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Widschwendter, Peter; Friedl, Thomas W. P.; Schwentner, Lukas; DeGregorio, Nikolaus; Jaeger, Bernadette; Schramm, Amelie; Bekes, Inga; Deniz, Miriam; Lato, Krisztian; Weissenbacher, Tobias; Kost, Bernd; Andergassen, Ulrich; Jueckstock, Julia; Neugebauer, Julia; Trapp, Elisabeth; Fasching, Peter A.; Beckmann, Matthias W.; Schneeweiss, Andreas; Schrader, Ines; Rack, Brigitte; Janni, Wolfgang and Scholz, Christoph (2015): The influence of obesity on survival in early, high-risk breast cancer: results from the randomized SUCCESS A trial. In: Breast Cancer Research 17:129 [PDF, 1MB]

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Introduction: Obese breast cancer patients have worse prognosis than normal weight patients, but the level at which obesity is prognostically unfavorable is unclear. Methods: This retrospective analysis was performed using data from the SUCCESS A trial, in which 3754 patients with high-risk early breast cancer were randomized to anthracycline-and taxane-based chemotherapy with or without gemcitabine. Patients were classified as underweight/normal weight (body mass index (BMI) < 25.0),overweight (BMI 25.0-29.9),slightly obese (BMI 30.0-34.9),moderately obese (BMI 35.0-39.9) and severely obese (BMI >= 40.0),and the effect of BMI on disease-free survival (DFS) and overall survival (OS) was evaluated (median follow-up 65 months). In addition, subgroup analyses were conducted to assess the effect of BMI in luminal A-like, luminal B-like, HER2 (human epidermal growth factor 2)-positive and triple-negative tumors. Results: Multivariate analyses revealed an independent prognostic effect of BMI on DFS (p = 0.001) and OS (p = 0.005). Compared with underweight/normal weight patients, severely obese patients had worse DFS (hazard ratio (HR) 2.70, 95 % confidence interval (CI) 1.71-4.28, p < 0.001) and OS (HR 2.79, 95 % CI 1.63-4.77, p < 0.001),while moderately obese, slightly obese and overweight patients did not differ from underweight/normal weight patients with regard to DFS or OS. Subgroup analyses showed a similar significant effect of BMI on DFS and OS in patients with triple-negative breast cancer (TNBC),but not in patients with other tumor subtypes. Conclusions: Severe obesity (BMI = 40) significantly worsens prognosis in early breast cancer patients, particularly for triple-negative tumors.

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