Interaction between body mass index and hormone-receptor status as a prognostic factor in lymph-node-positive breast cancer

PLoS One. 2017 Mar 1;12(3):e0170311. doi: 10.1371/journal.pone.0170311. eCollection 2017.

Abstract

The aim of this study was to determine the relationship between the body mass index (BMI) at a breast cancer diagnosis and various factors including the hormone-receptor, menopause, and lymph-node status, and identify if there is a specific patient subgroup for which the BMI has an effect on the breast cancer prognosis. We retrospectively analyzed the data of 8,742 patients with non-metastatic invasive breast cancer from the research database of Asan Medical Center. The overall survival (OS) and breast-cancer-specific survival (BCSS) outcomes were compared among BMI groups using the Kaplan-Meier method and Cox proportional-hazards regression models with an interaction term. There was a significant interaction between BMI and hormone-receptor status for the OS (P = 0.029), and BCSS (P = 0.013) in lymph-node-positive breast cancers. Obesity in hormone-receptor-positive breast cancer showed a poorer OS (adjusted hazard ratio [HR] = 1.51, 95% confidence interval [CI] = 0.92 to 2.48) and significantly poorer BCSS (HR = 1.80, 95% CI = 1.08 to 2.99). In contrast, a high BMI in hormone-receptor-negative breast cancer revealed a better OS (HR = 0.44, 95% CI = 0.16 to 1.19) and BCSS (HR = 0.53, 95% CI = 0.19 to 1.44). Being underweight (BMI < 18.50 kg/m2) with hormone-receptor-negative breast cancer was associated with a significantly worse OS (HR = 1.98, 95% CI = 1.00-3.95) and BCSS (HR = 2.24, 95% CI = 1.12-4.47). There was no significant interaction found between the BMI and hormone-receptor status in the lymph-node-negative setting, and BMI did not interact with the menopause status in any subgroup. In conclusion, BMI interacts with the hormone-receptor status in a lymph-node-positive setting, thereby playing a role in the prognosis of breast cancer.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Body Mass Index*
  • Breast Neoplasms* / diagnosis
  • Breast Neoplasms* / mortality
  • Breast Neoplasms* / physiopathology
  • Disease-Free Survival
  • Female
  • Humans
  • Lymphatic Metastasis
  • Middle Aged
  • Obesity* / diagnosis
  • Obesity* / mortality
  • Obesity* / physiopathology
  • Retrospective Studies
  • Survival Rate

Grants and funding

This study was supported by a grant (2016-668) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea (http://en.ails.amc.seoul.kr/eng/ailse/main.do) and the National Research Foundation of Korea (http://www.nrf.re.kr/nrf_eng_cms/) grant funded by the Korea government (MSIP) (No. 2015R1C1A2A01053155). This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI14C1061). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.