Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1354, Houston, TX, 77030, USA.
Department of Medical Oncology, The National Cancer Institute, Cairo University, Cairo, Egypt.
Breast Cancer Res Treat. 2018 Sep;171(2):501-511. doi: 10.1007/s10549-018-4853-4. Epub 2018 Jun 18.
We hypothesized that an increase in BMI category during neoadjuvant chemotherapy (NAC) would be associated with pathological complete response (pCR) rate and worse survival outcomes in primary breast cancer patients.
We reviewed the records of 4029 patients with stage I-III breast cancer who had undergone NAC and definitive surgery at our institution between May 1, 1990 and April 30, 2013. BMI values at baseline and after NAC were recorded, and the corresponding BMI category was assessed with the WHO classification. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method, and multivariate Cox regression models were used to estimate the effect of covariates of interest on OS and RFS.
The median follow-up period was 3.95 years. A change in BMI category from normal to obese during NAC was independently associated with shorter OS duration than was maintaining a normal weight [hazard ratio (HR) 1.637; 95%CI 1.066-2.514; p = 0.0242]. Kaplan-Meier curves among breast cancer subtypes showed differences, and a decrease in BMI led to better RFS and OS rates in obese patients with HR+/HER2- disease; those who maintained BMI also showed better prognosis for triple-negative breast cancer (TNBC). We saw no association between BMI change and pCR rate.
Our data suggest that inability to maintain normal weight during NAC is a predictive marker of poor survival but not pCR. It may be important for patients to maintain a normal weight during NAC.
我们假设，新辅助化疗（NAC）期间 BMI 类别增加与原发性乳腺癌患者的病理完全缓解（pCR）率和生存结局恶化相关。
我们回顾了 1990 年 5 月 1 日至 2013 年 4 月 30 日期间在我院接受 NAC 和确定性手术的 4029 例 I-III 期乳腺癌患者的记录。记录基线和 NAC 后的 BMI 值，并采用世界卫生组织（WHO）分类评估相应的 BMI 类别。使用 Kaplan-Meier 方法估计总生存（OS）和无复发生存（RFS），并使用多变量 Cox 回归模型估计 OS 和 RFS 中感兴趣的协变量的影响。
中位随访时间为 3.95 年。与保持正常体重相比，NAC 期间 BMI 类别从正常变为肥胖与 OS 持续时间缩短独立相关[风险比（HR）1.637；95%置信区间 1.066-2.514；p=0.0242]。乳腺癌亚型的 Kaplan-Meier 曲线存在差异，肥胖 HR+/HER2- 患者中 BMI 降低导致 RFS 和 OS 率更好；保持 BMI 的患者也表现出更好的三阴性乳腺癌（TNBC）预后。我们没有发现 BMI 变化与 pCR 率之间的关联。
我们的数据表明，NAC 期间无法保持正常体重是生存不良的预测标志物，但不是 pCR。患者在 NAC 期间保持正常体重可能很重要。
