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Relationship Between Obesity and Pathologic Response to Neoadjuvant Chemotherapy Among Women With Operable Breast Cancer

Jennifer K. Litton, Ana M. Gonzalez-Angulo, Carla L. Warneke, Aman U. Buzdar, Shu-Wan Kau, Melissa Bondy, Somdat Mahabir, Gabriel N. Hortobagyi, Abenaa M. Brewster

From the Departments of Breast Medical Oncology, Epidemiology, and Clinical Cancer Prevention and Division of Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, TX

Corresponding author: Abenaa M. Brewster MD, MHS, PO Box 301439, Houston, TX 77230-1439; e-mail: abrewster{at}mdanderson.org

Purpose To understand the mechanism through which obesity in breast cancer patients is associated with poorer outcome, we evaluated body mass index (BMI) and response to neoadjuvant chemotherapy (NC) in women with operable breast cancer.

Patients and Methods From May 1990 to July 2004, 1,169 patients were diagnosed with invasive breast cancer at M. D. Anderson Cancer Center and received NC before surgery. Patients were categorized as obese (BMI 30 kg/m²), overweight (BMI of 25 to < 30 kg/m²), or normal/underweight (BMI < 25 kg/m²). Logistic regression was used to examine associations between BMI and pathologic complete response (pCR). Breast cancer–specific, progression-free, and overall survival times were examined using the Kaplan-Meier method and Cox proportional hazards regression analysis. All statistical tests were two-sided.

Results Median age was 50 years; 30% of patients were obese, 32% were overweight, and 38% were normal or underweight. In multivariate analysis, there was no significant difference in pCR for obese compared with normal weight patients (odds ratio [OR] = 0.78; 95% CI, 0.49 to 1.26). Overweight and the combination of overweight and obese patients were significantly less likely to have a pCR (OR = 0.59; 95% CI, 0.37 to 0.95; and OR = 0.67; 95% CI, 0.45 to 0.99, respectively). Obese patients were more likely to have hormone-negative tumors (P < .01), stage III tumors (P < .01), and worse overall survival (P = .006) at a median follow-up time of 4.1 years.

Conclusion Higher BMI was associated with worse pCR to NC. In addition, its association with worse overall survival suggests that greater attention should be focused on this risk factor to optimize the care of breast cancer patients.

Presented in part at the 43rd Annual Meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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This article has been cited by other articles:

				E. Andreopoulou and G. N. Hortobagyi In Reply J. Clin. Oncol., March 1, 2009; 27(7): 1147 - 1148. [Full Text] [PDF]

				J. K. Litton and A. M. Brewster In Reply J. Clin. Oncol., February 10, 2009; 27(5): 830 - 831. [Full Text] [PDF]

				H. W. Daniell Weight Loss After Breast Cancer Diagnosis May Not Improve Prognosis J. Clin. Oncol., February 10, 2009; 27(5): 829 - 830. [Full Text] [PDF]

				J. J. Griggs and M. S. Sabel Obesity and Cancer Treatment: Weighing the Evidence J. Clin. Oncol., September 1, 2008; 26(25): 4060 - 4062. [Full Text] [PDF]