title: The influence of obesity on survival in early, high-risk breast cancer: results from the randomized SUCCESS A trial.
abstract: BACKGROUND
  Obese breast cancer patients have worse prognosis than normal weight patients, but the level at which obesity is prognostically unfavorable is unclear.
  
  
  METHODS
  This retrospective analysis was performed using data from the SUCCESS A trial, in which 3754 patients with high-risk early breast cancer were randomized to anthracycline- and taxane-based chemotherapy with or without gemcitabine. Patients were classified as underweight/normal weight (body mass index (BMI) < 25.0), overweight (BMI 25.0-29.9), slightly obese (BMI 30.0-34.9), moderately obese (BMI 35.0-39.9) and severely obese (BMI ≥ 40.0), and the effect of BMI on disease-free survival (DFS) and overall survival (OS) was evaluated (median follow-up 65 months). In addition, subgroup analyses were conducted to assess the effect of BMI in luminal A-like, luminal B-like, HER2 (human epidermal growth factor 2)-positive and triple-negative tumors.
  
  
  RESULTS
  Multivariate analyses revealed an independent prognostic effect of BMI on DFS (p = 0.001) and OS (p = 0.005). Compared with underweight/normal weight patients, severely obese patients had worse DFS (hazard ratio (HR) 2.70, 95 % confidence interval (CI) 1.71-4.28, p < 0.001) and OS (HR 2.79, 95 % CI 1.63-4.77, p < 0.001), while moderately obese, slightly obese and overweight patients did not differ from underweight/normal weight patients with regard to DFS or OS. Subgroup analyses showed a similar significant effect of BMI on DFS and OS in patients with triple-negative breast cancer (TNBC), but not in patients with other tumor subtypes.
  
  
  CONCLUSIONS
  Severe obesity (BMI ≥ 40) significantly worsens prognosis in early breast cancer patients, particularly for triple-negative tumors.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT02181101 . Registered September 2005.
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. p.widschwendter@gmx.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Widschwendter
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. thomas.friedl@uniklinik-ulm.de.
authors.forename: Thomas Wp
authors.initials: TW
authors.lastname: Friedl
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. lukas.schwentner@uniklinik-ulm.de.
authors.forename: Lukas
authors.initials: L
authors.lastname: Schwentner
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. nikolaus.degregorio@uniklinik-ulm.de.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: DeGregorio
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. bernadette.jaeger@uniklinik-ulm.de.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Jaeger
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. amelie.schramm@uniklinik-ulm.de.
authors.forename: Amelie
authors.initials: A
authors.lastname: Schramm
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. inga.bekes@uniklinik-ulm.de.
authors.forename: Inga
authors.initials: I
authors.lastname: Bekes
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. miriam.deniz@uniklinik-ulm.de.
authors.forename: Miriam
authors.initials: M
authors.lastname: Deniz
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. krisztian.lato@uniklinik-ulm.de.
authors.forename: Krisztian
authors.initials: K
authors.lastname: Lato
authors.affiliation: Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany. tobias.weissenbacher@med.uni-muenchen.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Weissenbacher
authors.affiliation: Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany. bernd.kost@med.uni-muenchen.de.
authors.forename: Bernd
authors.initials: B
authors.lastname: Kost
authors.affiliation: Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany. ulrich.andergassen@med.uni-muenchen.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Andergassen
authors.affiliation: Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany. julia.jueckstock@med.uni-muenchen.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Jueckstock
authors.affiliation: Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany. julia.neugebauer@med.uni-muenchen.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Neugebauer
authors.affiliation: Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany. elisabeth.trapp@med.uni.muenchen.de.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Trapp
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Schloßplatz 4, 91054, Erlangen, Germany. peter.fasching@uk-erlangen.de.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Fasching
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Schloßplatz 4, 91054, Erlangen, Germany. matthias.beckmann@uk-erlangen.de.
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.affiliation: Department of Gynecology and Obstetrics, University of Heidelberg, Grabengasse 1, 69117, Heidelberg, Germany. andreas.schneeweiss@med.uni-heidelberg.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneeweiss
authors.affiliation: Gynecologic-Oncological Office, Pelikanplatz 23, 30177, Hannover, Germany. info@gyn-onko-praxis-hannover.de.
authors.forename: Ines
authors.initials: I
authors.lastname: Schrader
authors.affiliation: Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany. brigitte.rack@med.uni-muenchen.de.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Rack
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. wolfgang.janni@uniklinik-ulm.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Janni
authors.affiliation: Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany. christoph.scholz@uniklinik-ulm.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Scholz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015992:Body Mass Index; D001952:Bridged-Ring Compounds / Q000627:therapeutic use; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000473:pathology*; D050177:Overweight / Q000150:complications; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012189:Retrospective Studies; D043823:Taxoids / Q000627:therapeutic use; D064726:Triple Negative Breast Neoplasms / Q000401:mortality* / Q000473:pathology*; D055815:Young Adult; D000093542:Gemcitabine
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D001952:Bridged-Ring Compounds; D003841:Deoxycytidine; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; D000093542:Gemcitabine; C080625:taxane; C508053:ERBB2 protein, human