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Prognostic Value of Body Mass Index in Locally Advanced Breast Cancer

Authors' Affiliations: ¹ Department of Breast Medical Oncology and ² Division of Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, Texas and ³ Medical Oncology, Department of Health and Medical Services, Dubai Hospital, Dubai, United Arab Emirates

Requests for reprints: Massimo Cristofanilli, Department of Breast Medical Oncology, Unit 1354, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030. Phone: 713-792-2817; Fax: 713-745-4385; E-mail: mcristof{at}mdanderson.org.

Purpose: The purpose of this retrospective study was to determine the association and prognostic value of body mass index (BMI) at the time of initial diagnosis in patients with locally advanced breast cancer (LABC). The analysis includes the subsets of inflammatory (IBC) and noninflammatory (non-IBC LABC) breast cancer.

Experimental Design: We identified 602 patients who had LABC treated on prospective clinical trials. BMI was divided into three groups: (a) 24.9 (normal/underweight), (b) 25.0 to 29.9 (overweight), and (c) 30 (obese). Kaplan-Meier product limit method was used to estimate survival outcomes. Cox proportional hazards were used to determine associations between survival and BMI and to test for an interaction between BMI and breast cancer type.

Results: Eighty-two percent had non-IBC LABC and 18% had IBC. Obese patients tended to have a higher incidence of IBC compared with overweight and normal/underweight groups (P = 0.01). Median follow up was 6 years for all patients. Median overall survival (OS) and recurrence-free survival (RFS) were 8.8 and 5.9 years, respectively. Patients with LABC who were obese or overweight had a significantly worse OS and RFS (P = 0.001) and a higher incidence of visceral recurrence compared with normal/underweight patients. In a multivariable model, BMI remained significantly associated with both OS and RFS for the entire cohort. The interactions between BMI and LABC subsets and between BMI and menopausal status were not statistically significant.

Conclusion: Patients with LABC and high BMI have a worse prognosis. Evaluation of the biological factors associated with this observation can provide tools for additional therapeutic interventions.