title: Effect of obesity on disease-free and overall survival in node-positive breast cancer patients in a large French population: a pooled analysis of two randomised trials.
abstract: BACKGROUND
  To examine the association between baseline body mass index (BMI), and disease-free survival (DFS) and overall survival (OS) in a large French early-stage breast cancer population included in the UNICANCER Programme d'Action Concerté Sein-01 (PACS01) and PACS04 phase III randomised trials.
  
  
  METHODS
  After a median follow-up of 5.9years, this report analyses 4996 patients with node-positive breast cancer, and randomly assigned to adjuvant anthracycline-based chemotherapy combined or not with taxanes. Univariate analyses were used to study the effects of well known prognostic factors and BMI on DFS and OS. BMI was obtained at baseline, before chemotherapy initiation, and obesity was defined as a BMI⩾30kg/m(2). Cox proportional hazards regression models were secondly used to assess the influence of BMI after adjusting for other factors. Exhaustive analysis of the dose intensity delivered was also studied for comparison between obese and non-obese patients.
  
  
  RESULTS
  Obese patients initially present with more advanced disease at diagnosis compared to non-obese patients. By univariate analysis, obesity was moderately associated with poorer DFS (hazard ratio (HR)=1.18 [1.01-1.39] P=0.04), but mostly with poorer OS (HR=1.38 [1.13-1.69] P=0.002). Delivered dose intensity of anthracyclines and taxanes was not significantly different between obese and non-obese patients. After adjustment for disease characteristics, BMI had no influence either on DFS or OS.
  
  
  CONCLUSIONS
  This report suggests that in a French population, obesity has no impact on breast cancer prognosis when modern adjuvant chemotherapy, at the appropriate dose intensity, is delivered.
authors: Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France; Institut National de la Santé et de la Recherche Médicale (INSERM), CRI-866 Faculty of Medicine, Dijon, France; University of Burgundy, Dijon, France.
authors: Sylvain
authors: S
authors: Ladoire
authors: Biostatistics and Epidemiological Unit, EA 4184, Centre Georges François Leclerc, Dijon, France.
authors: Cecile
authors: C
authors: Dalban
authors: Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France.
authors: Henri
authors: H
authors: Roché
authors: Department of Medicine and Translational Research Unit, Institut Gustave Roussy, Villejuif, France.
authors: Marc
authors: M
authors: Spielmann
authors: Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France; University of Burgundy, Dijon, France.
authors: Pierre
authors: P
authors: Fumoleau
authors: Department of Medical Oncology, Centre François Baclesse, Caen, France.
authors: Christelle
authors: C
authors: Levy
authors: Fédération Nationale des Centres de Lutte Contre le Cancer, Paris, France.
authors: Anne Laure
authors: AL
authors: Martin
authors: EA3920, University of Franche-Comté, Besancon, France.
authors: Fiona
authors: F
authors: Ecarnot
authors: Methodology and Quality of Life in Oncology Unit, EA 3181, Quality of Life and Cancer Clinical Research Platform, University Hospital, Besancon, France.
authors: Frank
authors: F
authors: Bonnetain
authors: Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France; Institut National de la Santé et de la Recherche Médicale (INSERM), CRI-866 Faculty of Medicine, Dijon, France; University of Burgundy, Dijon, France. Electronic address: fghiringhelli@cgfl.fr.
authors: François
authors: F
authors: Ghiringhelli
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D043823:Taxoids; D000077143:Docetaxel; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil
keywords: Adjuvant; Body mass index; Breast cancer; Prognostic factor