title: Body mass index and treatment outcomes following neoadjuvant therapy in women aged 45 y or younger: Evidence from a historic cohort.
abstract: Large and consistent evidence supports the role of body mass index (BMI) as a prognostic and predictive indicator in breast cancer. However, there is paucity of data specifically referred to women diagnosed at a young age across the different disease settings. We investigated the impact of BMI on treatment outcomes in 86 breast cancer patients aged 45 y or less treated with neoadjuvant chemotherapy (CT) followed by surgery.
  
  
  
  Pathologic complete response (pCR) was defined as the eradication of cancer from both breast and lymph nodes. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier product-limit method. Curves were compared by long rank test for significance. Potential predictors of survival were tested in Cox models.
  
  
  
  We observed a pCR in 19 patients (22%). Lower values of BMI were more commonly associated with pCR (p = 0.05). Results from univariate, but not multivariate, models were somewhat supportive of higher pCR rates in leaner women (p = 0.06). None of the variables impacted DFS. OS was longer in leaner patients (medians and 95%CI: 74.6 months, 66.2-82.9 and 58.5 months, 49.6-67.4, p = 0.009). Longer OS was also related to lower T-stage, adjuvant radiotherapy (RT), and non triple negative (TN) subtype (p = 0.046, p = 0.024, and p = 0.015, respectively). Cox models confirmed the protective role of lower BMI (Hazard Ratios: 0.30, 95%CI: 0.12-0.71, p = 0.007), non TN subtype and adjuvant RT (p = 0.008 and p = 0.024).
  
  
  
  In young breast cancer patients treated with neoadjuvant CT followed by surgery, lower values of BMI are associated with longer OS. Our data also showed longer OS in association with a non TN molecular subtype and adjuvant RT. The modifiable nature of BMI and aggressive biologic behavior of the disease diagnosed at a young age encourage further studies to corroborate our findings.
authors.affiliation: a Breast Department , National Cancer Institute of Naples IRCCS "G. Pascale" , Naples , Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: D'Aiuto
authors.affiliation: b Sbarro Institute for Cancer Research and Molecular Medicine e del Center for Biotechnology, College of Science and Technology, Temple University , Philadelphia , PA , USA.|c Department of Psychology of Developmental and Socialization Processes , La Sapienza University , Rome , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Chirico
authors.affiliation: a Breast Department , National Cancer Institute of Naples IRCCS "G. Pascale" , Naples , Italy.
authors.forename: Michele Antonio
authors.initials: MA
authors.lastname: De Riggi
authors.affiliation: a Breast Department , National Cancer Institute of Naples IRCCS "G. Pascale" , Naples , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Frasci
authors.affiliation: a Breast Department , National Cancer Institute of Naples IRCCS "G. Pascale" , Naples , Italy.
authors.forename: Michelino
authors.initials: M
authors.lastname: De Laurentiis
authors.affiliation: d Pathology Department , National Cancer Institute of Naples IRCCS "G.Pascale" , Naples , Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Di Bonito
authors.affiliation: e Division of Medical Oncology 2, Regina Elena National Cancer Institute , Rome , Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Vici
authors.affiliation: e Division of Medical Oncology 2, Regina Elena National Cancer Institute , Rome , Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pizzuti
authors.affiliation: e Division of Medical Oncology 2, Regina Elena National Cancer Institute , Rome , Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Sergi
authors.affiliation: e Division of Medical Oncology 2, Regina Elena National Cancer Institute , Rome , Italy.|f Scientific Direction, Regina Elena National Cancer Institute , Rome , Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Maugeri-Saccà
authors.affiliation: e Division of Medical Oncology 2, Regina Elena National Cancer Institute , Rome , Italy.|f Scientific Direction, Regina Elena National Cancer Institute , Rome , Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Barba
authors.affiliation: b Sbarro Institute for Cancer Research and Molecular Medicine e del Center for Biotechnology, College of Science and Technology, Temple University , Philadelphia , PA , USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Giordano
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Body mass index; breast cancer; neoadjuvant setting; young age