Background To evaluate the relationship between body mass index (BMI) and response to neoadjuvant chemotherapy (NCT) for breast cancer among Chinese women. Patients and Methods A total of 307 eligible patients were assigned to receive four cycles of paclitaxel and carboplatin before standard surgery for breast cancer from 2007 to 2011 at Shanghai Cancer Hospital. The patients were categorized as obese, overweight, normal weight, or underweight based on BMI according to World Health Organization (WHO) criteria. Pathological complete response (pCR) was defined as no invasive cancer in the breast or axillary tissue. A logistic regression and the Chi-squared test were used for detecting the predictors of pCR and determining the relationship between BMI category and pCR rate in the subgroup analysis with respect to other variables. Results Categorical BMI, estrogen receptor (ER), and progesterone receptor (PR) status were independent predictors of pCR according to the multivariate analysis. Patients with BMI≥25 were less likely to achieve a pCR to NCT compared with patients with BMI<25 (Odds ratio: 0.454, p = 0.033, multivariate analysis). In the subgroup analysis, the predictive value of BMI for pCR to NCT was significantly shown in post-menopausal patients (p = 0.004) and hormonal receptor status-negative patients (p = 0.038). The incidence of treatment-induced toxicity was similar among the different BMI categories. Conclusion Higher BMI was associated with worse pCR to NCT. Further approaches to investigating the mechanism of this influence of BMI on treatment response and a more appropriate schedule for calculating NCT dose for high-BMI-patients should be considered.
References
[1]
van den Brandt PA, Spiegelman D, Yaun SS, Adami HO, Beeson L, et al. (2000) Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol 152: 514–527.
[2]
Lahmann PH, Hoffmann K, Allen N, van Gils CH, Khaw KT, et al. (2004) Body size and breast cancer risk: findings from the European Prospective Investigation into Cancer And Nutrition (EPIC). Int J Cancer 111: 762–771.
[3]
Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23: 1370–1378.
[4]
Tartter PI, Papatestas AE, Ioannovich J, Mulvihill MN, Lesnick G, et al. (1981) Cholesterol and obesity as prognostic factors in breast cancer. Cancer 47: 2222–2227.
[5]
Caan BJ, Kwan ML, Hartzell G, Castillo A, Slattery ML, et al. (2008) Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control 19: 1319–1328.
[6]
Dawood S, Broglio K, Gonzalez-Angulo AM, Kau SW, Islam R, et al. (2008) Prognostic value of body mass index in locally advanced breast cancer. Clin Cancer Res 14: 1718–1725.
[7]
Nahleh Z (2011) Breast cancer, obesity and hormonal imbalance: a worrisome trend. Expert Rev Anticancer Ther 11: 817–819.
[8]
Ewertz M, Jensen MB, Gunnarsdottir KA, Hojris I, Jakobsen EH, et al. (2011) Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 29: 25–31.
[9]
Carmichael AR (2006) Obesity and prognosis of breast cancer. Obes Rev 7: 333–340.
[10]
Litton JK, Gonzalez-Angulo AM, Warneke CL, Buzdar AU, Kau SW, et al. (2008) Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer. J Clin Oncol 26: 4072–4077.
[11]
Chen XS, Nie XQ, Chen CM, Wu JY, Wu J, et al. (2010) Weekly paclitaxel plus carboplatin is an effective nonanthracycline-containing regimen as neoadjuvant chemotherapy for breast cancer. Ann Oncol 21: 961–967.
[12]
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr 68: 899–917.
[13]
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, et al. (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45: 228–247.
[14]
Carmichael AR, Bendall S, Lockerbie L, Prescott RJ, Bates T (2004) Does obesity compromise survival in women with breast cancer? Breast 13: 93–96.
[15]
Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, et al. (1999) Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol 17: 460–469.
[16]
Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, et al. (2008) Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol 26: 778–785.
[17]
Maehle BO, Tretli S, Skjaerven R, Thorsen T (2001) Premorbid body weight and its relations to primary tumour diameter in breast cancer patients; its dependence on estrogen and progesteron receptor status. Breast Cancer Res Treat 68: 159–169.
[18]
Schapira DV, Kumar NB, Lyman GH, Cox CE (1991) Obesity and body fat distribution and breast cancer prognosis. Cancer 67: 523–528.
[19]
Enger SM, Ross RK, Paganini-Hill A, Carpenter CL, Bernstein L (2000) Body size, physical activity, and breast cancer hormone receptor status: results from two case-control studies. Cancer Epidemiol Biomarkers Prev 9: 681–687.
[20]
Carmichael AR, Bates T (2004) Obesity and breast cancer: a review of the literature. Breast 13: 85–92.
[21]
Dal Maso L, Zucchetto A, Talamini R, Serraino D, Stocco CF, et al. (2008) Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer 123: 2188–2194.
[22]
Loi S, Milne RL, Friedlander ML, McCredie MR, Giles GG, et al. (2005) Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 14: 1686–1691.
[23]
Chen X, Lu W, Zheng W, Gu K, Chen Z, et al. (2010) Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat 122: 823–833.
[24]
Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, et al. (2010) Risk factors for lymphedema in a prospective breast cancer survivorship study: the Pathways Study. Arch Surg 145: 1055–1063.
[25]
Poikonen P, Blomqvist C, Joensuu H (2001) Effect of obesity on the leukocyte nadir in women treated with adjuvant cyclophosphamide, methotrexate, and fluorouracil dosed according to body surface area. Acta Oncol 40: 67–71.
