Impact of body mass index on neoadjuvant treatment outcome: a pooled analysis of eight prospective neoadjuvant breast cancer trials
Impact of body mass index on neoadjuvant treatment outcome: a pooled analysis of eight prospective neoadjuvant breast cancer trials
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DOI：
10.1007/s10549-015-3287-5
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发表时间：
2015-02-01
影响因子：
3.8
通讯作者：
Loibl, Sibylle
中科院分区：
文献类型：
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作者：
Fontanella, Caterina;Lederer, Bianca;Loibl, Sibylle
肥胖与乳腺癌（BC）风险增加和预后较差有关。根据接受新辅助化疗的原发性BC患者的BC亚型，我们评估了体重指数（BMI）对病理完全缓解（pCR）、无病（DFS）和总生存（OS）的影响。来自8项新辅助试验的8872例原发性BC患者根据BMI进行了分类：体重不足（< 18.5 kg/m(2)）、正常体重（18.5至< 25 kg/m(2)）、超重（25至< 30 kg/m(2)）、肥胖（30至< 40 kg/m(2)）和非常肥胖（千分之一/ 40 kg/m(2)）。BC亚型被定义为发光样（ER/PgR阳性和HER2阴性）、HER2/luminal （ER/PgR阳性和HER2阳性）、HER2样（ER/PgR阴性和HER2阳性）和三阴性（TNBC； ER/PgR-和HER2阴性）。正常体重组的pCR率高于其他BMI组（P = 0.003）。肥胖患者（87.3个月，P = 0.014和94.9个月，P = 0.001）和非常肥胖患者（66.6个月，P < 0.001和75.3个月，P < 0.001）的平均DFS和OS短于正常体重患者（91.5和98.8个月），亚群体治疗效果模式图分析证实了这一点，并且在luminal-like和TNBC中是一致的。BMI与pCR无交互作用。与所有其他BMI组相比，体重正常的患者经历较少的非血液学不良事件（P = 0.002），并且更有可能接受全紫杉烷剂量（P < 0.001）。在多变量分析中，紫杉烷的剂量对pCR有预测作用（P < 0.001）。较高的BMI与较低的pCR和对生存的不利影响相关。体重正常的患者对化疗的依从性最好，接受的紫杉烷剂量最高，这似乎与治疗结果有关。
Obesity is associated with an increased risk of breast cancer (BC) and poorer outcome. We assessed the impact of body mass index (BMI) on pathological complete response (pCR), disease-free (DFS), and overall survival (OS), according to BC subtypes in patients with primary BC treated with neoadjuvant chemotherapy. 8,872 patients with primary BC from eight neoadjuvant trials were categorized according to BMI: underweight (< 18.5 kg/m(2)), normal weight (18.5 to < 25 kg/m(2)), overweight (25 to < 30 kg/m(2)), obese (30 to < 40 kg/m(2)), and very obese (a parts per thousand yen40 kg/m(2)). BC subtypes were defined as luminal-like (ER/PgR-positive and HER2-negative), HER2/luminal (ER/PgR-positive and HER2-positive), HER2-like (ER/PgR-negative and HER2-positive), and triple-negative (TNBC; ER/PgR- and HER2-negative). pCR rate was higher in normal weight patients compared with all other BMI groups (P = 0.003). Mean DFS and OS were shorter in obese (87.3 months, P = 0.014 and 94.9 months, P = 0.001, respectively) and very obese (66.6 months, P < 0.001 and 75.3 months, P < 0.001, respectively) compared with normal weight patients (91.5 and 98.8 months, respectively) which was confirmed by subpopulation treatment effect pattern plot analyses and was consistent in luminal-like and TNBC. No interaction was observed between BMI and pCR. Normal weight patients experienced less non-hematological adverse events (P = 0.002) and were more likely to receive full taxane doses (P < 0.001) compared with all other BMI groups. In multivariable analysis, the dose of taxanes was predictive for pCR (P < 0.001). Higher BMI was associated with lower pCR and a detrimental impact on survival. Normal weight patients had the best compliance to chemotherapy and received the highest taxane doses, which seems to be related with treatment outcomes.