approach is still lacking in literature.

METHODS

A scientific board of internationally recognized specialists throughout different disciplines designed a shared proposal of holistic approach for BC patients.

RESULTS

A narrative review, containing information on BC treatment, endocrinological and diet aspects, physical activity, rehabilitation, integrative medicine, and digital narrative medicine, was developed.

CONCLUSIONS

In the context of a patient-centered care, BC treatment cannot be separated from a patient's long-term follow-up and care, and an organized interdisciplinary collaboration is the future in this disease's cure, to make sure that our patients will live longer and better.

TRIAL REGISTRATION

NCT05893368: New Model for Integrating Person-based Care (PbC) in the Treatment of Advanced HER2-negative Breast Cancer (PERGIQUAL). Registration date: 29th May 2023.

Ginsenoside Rg3 overcomes tamoxifen resistance through inhibiting glycolysis in breast cancer cells

Tamoxifen (TAM) resistance poses a significant clinical challenge in human breast cancer and exhibits high heterogeneity among different patients. Rg3, an original ginsenoside known to inhibit tumor growth, has shown potential for enhancing TAM sensitivity in breast cancer cells. However, the specific role and underlying mechanisms of Rg3 in this context remain unclear. Aerobic glycolysis, a metabolic process, has been implicated in chemotherapeutic resistance. In this study, we demonstrate that elevated glycolysis plays a central role in TAM resistance and can be effectively targeted and overcome by Rg3. Mechanistically, we observed upregulation of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3 (PFKFB3), a key mediator of glycolysis, in TAM-resistant MCF-7/TamR and T-47D/TamR cells. Crucially, PFKFB3 is indispensable for the synergistic effect of TAM and Rg3 combination therapy, which suppresses cell proliferation and glycolysis in MCF-7/TamR and T-47D/TamR cells, both in vitro and in vivo. Moreover, overexpression of PFKFB3 in MCF-7 cells mimicked the TAM resistance phenotype. Importantly, combination treatment significantly reduced TAM-resistant MCF-7 cell proliferation in an in vivo model. In conclusion, this study highlights the contribution of Rg3 in enhancing the therapeutic efficacy of TAM in breast cancer, and suggests that targeting TAM-resistant PFKFB3 overexpression may represent a promising strategy to improve the response to combination therapy in breast cancer.

Modeling of Mouse Experiments Suggests that Optimal Anti-Hormonal Treatment for Breast Cancer is Diet-Dependent

Estrogen receptor positive breast cancer is frequently treated with anti-hormonal treatment such as aromatase inhibitors (AI). Interestingly, a high body mass index has been shown to have a negative impact on AI efficacy, most likely due to disturbances in steroid metabolism and adipokine production. Here, we propose a mathematical model based on a system of ordinary differential equations to investigate the effect of high-fat diet on tumor growth. We inform the model with data from mouse experiments, where the animals are fed with high-fat or control (normal) diet. By incorporating AI treatment with drug resistance into the model and by solving optimal control problems we found differential responses for control and high-fat diet. To the best of our knowledge, this is the first attempt to model optimal anti-hormonal treatment for breast cancer in the presence of drug resistance. Our results underline the importance of considering high-fat diet and obesity as factors influencing clinical outcomes during anti-hormonal therapies in breast cancer patients.

Inversion of the Warburg Effect: Unraveling the Metabolic Nexus between Obesity and Cancer

Obesity is a well-established risk factor for cancer, significantly impacting both cancer incidence and mortality. However, the intricate molecular mechanisms connecting adipose tissue to cancer cell metabolism are not fully understood. This Review explores the historical context of tumor energy metabolism research, tracing its origins to Otto Warburg's pioneering work in 1920. Warburg's discovery of the "Warburg effect", wherein cancer cells prefer anaerobic glycolysis even in the presence of oxygen, laid the foundation for understanding cancer metabolism. Building upon this foundation, the "reverse Warburg effect" emerged in 2009, elucidating the role of aerobic glycolysis in cancer-associated fibroblasts (CAFs) and its contribution to lactate accumulation in the tumor microenvironment, subsequently serving as a metabolic substrate for cancer cells. In contrast, within high-adiposity contexts, cancer cells exhibit a unique metabolic shift termed the "inversion of the Warburg effect". This phenomenon, distinct from the stromal-dependent reverse Warburg effect, relies on increased nutrient abundance in obesity environments, leading to the generation of glucose from lactate as a metabolic substrate. This Review underscores the heightened tumor proliferation and aggressiveness associated with obesity, introducing the "inversion of the Warburg effect" as a novel mechanism rooted in the altered metabolic landscape within an obese milieu. The insights presented here open promising avenues for therapeutic exploration, offering fresh perspectives and opportunities for the development of innovative cancer treatment strategies.

Induction of Fatty Acid Oxidation Underlies DNA Damage-Induced Cell Death and Ameliorates Obesity-Driven Chemoresistance

The DNA damage response is essential for preserving genome integrity and eliminating damaged cells. Although cellular metabolism plays a central role in cell fate decision between proliferation, survival, or death, the metabolic response to DNA damage remains largely obscure. Here, this work shows that DNA damage induces fatty acid oxidation (FAO), which is required for DNA damage-induced cell death. Mechanistically, FAO induction increases cellular acetyl-CoA levels and promotes N-alpha-acetylation of caspase-2, leading to cell death. Whereas chemotherapy increases FAO related genes through peroxisome proliferator-activated receptor α (PPARα), accelerated hypoxia-inducible factor-1α stabilization by tumor cells in obese mice impedes the upregulation of FAO, which contributes to its chemoresistance. Finally, this work finds that improving FAO by PPARα activation ameliorates obesity-driven chemoresistance and enhances the outcomes of chemotherapy in obese mice. These findings reveal the shift toward FAO induction is an important metabolic response to DNA damage and may provide effective therapeutic strategies for cancer patients with obesity.

Oscillatory Hypoxia Can Induce Senescence of Adipose-Derived Mesenchymal Stromal Cells Potentiating Invasive Transformation of Breast Epithelial Cells

Obesity is strongly associated with occurrence, metastasis, and resistance to therapy in breast cancers, which also exhibit high adipose content in the tumor microenvironment. Adipose tissue-derived mesenchymal stromal cells (ASCs) are recruited to breast cancer by many mechanisms, including hypoxia, and contribute to metastatic transition of the cancer. Breast cancers are characterized by regions of hypoxia, which can be temporally unstable owing to a mismatch between oxygen supply and consumption. Using a high-sensitivity nanopatterned stromal invasion assay, we found that ASCs could promote stromal invasion of not only breast cancer cell lines but also MCF10A1, a cell line derived from untransformed breast epithelium. RNA sequencing of MCF10A1 cells conditioned with medium from ASCs revealed upregulation of genes associated with increased cell migration, chemotaxis, and metastasis. Furthermore, we found that fluctuating or oscillating hypoxia could induce senescence in ASCs, which could result in an increased invasive potential in the treated MCF10A1 cells. These findings highlight the complex interplay within the breast cancer microenvironment, hypoxia, and the role of ASCs in transforming even non-cancerous breast epithelium toward an invasive phenotype, providing insights into early metastatic events.

Elevated extracellular matrix protein 1 in circulating extracellular vesicles supports breast cancer progression under obesity conditions

The cargo content in small extracellular vesicles (sEVs) changes under pathological conditions. Our data shows that in obesity, extracellular matrix protein 1 (ECM1) protein levels are significantly increased in circulating sEVs, which is dependent on integrin-β2. Knockdown of integrin-β2 does not affect cellular ECM1 protein levels but significantly reduces ECM1 protein levels in the sEVs released by these cells. In breast cancer (BC), overexpressing ECM1 increases matrix metalloproteinase 3 (MMP3) and S100A/B protein levels. Interestingly, sEVs purified from high-fat diet-induced obesity mice (D-sEVs) deliver more ECM1 protein to BC cells compared to sEVs from control diet-fed mice. Consequently, BC cells secrete more ECM1 protein, which promotes cancer cell invasion and migration. D-sEVs treatment also significantly enhances ECM1-mediated BC metastasis and growth in mouse models, as evidenced by the elevated tumor levels of MMP3 and S100A/B. Our study reveals a mechanism and suggests sEV-based strategies for treating obesity-associated BC.

The impact of BMI on breast cancer - an updated systematic review and meta-analysis

BACKGROUND

Breast cancer is the most frequent form of cancer in women all over the world. It is the main cause of cancer death and the most often diagnosed cancer in women in 140 of the world's 184 countries. The link between breast cancer risk and body mass index (BMI) has gotten increasing attention in recent years, although the results are still debatable. Therefore, the current systematic review and meta-analysis evaluate the impact of BMI on breast cancer.

METHODS

The current study was carried out as a systematic review and meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched Cochrane, Google Scholar, PubMed, EMBASE and Scopus databases to identify eligible articles impact of BMI on breast cancer with the appropriate Medical Subject Headings (MeSH). The Newcastle-Ottawa checklist was used for the risk of assessment for the included studies. Meta-analysis was performed using Review Manager 5.3 software.

RESULTS

Forty-six studies were included in the current review, which met the selection criteria of the current review. Among included 46 studies in this review, 50% (n = 23) of the studies found the HER2 type of breast cancer followed by triple-negative and HR-positive. The obesity was significantly higher in the case group compared with the control group (P < .001). Heterogeneity between the 14 studies is medium (I2 = 72%). In this review, there was no significant relation between overweight and breast cancer in women (P > .05). Heterogenecity between the 14 studies is medium (I2 = 89%). However, after removing the publication bias a significant relation between overweightness and breast cancer in women (P = .0005) was observed.

CONCLUSION

Obese breast cancer patients are a specific type of patient. They are more likely to develop cancer. Their need to surgery and radiation may cause greater difficulties. Obesity and overweight in women greatly increase the risk of breast cancer, according to the findings of the current meta-analysis. To confirm these findings and understand the pathogenic pathways, more research is required.

Association between dietary inflammatory index and body fat percentage among newly diagnosed breast cancer patients

BACKGROUND

Obesity, particularly excessive body fat, is an established risk factor and substantial prognostic determinant in breast cancer. Recent studies suggested that diet-related inflammation plays a key role in obesity. This study aimed to determine the association between energy-adjusted dietary inflammatory index (E-DII) and body composition, particularly body fat percentage, among patients with newly diagnosed breast cancer.

MATERIALS AND METHODS

This cross-sectional study was conducted on 124 breast cancer outpatients within the first year of diagnosis and yet to commence oncological treatment. Body composition parameters [body weight, body mass index (BMI), body fat percentage, fat mass over fat-free mass ratio (FM/FFM), muscle mass, and visceral fat] were obtained using a bioelectrical impedance analyzer. Body fat percentage was categorized into two groups which were normal (<35%) and high (≥35%). The E-DII was calculated from the validated 165-items Food Frequency Questionnaire (FFQ) and categorized into three groups or tertiles. Multiple logistic regression analysis was used to determine the association between the E-DII and body fat percentage.

RESULTS

Mean body weight, body fat percentage, FM/FFM, and visceral fat increased as E-DII increased from the lowest tertile (T1) to the most pro-inflammatory tertile (T3) (p for trend <0.05). E-DII was positively associated with body fat percentage (OR 2.952; 95% CI 1.154-7.556; p = 0.024) and remained significant after adjustment for cancer stage, age, physical activity, ethnicity, smoking history, and presence of comorbidities. Compared to T1, participants in T3 had a significantly lower consumption of fiber, vitamin A, beta-carotene, vitamin C, iron, thiamine, riboflavin, niacin, vitamin B6, folic acid, zinc, magnesium, and selenium, but a higher intake of total fat, saturated fat, and monounsaturated fatty acids.

CONCLUSIONS

A higher E-DII was associated with increased body fat percentage, suggesting the potential of advocating anti-inflammatory diet to combat obesity among newly diagnosed breast cancer patients.

Identification of lysyl oxidase as an adipocyte-secreted mediator that promotes a partial mesenchymal-to-epithelial transition in MDA-MB-231 cells

Aim

Breast cancer (BC) is the most common cancer in women worldwide, where adiposity has been linked to BC morbidity. In general, obese premenopausal women diagnosed with triple-negative BC (TNBC) tend to have larger tumours with more metastases, particularly to the bone marrow, and worse prognosis. Previous work using a 3-dimensional (3D) co-culture system consisting of TNBC cells, adipocytes and the laminin-rich extracellular matrix (ECM) trademarked as Matrigel, demonstrated that adipocytes and adipocyte-derived conditioned media (CM) caused a partial mesenchymal-to-epithelial transition (MET). Given that MET has been associated with secondary tumour formation, this study sought to identify molecular mediators responsible for this phenotypic change.

Methods

Adipocytes were cultured with and without Matrigel, where semi-quantitative proteomics was used to identify proteins whose presence in the CM was induced or enhanced by Matrigel, which were referred to as adipocyte-secreted ECM-induced proteins (AEPs). The AEPs identified were assessed for association with prognosis in published proteomic datasets and prior literature. Of these, 4 were evaluated by the reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA), followed by a functional and MET marker analysis of 1 AEP on MDA-MB-231 cells grown on Matrigel or as monolayers.

Results

The 4 AEPs showed a positive correlation between protein expression and poor prognosis. RT-qPCR analysis reported no significant change in AEPs mRNA expression. However, lysyl oxidase (LOX) was increased in CM of ECM-exposed adipocytes. Recombinant LOX (rLOX) caused the mesenchymal MDA-MB-231 TNBC cells to form less branched 3D structures and reduced the expression of vimentin.

Conclusions

The data suggest that adipocyte-secreted LOX changes the mesenchymal phenotype of BC cells in a manner that could promote secondary tumour formation, particularly at sites high in adipocytes such as the bone marrow. Future efforts should focus on determining whether targeting LOX could reduce BC metastasis in obese individuals.

The impact of body mass index on survival endpoints among patients with metastatic urothelial carcinoma undergoing treatment with immune checkpoint inhibitors: A real-world multicenter analysis

BACKGROUND

Studies on the correlation between high body mass index (BMI) and extended survival among patients receiving immune checkpoint inhibitors (ICIs) have been made, although findings have shown variability. Our research explored the phenomenon of the "obesity paradox" in patients with metastatic urothelial carcinoma (mUC) undergoing treatment with ICIs.

MATERIALS AND METHODS

We conducted a retrospective analysis of patients diagnosed with mUC who received a minimum of one cycle of ICI treatment at two medical centers in Taiwan from September 2015 to January 2023. Features of patients' clinicopathologic factors, including age, sex, primary or metastatic location, treatment line, and BMI were examined. The primary outcome were overall survival (OS) and progression-free survival (PFS), which were assessed utilizing the Kaplan-Meier method. We employed the Cox-regression model to adjust for multiple covariates.

RESULTS

A total of 215 patients were included, with 128 (59.5%) being male, and the median age was 70 years. In the obese group (BMI ≥25 kg/m2 ), patients demonstrated significantly better median OS compared to the non-obese group (BMI <25 kg/m2 ) (21.9 vs. 8.3 months; p = 0.021). However, there was no significant difference in median PFS between the high and low BMI groups (4.7 vs. 2.8 months; p = 0.16). Post-hoc subgroup revealed a survival benefit from ICI treatment in male patients within the BMI ≥25 kg/m2 group (HR 0.49, 95% CI 0.30-0.81, p = 0.005).

CONCLUSION

Based on real-world data from the Asia-Pacific region, there appears to be a correlation between obesity and prolonged OS in patients receiving ICI treatment for mUC.

Liraglutide attenuates obese-associated breast cancer cell proliferation via inhibiting PI3K/Akt/mTOR signaling pathway

This study aims to explore the anti-proliferative, pro-apoptotic, and anti-migration activities of liraglutide (LGT) in MCF-7 breast cancer (BC) cells in subjects with obesity, particularly its effects on the PI3K/Akt/mTOR/AMPK pathway. The role of AMPK/SIRT-1, an essential regulator of adipokine production, in the effect of LGT on the production of adipose-derived adipokine was also assessed. MCF-7 cells were incubated in conditioned medium (CM) generated from adipose-derived stem cells (ADSCs) of obese subjects. MCF-7 cells were then treated with LGT for 72 h. Anti-proliferative, pro-apoptotic, and anti-migration activities were investigated using alamarBlue, annexin V stain, and scratch assay, respectively. Protein levels of phosphorylated PI3K, p-Akt, p-mTOR, and p-AMPK were investigated using immunoblotting. Levels of adipokines in ADSCs were determined using RT-PCR before and after transfection of ADSCs using the specific small interference RNA sequences for AMPK and SIRT-1. LGT evoked anti-proliferative, apoptotic, and potential anti-migratory properties on MCF-7 cells incubated in CM from obese ADSCs and significantly mitigated the activity of the PI3K/Akt/mTOR survival pathway-but not AMPK-in MCF-7 cells. Furthermore, the anti-proliferative effects afforded by LGT were similar to those mediated by LY294002 (PI3K inhibitor) and rapamycin (mTOR inhibitor). Our results reveal that transfection of AMPK/SIRT-1 genes did not affect the beneficial role of LGT in the expression of adipokines in ADSCs. In conclusion, LGT elicits anti-proliferative, apoptotic, and anti-migratory effects on BC cells in obese conditions by suppressing the activity of survival pathways; however, this effect is independent of the AMPK/SIRT1 pathway in ADSCs or AMPK in BC cells.

The prognostic impact of body mass index in breast cancer according to tumor subtype

PURPOSE

Several studies demonstrated that obesity and underweight were negatively associated with outcomes of breast cancer. However, the results are still controversial, and the impact of body mass index (BMI) on distant metastasis-free survival (MFS), which might directly affect mortality, was less well evaluated. Our study aimed to verify the prognostic effect of BMI in breast cancer.

METHODS

A retrospective analysis of 504 patients with stage I-III breast cancer who underwent surgery from January 2005 to December 2013 was performed. The patients were divided into three groups according to preoperative BMI: underweight <18.5 kg/m2, normal weight 18.5-24.9 kg/m2, and overweight ≥25 kg/m2. The association between body weight status and breast cancer recurrence was analyzed. Subgroup analysis by tumor subtype according to receptor status was also performed.

RESULTS

The median follow-up period was 88 months. For disease recurrence, histologic grade and human epidermal growth factor receptor 2 (HER2)-positivity were independent prognostic factors in multivariate analysis. Stage, histologic grade, HER2-positivity, and BMI status were independent prognostic factors for distant metastasis. In survival analysis, overweight and underweight were significant predisposing factors for MFS, but not for disease-free survival (DFS). In the estrogen receptor (ER)-positive group, overweight and underweight patients had significantly worse DFS and MFS than normal weight patients. In the ER-negative or HER2-positive group, BMI status had no significant association with DFS and MFS.

CONCLUSION

The prognostic role of BMI on the survival outcomes of patients with breast cancer was different by tumor subtype. In ER-positive patients, overweight and underweight statuses had a negative prognostic effect on DFS and MFS, respectively.

A remarkable response to palliative treatment in metastatic breast cancer: A case report and comprehensive literature review

The case report describes a patient with stage IV breast cancer which metastasized to the lungs. The patient's initial computed tomography (CT) scan revealed a malignant lesion in the upper outer quadrant of the left breast and multiple pulmonary nodules, suggesting pulmonary metastasis. After starting palliative chemotherapy with intravenous paclitaxel and subcutaneous injections of Herceptin, a follow-up CT scan 3 months after the initiation of treatment showed the disappearance of metastasis, and her cancer regressed to stage II breast cancer that could be surgically resected. This case report highlights the importance of timely and appropriate palliative treatment measures, which can lead to unexpected outcomes, such as the regression of metastatic lesions and the possibility of curative treatment in such advanced cancer.

The Effect of Adipocyte-Secreted Factors in Activating Focal Adhesion Kinase-Mediated Cell Signaling Pathway towards Metastasis in Breast Cancer Cells

Obesity-associated perturbations in the normal secretion of adipocytokines from white adipocytes can drive the metastatic progression of cancer. However, the association between obesity-induced changes in secretory factors of white adipocytes and subsequent transactivation of the downstream effector proteins impacting metastasis in breast cancer cells remains unclear. Focal adhesion kinase, a cytoplasmic signal transducer, regulates the biological phenomenon of metastasis by activating downstream targets such as beta-catenin and MMP9. Thus, the possible role of phosphorylated FAK in potentiating cancer cell migration was investigated. To elucidate this potential relationship, MCF7 (ER+), MDA-MB-231 (Triple Negative) breast cancer cells, and MCF-10A non-tumorigenic breast cells were exposed to in vitro murine adipocyte-conditioned medium derived from 3T3-L1 MBX cells differentiated to obesity with fatty acid supplementation. Our results show that the conditioned medium derived from these obese adipocytes enhanced motility and invasiveness of breast cancer cells. Importantly, no such changes were observed in the non-tumorigenic breast cells. Our results also show that increased FAK autophosphorylation was followed by increased expression of beta-catenin and MMP9 in the breast cancer cells when exposed to obese adipocyte-conditioned medium, but not in the MCF10A cells. These results indicate that adipocyte-derived secretory factors induced FAK activation through phosphorylation. This in turn increased breast cancer cell migration and invasion by activating its downstream effector proteins beta-catenin and MMP9.

Adipocyte regulation of cancer stem cells

Cancer stem cells (CSCs) are a highly tumorigenic subpopulation of the cancer cells within a tumor that drive tumor initiation, progression, and therapy resistance. In general, stem cell niche provides a specific microenvironment in which stem cells are present in an undifferentiated and self-renewable state. CSC niche is a specialized tumor microenvironment for CSCs which provides cues for their maintenance and propagation. However, molecular mechanisms for the CSC-niche interaction remain to be elucidated. We have revealed that adipsin (complement factor D) and its downstream effector hepatocyte growth factor are secreted from adipocytes and enhance the CSC properties in breast cancers in which tumor initiation and progression are constantly associated with the surrounding adipose tissue. Considering that obesity, characterized by excess adipose tissue, is associated with an increased risk of multiple cancers, it is reasonably speculated that adipocyte-CSC interaction is similarly involved in many types of cancers, such as pancreas, colorectal, and ovarian cancers. In this review, various molecular mechanisms by which adipocytes regulate CSCs, including secretion of adipokines, extracellular matrix production, biosynthesis of estrogen, metabolism, and exosome, are discussed. Uncovering the roles of adipocytes in the CSC niche will propose novel strategies to treat cancers, especially those whose progression is linked to obesity.