title: Obesity, diabetes, and survival outcomes in a large cohort of early-stage breast cancer patients.
abstract: BACKGROUND
  To determine the relationship between obesity, diabetes, and survival in a large cohort of breast cancer patients receiving modern chemotherapy and endocrine therapy.
  
  
  METHODS
  We identified 6342 patients with stage I-III breast cancer treated between 1996 and 2005. Patients were evaluated according to body mass index (BMI) category and diabetes status.
  
  
  RESULTS
  In a multivariate model adjusted for body mass index, diabetes, medical comorbidities, patient- and tumor-related variables, and adjuvant therapies, relative to the normal weight, hazard ratios (HRs) for recurrence-free survival (RFS), overall survival (OS), and breast cancer-specific survival (BCSS) for the overweight were 1.18 [95% confidence interval (CI) 1.02-1.36], 1.20 (95% CI 1.00-1.42), and 1.21 (95% CI 0.98-1.48), respectively. HRs for RFS, OS, and BCSS for the obese were 1.13 (95% CI 0.98-1.31), 1.24 (95% CI 1.04-1.48), and 1.23 (95% CI 1.00-1.52), respectively. Subset analyses showed these differences were significant for the ER-positive, but not ER-negative or HER2-positive, groups. Relative to nondiabetics, HRs for diabetics for RFS, OS, and BCSS were 1.21 (95% CI 0.98-1.49), 1.39 (95% CI 1.10-1.77), and 1.04 (95% CI 0.75-1.45), respectively.
  
  
  CONCLUSIONS
  In patients receiving modern adjuvant therapies, obesity has a negative impact on RFS, OS, and BCSS; and diabetes has a negative impact on RFS and OS. Control of both may be important to improving survival in obese and diabetic breast cancer patients.
authors.affiliation: Lester and Sue Smith Breast Center, Department of Medicine, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston; Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston. Electronic address: jiralers@bcm.edu.
authors.forename: S
authors.initials: S
authors.lastname: Jiralerspong
authors.affiliation: Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston; James P. Wilmot Cancer Center, Department of Medicine, University of Rochester, Rochester.
authors.forename: E S
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, USA.
authors.forename: W
authors.initials: W
authors.lastname: Dong
authors.affiliation: Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, USA.
authors.forename: L
authors.initials: L
authors.lastname: Feng
authors.affiliation: Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston.
authors.forename: G N
authors.initials: GN
authors.lastname: Hortobagyi
authors.affiliation: Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston.
authors.forename: S H
authors.initials: SH
authors.lastname: Giordano
mesh_terms: D018943:Anthracyclines / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001823:Body Composition; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality*; D001952:Bridged-Ring Compounds / Q000627:therapeutic use; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D017239:Paclitaxel / Q000627:therapeutic use; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D013534:Survival; D013629:Tamoxifen / Q000627:therapeutic use; D043823:Taxoids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D001952:Bridged-Ring Compounds; D017239:Paclitaxel; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D013629:Tamoxifen; D043823:Taxoids; C080625:taxane; C508053:ERBB2 protein, human
keywords: body mass index; breast cancer; diabetes; obesity; prognosis; survival outcomes