TY - JOUR
T1 - The prognostic and predictive effect of body mass index in hormone receptor-positive breast cancer
AU - Lammers, Senna W M
AU - Geurts, Sandra M E
AU - Van Hellemond, Irene E G
AU - Swinkels, Astrid C P
AU - Smorenburg, Carolien H
AU - Van Der Sangen, Maurice J C
AU - Kroep, Judith R
AU - De Graaf, Hiltje
AU - Honkoop, Aafke H
AU - Erdkamp, Frans L G
AU - De Roos, Wilfred K
AU - Linn, Sabine C
AU - Imholz, Alexander L T
AU - Smidt, Marjolein L
AU - Vriens, Ingeborg J H
AU - Tjan-Heijnen, Vivianne C G
AU - Dutch Breast Cancer Research Group (BOOG) for the DATA Investigators
PY - 2023/11/22
Y1 - 2023/11/22
N2 - 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 randomised controlled trial evaluating the efficacy of six vs three years of anastrozole after two to three years of adjuvant tamoxifen in postmenopausal women with HR+ BC. Patients were classified as normal weight (BMI: 18.5-24.9?kg/m2), overweight (25-29.9?kg/m2), or obese (=30?kg/m2). The primary endpoint was DFS, evaluated from randomisation (prognostic analyses) or three years after randomisation onwards (predictive analyses; aDFS) using multivariable Cox regression analyses. P-values were two-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): 0.97-1.38 and HR?=?1.26; 95% CI 1.03-1.54, respectively). The adverse prognostic effect of BMI was observed in women aged <60?years, but not in women aged =60?years (p-interaction?=?0.009). The effect of extended anastrozole on aDFS was similar in normal weight (HR?=?1.00; 95% CI 0.74-1.35), overweight (HR?=?0.74; 95% CI 0.56-0.98), and obese patients (HR?=?0.97; 95% CI 0.69-1.36)(p-interaction?=?0.24). CONCLUSION: In this study among 1,781?HR+ BC patients, overweight and obesity were adverse prognostic factors for DFS. BMI did not impact the efficacy of extended anastrozole.
AB - 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 randomised controlled trial evaluating the efficacy of six vs three years of anastrozole after two to three years of adjuvant tamoxifen in postmenopausal women with HR+ BC. Patients were classified as normal weight (BMI: 18.5-24.9?kg/m2), overweight (25-29.9?kg/m2), or obese (=30?kg/m2). The primary endpoint was DFS, evaluated from randomisation (prognostic analyses) or three years after randomisation onwards (predictive analyses; aDFS) using multivariable Cox regression analyses. P-values were two-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): 0.97-1.38 and HR?=?1.26; 95% CI 1.03-1.54, respectively). The adverse prognostic effect of BMI was observed in women aged <60?years, but not in women aged =60?years (p-interaction?=?0.009). The effect of extended anastrozole on aDFS was similar in normal weight (HR?=?1.00; 95% CI 0.74-1.35), overweight (HR?=?0.74; 95% CI 0.56-0.98), and obese patients (HR?=?0.97; 95% CI 0.69-1.36)(p-interaction?=?0.24). CONCLUSION: In this study among 1,781?HR+ BC patients, overweight and obesity were adverse prognostic factors for DFS. BMI did not impact the efficacy of extended anastrozole.
U2 - 10.1093/jncics/pkad092
DO - 10.1093/jncics/pkad092
M3 - Article
SN - 2515-5091
VL - 7
JO - JNCI Cancer Spectrum
JF - JNCI Cancer Spectrum
IS - 6
M1 - pkad092
ER -