Abstract
Objectives
The purpose of this study was to evaluate the relationship between body mass index and lipid profiles with breast cancer prognosis together with the relationship of these parametres with known breast cancer prognostic indices including c-erbB2 expression.
Patients and methods
Four hundred and thirty-three patients diagnosed with breast cancer at Ankara University, Faculty of Medicine, Department of Medical Oncology made up the study population. The primary endpoints were relapse and death. Body mass index at the time of diagnosis, lipid levels at the time of diagnosis, estrogen receptor status, progesterone receptor status, c-erbB2 expression, tumor grade, patient age, axillary lymph node involvement level, tumor stage, menopausal status and surgery details were taken into account.
Results
The mean body mass indices were similar in the remission, relapse and mortality groups. Patients with body mass indices higher than 30 kg/m² had a lower incidence of c-erbB2 expression when compared to patients with body mass indices < 18.5 kg/m2 (19 vs. 50 %, p = 0.009). Survival analysis revealed that patients with body mass indices < 18.5 kg/m2 had significantly shorter disease free survivals when compared to patients with body mass indices between 25 and 29.9 kg/m2. Mean serum lipid levels were similar in the remission, relapse and mortality groups. A trend toward relapse was shown in patients with total cholesterol > 240 mg/dl, but this was statistically insignificant. Survival analysis revealed that patients with triglyceride levels lower than 150 mg/dl had a statistically significant longer disease-free survival when compared to the other groups. Again a trend towards shorter overall survival was seen in patients with total cholesterol > 240 mg/dl, but this relationship was also statistically insignificant.
Conclusion
Most large previous studies reported adverse breast cancer outcome with obesity. However in our study, patients with lower body weight had a shorter disease-free survival. This could be explained by the low number of patients in this study, genetic profile of the patient population, possible weight changes after treatment and the inverse relationship between body mass index and c-erbB2 expression.
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References
Dahlberg S, Liu PY (1992) Prognostic factors in clinical trials. Breast Cancer Res Treat 22(3):193–196
Carter CL, Allen C, Henson DE (1989) Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 63(1):181–187
Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experince from a large study with a long term follow up. Histopathology 19(5):403–410
World Health Organization (2009) Programmes and projects. Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en./
Renehan AG, Tyson M, Egger M (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371:569–578
Whiteman MK, Hillis SD, Curtis KM et al (2005) Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Bio-markers Prev 14:2009–2014
Zhang S, Folsom Ari Sellers TA et al (1995) Better breast cancer survival for postmenopausal women who are less overweight and eat less fat: Iowa Womens Health Study. Cancer 76:275–283
Dal Maso L, Zucchetto A, Talamini R et al (2008) Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer 123:2188–2194
Xiaoli C, Wei L, Wei ZH et al (2010) Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat 122:823–833
Carmichael AR (2006) Obesity and prognosis of breast cancer. Obes Rev 7:333–340
Berclaz G, Li S, Price KN, Coates AS, Castliglione-Gertsch M, Rudenstam C, Holmberg SB, Lindtner J, Erzen D, Collins J, Snyder R, Thürlimann B, Fey MF, Mendiola C, Dudley WI, Simoncici E, Crivellari D, Gelber RD, Goldhirsch A (2004) Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience. Ann Oncol 15:875–884
Ewertz M, Jensen MB, Gunnarstottır KA et al (2011) Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 29(1):25–31
Xue F, Michels KB (2007) Diabetes, metabolic syndrome, and breast cancer: a review of the current evidence. Am J Clin Nutr 86(3):823–835
Rajala MW, Scherer PE (2003) Mini review: the adipocyte—at the crossroads of energy homeostasis, inflammation, and atherosclerosis. Endocrinology 144:3765–3773
Reaven GM (1988) Banting lecture: Role of insulin resistance in human disease. Diabetes 37(1988):1595–1607
Wajchenberg BL (2000) Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 21(6):697–738
Key TJ, Appleby PN, Reeves GK et al (2003) Body mass index, serum sex hormones and breast cancer risk in postmenopausal women. J Natl Cancer Inst 95:1218–1226
Cleary MP, Grossmanm ME (2009) Mini review. Obesity and breast cancer—the estrogen connection. Endocrinology 150:2537–2542
Goodwin PJ, Ennis M, Kl Pritchard et al (2002) Fasting insulin and outcome in early breast cancer: results of a prospective cohort study. J Clin Oncol 20:42–51
Zhang X, Yee D (2000) Tyrosine kinase signalling in breast cancer: insulin like growth factors and their receptors in breast cancer. Breast Cancer Res 2:170–175
Olefsky JM, Glass CK (2010) Macrophages, inflammation and insulin resistance. Annu Rev Physiol 72:219–246
Purohit A, Newman SP, Reed MJ (2002) The role of cytokines in regulating estrogen synthesis: implications for the etiology of breast cancer. Breast Cancer Res 4:65–69
Ishikawa M, Kitayama J, Nagawa H (2004) Enhanced expression of leptin and leptin receptor in human breast cancer. Clin Cancer Res 10:4325–4331
Mantzoros C, Petridou E, Dessypris N et al (2004) Adiponectin and breast cancer risk. J Clin Endocrinol Metab 89:1102–1117
Kumar NB, Cantor A, Allen K et al (2000) Android obesity at diagnosis and breast carcinoma survival: evaluation of the effects of anthropometric variables at diagnosis, including body composition and body fat distribution and weight gain during life span, and survival from breast carcinoma. Cancer 88:2751–2757
Obemair A, Kurz C, Hanzal E et al (1995) The influence of obesity on the disease free survival in primary breast cancer. Anticancer Res 15:2265–2269
Katoh A, Watzlaf VJ, D’Amico F (1994) An examination of obesity and breast cancer survival in post menopausal women. Br J Cancer 70:928–933
Sohrabi A, Sandoz J, Spratt JS et al (1980) Recurrance of breast cancer. Obesity, tumor size and axillary lymph node metastases. JAMA 244:264–265
Marret H, Perrotin F, Bougnoux P et al (2001) Low body mass index is an independent predictive factor of local recurrance after conservative treatment for breast cancer. Breast Canc Res Treat 66:17–23
Rosenberg L, Czene K, Hall P (2009) Obesity and poor breast cancer prognosis: an illusion because of hormone replacement therapy? Br J Cancer 100:1486–1491
Adult Treatment Panel III (2002) Third Report of the National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) Final Report. Circulation 106: 3143–3422
Phipps AI, Malone KE, Porter PL, Daling JR, Li CI (2008) Body size and risk of luminal, HER2-overexpressing, and triple-negative breast cancer in postmenopausal women. Cancer Epidemiol Biomarkers Prev 17(8):2078–2086
Millikan RC, Newman B, Tse CK, Moorman PG, Conway K, Dressler LG, Smith LV, Labbok MH, Geradts J, Bensen JT, Jackson S, Nyante S, Livasy C, Carey L, Earp HS, Perou CM (2008) Epidemiology of basal-like breast cancer. Breast Cancer Res Treat 109(1):123–139
Yang XR, Sherman ME, Rimm DL, Lissowska J, Brinton LA, Peplonska B, Hewitt SM, Anderson WF, Szeszenia-Dabrowska N, Bardin-Mikolajczak A, Zatonski W, Cartun R, Mandich D, Rymkiewicz G, Ligaj M, Lukaszek S, Kordek R, García-Closas M (2007) Differences in risk factors for breast cancer molecular subtypes in a population-based study. Cancer Epidemiol Biomarkers Prev 16(3):439–443
Kwan ML, Kushi LH, Weltzien E, Maring B, Kutner SE, Fulton RS, Lee MM, Ambrosone CB, Caan BJ (2009) Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. Breast Cancer Res 11(3):R31 Epub 2009 May 22
Maiti B, Kundranda MN, Spiro TP, Daw HA (2010) The association of metabolic syndrome with triple-negative breast cancer. Breast Cancer Res Treat 121(2):479–483
Bahl M, Enis M, Tannock F, Hux J, Pritchard I, Koo J, Goodwin P (2005) Serum lipids and outcome of early-stage breast cancer: results of a prospective cohort study. Breast Cancer Res Treat 94:135–144
Petrelli JM, Calle EE, Rodriquez C, Thun MJ (2002) Body mass index, height and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes Control 13(4):325–332
Marret H, Perrotin F, Bougnoux P, Descamps P, Hubert B, Lefranc T, LeFloch O, Lansac J, Body G (2001) Low body mass index is an independent predictive factor of local recurrence after conservative treatment for breast cancer. Breast Cancer Res Treat 66(1):17–23
Stark A, Schultz D, Kapke A, Nadkarni P, Burke M, Linden M, Raju U (2009) Obesity and risk of the less commonly diagnosed subtypes of breast cancer. Eur J Surg Oncol 35(9):928–935
Van Mieghem T, Leunen K, Pochet N, De Moor B, De Smet F, Amant F, Berteloot P, Timmerman D, Vanden Bempt I, Drijkoningen R et al (2007) Body mass index and HER-2 overexpression in breast cancer patients over 50 years of age. Breast Cancer Res Treat 106(1):127–133
Halbert CH, Weathers B, Esteve R, Audrain-McGovern J, Kumanyika S, DeMichele A, Barg F (2008) Experiences with weight change in African–American breast cancer survivors. Breast J 14(2):182–187
Collaborate Group on Hormonal Factors in Breast Cancer (1996) Breast cancer and hormonal contraceptives: collaborate reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from epidemiological studies. Lancet 347(9017):1713–1727
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Mousa, U., Onur, H. & Utkan, G. Is obesity always a risk factor for all breast cancer patients? c-erbB2 expression is significantly lower in obese patients with early stage breast cancer. Clin Transl Oncol 14, 923–930 (2012). https://doi.org/10.1007/s12094-012-0878-z
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DOI: https://doi.org/10.1007/s12094-012-0878-z