title: Obesity and survival in operable breast cancer patients treated with adjuvant anthracyclines and taxanes according to pathological subtypes: a pooled analysis.
abstract: BACKGROUND
  Obesity is an unfavorable prognostic factor in breast cancer (BC) patients regardless of menopausal status and treatment received. However, the association between obesity and survival outcome by pathological subtype requires further clarification.
  
  
  METHODS
  We performed a retrospective analysis including 5,683 operable BC patients enrolled in four randomized clinical trials (GEICAM/9906, GEICAM/9805, GEICAM/2003-02, and BCIRG 001) evaluating anthracyclines and taxanes as adjuvant treatments. Our primary aim was to assess the prognostic effect of body mass index (BMI) on disease recurrence, breast cancer mortality (BCM), and overall mortality (OM). A secondary aim was to detect differences of such prognostic effects by subtype.
  
  
  RESULTS
  Multivariate survival analyses adjusting for age, tumor size, nodal status, menopausal status, surgery type, histological grade, hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, chemotherapy regimen, and under-treatment showed that obese patients (BMI 30.0 to 34.9) had similar prognoses to that of patients with a BMI < 25 (reference group) in terms of recurrence (Hazard Ratio [HR] = 1.08, 95% Confidence Interval [CI] = 0.90 to 1.30), BCM (HR = 1.02, 0.81 to 1.29), and OM (HR = 0.97, 0.78 to 1.19). Patients with severe obesity (BMI ≥ 35) had a significantly increased risk of recurrence (HR = 1.26, 1.00 to 1.59, P = 0.048), BCM (HR = 1.32, 1.00 to 1.74, P = 0.050), and OM (HR = 1.35, 1.06 to 1.71, P = 0.016) compared to our reference group. The prognostic effect of severe obesity did not vary by subtype.
  
  
  CONCLUSIONS
  Severely obese patients treated with anthracyclines and taxanes present a worse prognosis regarding recurrence, BCM, and OM than patients with BMI < 25. The magnitude of the harmful effect of BMI on survival-related outcomes was similar across subtypes.
authors.forename: Bella
authors.initials: B
authors.lastname: Pajares
authors.forename: Marina
authors.initials: M
authors.lastname: Pollán
authors.forename: Miguel
authors.initials: M
authors.lastname: Martín
authors.forename: John R
authors.initials: JR
authors.lastname: Mackey
authors.forename: Ana
authors.initials: A
authors.lastname: Lluch
authors.forename: Joaquín
authors.initials: J
authors.lastname: Gavila
authors.forename: Charles
authors.initials: C
authors.lastname: Vogel
authors.forename: Manuel
authors.initials: M
authors.lastname: Ruiz-Borrego
authors.forename: Lourdes
authors.initials: L
authors.lastname: Calvo
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Pienkowski
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Rodríguez-Lescure
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Seguí
authors.forename: Olivier
authors.initials: O
authors.lastname: Tredan
authors.forename: Antonio
authors.initials: A
authors.lastname: Antón
authors.forename: Manuel
authors.initials: M
authors.lastname: Ramos
authors.forename: María del Carmen
authors.initials: Mdel C
authors.lastname: Cámara
authors.forename: César
authors.initials: C
authors.lastname: Rodríguez-Martín
authors.forename: Eva
authors.initials: E
authors.lastname: Carrasco
authors.forename: Emilio
authors.initials: E
authors.lastname: Alba
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009765:Obesity / Q000209:etiology*; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D043823:Taxoids / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; C508053:ERBB2 protein, human