Department of Breast Surgery, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, PR China.
PLoS One. 2012;7(7):e41380. doi: 10.1371/journal.pone.0041380. Epub 2012 Jul 25.
To evaluate the relationship between body mass index (BMI) and response to neoadjuvant chemotherapy (NCT) for breast cancer among Chinese women.
A total of 307 eligible patients were assigned to receive four cycles of paclitaxel and carboplatin before standard surgery for breast cancer from 2007 to 2011 at Shanghai Cancer Hospital. The patients were categorized as obese, overweight, normal weight, or underweight based on BMI according to World Health Organization (WHO) criteria. Pathological complete response (pCR) was defined as no invasive cancer in the breast or axillary tissue. A logistic regression and the Chi-squared test were used for detecting the predictors of pCR and determining the relationship between BMI category and pCR rate in the subgroup analysis with respect to other variables.
Categorical BMI, estrogen receptor (ER), and progesterone receptor (PR) status were independent predictors of pCR according to the multivariate analysis. Patients with BMI≥25 were less likely to achieve a pCR to NCT compared with patients with BMI<25 (Odds ratio: 0.454, p = 0.033, multivariate analysis). In the subgroup analysis, the predictive value of BMI for pCR to NCT was significantly shown in post-menopausal patients (p = 0.004) and hormonal receptor status-negative patients (p = 0.038). The incidence of treatment-induced toxicity was similar among the different BMI categories.
Higher BMI was associated with worse pCR to NCT. Further approaches to investigating the mechanism of this influence of BMI on treatment response and a more appropriate schedule for calculating NCT dose for high-BMI-patients should be considered.
评估体质指数（BMI）与中国女性乳腺癌新辅助化疗（NCT）反应之间的关系。
2007 年至 2011 年，上海肿瘤医院共有 307 名符合条件的患者被分配接受四个周期的紫杉醇和卡铂治疗，然后再进行标准乳腺癌手术。根据世界卫生组织（WHO）标准，患者根据 BMI 分为肥胖、超重、正常体重或体重不足。病理完全缓解（pCR）定义为乳房或腋窝组织中无浸润性癌。采用逻辑回归和卡方检验检测 pCR 的预测因子，并在亚组分析中根据其他变量确定 BMI 类别与 pCR 率之间的关系。
根据多变量分析，分类 BMI、雌激素受体（ER）和孕激素受体（PR）状态是 pCR 的独立预测因子。与 BMI<25 的患者相比，BMI≥25 的患者更不可能实现 NCT 的 pCR（优势比：0.454，p=0.033，多变量分析）。在亚组分析中，BMI 对 NCT 治疗 pCR 的预测价值在绝经后患者（p=0.004）和激素受体状态阴性患者（p=0.038）中显著显示。不同 BMI 类别之间的治疗诱导毒性发生率相似。
较高的 BMI 与 NCT 的 pCR 较差相关。应进一步研究 BMI 对治疗反应的影响机制，并考虑为高 BMI 患者计算 NCT 剂量的更合适方案。
