title: Effects of obesity on presentation of breast cancer, lymph node metastasis and patient survival: a retrospective review.
abstract: BACKGROUND
  As data on the relation between obesity and lymph node ratio are missing in the literature, we here aimed to assess the impact of obesity on this parameter and other clinicopathological features of breast cancer cases and patient survival.
  
  
  METHODS
  Medical data of 646 patients, all referred to two centers in Tehran, Iran, were reviewed. Factors that showed significant association on univariate analysis were entered in a regression model. Kaplan-Meier and Cox-regression were employed for survival analysis.
  
  
  RESULTS
  Obesity was correlated with the expression of estrogen and progesterone receptor (p=0.004 and p=0.039, respectively), metastasis to axillary lymph nodes (p=0.017), higher lymph node rate (p<0.001) and larger tumor size (p<0.001). The effect of obesity was stronger in premenopausal women. There was no association between obesity and expression of human epidermal growth factor receptor. Three factors showed independent association with BMI on multivariate analysis; tumor size, estrogen receptor and lymph node ratio. Obesity was predictive of shorter disease-free survival with a hazard ratio of 3.324 (95%CI: 1.225-9.017) after controlling for the above-mentioned variables.
  
  
  CONCLUSIONS
  The findings of this study support the idea that obese women experience more advanced disease with higher axillary lymph node ratio, and therefore higher stage at the time of diagnosis. Furthermore, obesity was associated with poorer survival independent of lymph node rate.
authors.affiliation: Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran. akaviani@tums.ac.ir
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kaviani
authors.forename: Mohamadreza
authors.initials: M
authors.lastname: Neishaboury
authors.forename: Narjes
authors.initials: N
authors.lastname: Mohammadzadeh
authors.forename: Maryam
authors.initials: M
authors.lastname: Ansari-Damavandi
authors.forename: Khatereh
authors.initials: K
authors.lastname: Jamei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human