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Prognostic role of body mass index is different according to menopausal status and tumor subtype in breast cancer patients

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Although controversial, obesity and underweight may have a negative impact on breast cancer outcome. However, the relationship between body mass index (BMI) and breast cancer outcomes according to tumor subtype and menopausal status remains unclear.

Methods

This study investigated the association between BMI and breast cancer outcome in stage I–III breast cancer patients. The relationships were further evaluated according to tumor subtype and menopausal status.

Results

A total of 5919 patients, 3475 (58.7%) hormone receptor (HR)(+) human epidermal growth factor receptor 2 (HER2)(–), 608 (10.3%) HR(+)HER2(+), 621 (10.5%) HR(–)HER2(+), and 1079 (18.2%) HR(–)HER2(–) were included. Underweight and obesity had a negative impact on relapse-free survival but did not affect overall survival. Importantly, the prognostic role of BMI was different according to tumor subtype and menopausal status. In HR(+)HER2(–) patients, underweight was associated with poor relapse-free survival and overall survival in pre-menopausal women. In contrast, obesity had negative impact on relapse-free survival and overall survival in HR(+)HER2(–) post-menopausal patients. Underweight may have a negative prognostic role in HR(+)HER2(+) patients. However, BMI did not impact the outcome of HR(–)HER2(+) and HR(–)HER2(–) patients.

Conclusions

The impact of BMI on breast cancer outcome was dependent on tumor subtype and menopausal status. In HR(+)HER2(–) patients, underweight and obesity had a negative prognostic role in pre-menopausal and post-menopausal women, respectively. These findings in Asian population should be further evaluated and compared in Western population.

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Funding

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant No. HC17C0043).

Author information

Author notes

  1. Jung Youn Kim and Dae-Won Lee have contributed equally to this work.

Authors and Affiliations

  1. College of Medicine, Cancer Research Institute, Seoul National University, Seoul, South Korea

    Jung Youn Kim, Kyung-Hun Lee, Ahrum Min, Han-Byoel Lee, Hyeong-Gon Moon, Tae-Yong Kim, Sae-Won Han, Do-Youn Oh, Wonshik Han, Dong-Young Noh & Seock-Ah Im

  2. Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea

    Jung Youn Kim, Kyung-Hun Lee, Ahrum Min, Tae-Yong Kim, Sae-Won Han, Do-Youn Oh & Seock-Ah Im

  3. Department of Internal Medicine, Seoul National University Hospital, 101 Daehang-Ro, Jongno-Gu, Seoul, 110-744, South Korea

    Dae-Won Lee, Kyung-Hun Lee, Tae-Yong Kim, Sae-Won Han, Do-Youn Oh & Seock-Ah Im

  4. Department of Pathology, Seoul National University Hospital, Seoul, South Korea

    Han Suk Ryu & In Ae Park

  5. Department of Surgery, Seoul National University Hospital, Seoul, South Korea

    Han-Byoel Lee, Hyeong-Gon Moon, Wonshik Han & Dong-Young Noh

  6. Department of Preventive Medicine, The Catholic University of Korea, Seoul, South Korea

    Sukil Kim

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  1. Jung Youn Kim
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Corresponding author

Correspondence to Kyung-Hun Lee.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The study protocol was reviewed and approved by the institutional review board of SNUH [H-1709-052-883]. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

As this study was retrospectively designed, informed consent was waived by the IRB of Seoul National University Hospital.

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Electronic supplementary material

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10549_2019_5249_MOESM1_ESM.tif

Supplement Figure 1. Prognostic role of BMI according to tumor subtype. (1A: HR(+)HER2(-), relapse-free survival; 1B: HR(+)HER2(-), overall survival; 1C: HR(+)HER2(+), relapse-free survival; 1D: HR(+)HER2(+), overall survival). Supplementary material 1 (TIFF 889 kb)

10549_2019_5249_MOESM2_ESM.tif

Supplement Figure 2. Prognostic role of BMI according to menopause status. (2A: pre-menopausal, relapse-free survival; 2B: pre-menopausal, overall survival; 2C: post-menopausal, relapse-free survival; 2D: post-menopausal, overall survival). Supplementary material 2 (TIFF 894 kb)

10549_2019_5249_MOESM3_ESM.tif

Supplement Figure 3. Prognostic role of BMI in HR(+)HER2(+) patients stratified by menopause status. (3A: pre-menopausal, relapse-free survival; 3B: pre-menopausal, overall survival; 3C: post-menopausal, relapse-free survival; 3D: post-menopausal, overall survival). Supplementary material 3 (TIFF 877 kb)

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Kim, J.Y., Lee, DW., Lee, KH. et al. Prognostic role of body mass index is different according to menopausal status and tumor subtype in breast cancer patients. Breast Cancer Res Treat 176, 453–460 (2019). https://doi.org/10.1007/s10549-019-05249-1

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