Fontanella Caterina, Lederer Bianca, Gade Stephan, Vanoppen Mieke, Blohmer Jens Uwe, Costa Serban Dan, Denkert Carsten, Eidtmann Holger, Gerber Bernd, Hanusch Claus, Hilfrich Jörn, Huober Jens, Schneeweiss Andreas, Paepke Stefan, Jackisch Christian, Mehta Keyur, Nekljudova Valentina, Untch Michael, Neven Patrick, von Minckwitz Gunter, Loibl Sibylle
German Breast Group, Neu-Isenburg, Germany,
Breast Cancer Res Treat. 2015 Feb;150(1):127-39. doi: 10.1007/s10549-015-3287-5. Epub 2015 Feb 13.
Obesity is associated with an increased risk of breast cancer (BC) and poorer outcome. We assessed the impact of body mass index (BMI) on pathological complete response (pCR), disease-free (DFS), and overall survival (OS), according to BC subtypes in patients with primary BC treated with neoadjuvant chemotherapy. 8,872 patients with primary BC from eight neoadjuvant trials were categorized according to BMI: underweight (<18.5 kg/m(2)), normal weight (18.5 to <25 kg/m(2)), overweight (25 to <30 kg/m(2)), obese (30 to <40 kg/m(2)), and very obese (≥40 kg/m(2)). BC subtypes were defined as luminal-like (ER/PgR-positive and HER2-negative), HER2/luminal (ER/PgR-positive and HER2-positive), HER2-like (ER/PgR-negative and HER2-positive), and triple-negative (TNBC; ER/PgR- and HER2-negative). pCR rate was higher in normal weight patients compared with all other BMI groups (P = 0.003). Mean DFS and OS were shorter in obese (87.3 months, P = 0.014 and 94.9 months, P = 0.001, respectively) and very obese (66.6 months, P < 0.001 and 75.3 months, P < 0.001, respectively) compared with normal weight patients (91.5 and 98.8 months, respectively) which was confirmed by subpopulation treatment effect pattern plot analyses and was consistent in luminal-like and TNBC. No interaction was observed between BMI and pCR. Normal weight patients experienced less non-hematological adverse events (P = 0.002) and were more likely to receive full taxane doses (P < 0.001) compared with all other BMI groups. In multivariable analysis, the dose of taxanes was predictive for pCR (P < 0.001). Higher BMI was associated with lower pCR and a detrimental impact on survival. Normal weight patients had the best compliance to chemotherapy and received the highest taxane doses, which seems to be related with treatment outcomes.
肥胖与乳腺癌（BC）风险增加及较差预后相关。我们评估了体重指数（BMI）对新辅助化疗治疗的原发性BC患者病理完全缓解（pCR）、无病生存期（DFS）和总生存期（OS）的影响，并根据BC亚型进行分析。来自八项新辅助试验的8872例原发性BC患者根据BMI分类为：体重过轻（<18.5kg/m²）、正常体重（18.5至<25kg/m²）、超重（25至<30kg/m²）、肥胖（30至<40kg/m²）和极度肥胖（≥40kg/m²）。BC亚型定义为管腔样（ER/PgR阳性且HER2阴性）、HER2/管腔样（ER/PgR阳性且HER2阳性）、HER2样（ER/PgR阴性且HER2阳性）和三阴性（TNBC；ER/PgR和HER2阴性）。与所有其他BMI组相比，正常体重患者的pCR率更高（P = 0.003）。肥胖（分别为87.3个月，P = 0.014和94.9个月，P = 0.001）和极度肥胖（分别为66.6个月，P < 0.001和75.3个月，P < 0.001）患者的平均DFS和OS短于正常体重患者（分别为91.5和98.8个月），亚组治疗效应模式图分析证实了这一点，并且在管腔样和TNBC中一致。未观察到BMI与pCR之间的相互作用。与所有其他BMI组相比，正常体重患者发生的非血液学不良事件较少（P = 0.002），并且更有可能接受全剂量紫杉烷治疗（P < 0.001）。在多变量分析中，紫杉烷剂量可预测pCR（P < 0.001）。较高的BMI与较低的pCR相关，并对生存有不利影响。正常体重患者对化疗的依从性最佳，接受的紫杉烷剂量最高，这似乎与治疗结果有关。
