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Lammers, S.W.M.; Geurts, S.M.E.; Hellemond, I.E.G. van; Swinkels, A.C.P.; Smorenburg, C.H.; Sangen, M.J.C. van der; ... ; Dutch Breast Canc Res Grp BOOG (2023)

The prognostic and predictive effect of body mass index in hormone receptor-positive breast cancer

Article / Letter to editor
Background Obesity has been associated with an adverse prognosis and reduced efficacy of endocrine therapy in patients with hormone receptor-positive (HR+) breast cancer (BC). This study determines the prognostic and predictive effect of body mass index (BMI) on the disease-free survival (DFS) of postmenopausal HR+ BC patients.Methods Patients were identified from the DATA study (NCT00301457), a randomized controlled trial evaluating the efficacy of 6 vs 3 years of anastrozole after 2 to 3 years of adjuvant tamoxifen in postmenopausal women with HR+ BC. Patients were classified as normal weight (BMI: 18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (>= 30.0 kg/m2). The primary endpoint was DFS, evaluated from randomization (prognostic analyses) or 3 years after randomization onwards (predictive analyses; aDFS) using multivariable Cox regression analyses. P-values were 2-sided.Results This study included 678 normal weight, 712 overweight, and 391 obese patients. After a...Show moreBackground Obesity has been associated with an adverse prognosis and reduced efficacy of endocrine therapy in patients with hormone receptor-positive (HR+) breast cancer (BC). This study determines the prognostic and predictive effect of body mass index (BMI) on the disease-free survival (DFS) of postmenopausal HR+ BC patients.Methods Patients were identified from the DATA study (NCT00301457), a randomized controlled trial evaluating the efficacy of 6 vs 3 years of anastrozole after 2 to 3 years of adjuvant tamoxifen in postmenopausal women with HR+ BC. Patients were classified as normal weight (BMI: 18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (>= 30.0 kg/m2). The primary endpoint was DFS, evaluated from randomization (prognostic analyses) or 3 years after randomization onwards (predictive analyses; aDFS) using multivariable Cox regression analyses. P-values were 2-sided.Results This study included 678 normal weight, 712 overweight, and 391 obese patients. After a median follow-up of 13.1 years, overweight and obesity were identified as negative prognostic factors for DFS (hazard ratio (HR) = 1.16; 95% confidence interval (CI) = 0.97 to 1.38 and HR = 1.26; 95% CI = 1.03 to 1.54, respectively). The adverse prognostic effect of BMI was observed in women aged younger than 60 years, but not in women aged 60 years or older (P-interaction = .009). The effect of extended anastrozole on aDFS was similar in normal weight (HR = 1.00; 95% CI = 0.74 to 1.35), overweight (HR = 0.74; 95% CI = 0.56 to 0.98), and obese patients (HR = 0.97; 95% CI = 0.69 to 1.36) (P-interaction = .24).Conclusion In this study among 1781 HR+ BC patients, overweight and obesity were adverse prognostic factors for DFS. BMI did not impact the efficacy of extended anastrozole.Show less
All authors
Lammers, S.W.M.; Geurts, S.M.E.; Hellemond, I.E.G. van; Swinkels, A.C.P.; Smorenburg, C.H.; Sangen, M.J.C. van der; Kroep, J.R.; Graaf, H. de; Honkoop, A.H.; Erdkamp, F.L.G.; Roos, W.K. de; Linn, S.C.; Imholz, A.L.T.; Smidt, M.L.; Vriens, I.J.H.; Tjan-Heijnen, V.C.G.; Dutch Breast Canc Res Grp BOOG
Date
2023-10-31
Journal
JNCI Cancer Spectrum
Volume
7
Issue
6
DOI
doi:10.1093/jncics/pkad092
Link
https://academic.oup.com/jncics/article/7/6/pkad092/7441506