title: Body Mass Index at Diagnosis and Breast Cancer Survival Prognosis in Clinical Trial Populations from NRG Oncology/NSABP B-30, B-31, B-34, and B-38.
abstract: BACKGROUND
  Body mass index (BMI) has been associated with breast cancer outcomes. However, few studies used clinical trial settings where treatments and outcomes are consistently evaluated and documented. There are also limited data assessing how patient/disease characteristics and treatment may alter the BMI-breast cancer association.
  
  
  METHODS
  We evaluated 15,538 breast cancer participants from four NSABP protocols. B-34 studied early-stage breast cancer patients (N = 3,311); B-30 and B-38 included node-positive breast cancer patients (N = 5,265 and 4,860); and B-31 studied node-positive and HER2-positive breast cancer patients (N = 2,102). We used Cox proportional hazards regression to calculate adjusted hazards ratios (HR) for risk of death and recurrence, and conducted separate analyses by estrogen receptor (ER) status and treatment group.
  
  
  RESULTS
  In B-30, increased BMI was significantly related to survival. Compared with BMI < 25, HRs were 1.04 for BMI 25 to 29.9 and 1.18 for BMI ≥ 30 (P = 0.02). Separate analyses indicated the significant relationship was only in ER-positive disease (P = 0.002) and the subgroup treated with doxorubicin/cyclophosphamide (P = 0.005). There were no significant trends across BMI for the other three trials. Similar results were found for recurrence. Increased BMI was significantly related to recurrence in B-30 (P = 0.03); and the significant relationship was only in ER-positive breast cancers (P = 0.001). Recurrence was also significant among ER-positive disease in B-38 (P = 0.03).
  
  
  CONCLUSIONS
  In our investigation, we did not find a consistent relationship between BMI at diagnosis and breast cancer recurrence or death.
  
  
  CONCLUSIONS
  This work demonstrates that the heterogeneity of breast cancer between different breast cancer populations and the different therapies used to treat them may modify any association that exists between BMI and breast cancer outcome.
authors.affiliation: NRG Oncology, Pittsburgh, Pennsylvania. University of Pittsburgh, Pittsburgh, Pennsylvania. cecchinir@nrgoncology.org.
authors.forename: Reena S
authors.initials: RS
authors.lastname: Cecchini
authors.affiliation: NRG Oncology/NSABP, Pittsburgh, Pennsylvania. Washington Cancer Institute, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Swain
authors.affiliation: NRG Oncology, Pittsburgh, Pennsylvania. University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Costantino
authors.affiliation: NRG Oncology/NSABP, Pittsburgh, Pennsylvania. University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Priya
authors.initials: P
authors.lastname: Rastogi
authors.affiliation: NRG Oncology, Pittsburgh, Pennsylvania. University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jong-Hyeon
authors.initials: JH
authors.lastname: Jeong
authors.affiliation: NRG Oncology, Pittsburgh, Pennsylvania. University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Anderson
authors.affiliation: NRG Oncology, Pittsburgh, Pennsylvania. University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Gong
authors.initials: G
authors.lastname: Tang
authors.affiliation: NRG Oncology/NSABP, Pittsburgh, Pennsylvania. Virginia Commonwealth University (VCU) Massey Cancer Center, Richmond, Virginia.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Geyer
authors.affiliation: NRG Oncology/NSABP, Pittsburgh, Pennsylvania. University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Barry C
authors.initials: BC
authors.lastname: Lembersky
authors.affiliation: NRG Oncology/NSABP, Pittsburgh, Pennsylvania. Lucille Parker Markey Cancer Center, University of Kentucky, Lexington, Kentucky.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Romond
authors.affiliation: NRG Oncology/NSABP, Pittsburgh, Pennsylvania. Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Alexander H G
authors.initials: AH
authors.lastname: Paterson
authors.affiliation: NRG Oncology/NSABP, Pittsburgh, Pennsylvania. Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: Norman
authors.initials: N
authors.lastname: Wolmark
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; C508053:ERBB2 protein, human