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Chen L, Wu F, Chen X, Chen Y, Deng L, Cai Q, Wu L, Guo W, Chen M, Li Y, Zhang W, Jin X, Chen H, Nie Q, Wu X, Lin Y, Wang C, Fu F. Impact of body mass index in therapeutic response for HER2 positive breast cancer treated with neoadjuvant targeted therapy: a multi-center study and meta-analysis. NPJ Breast Cancer 2023; 9:46. [PMID: 37258524 DOI: 10.1038/s41523-023-00552-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
While overweight/obesity has become a major public health issue worldwide, any association between body mass index (BMI) and therapeutic response in neoadjuvant targeted therapy treated HER2 positive breast cancer patients remain unclear. The information from a total of four-hundred and ninety-one neoadjuvant targeted therapy treated HER2 positive breast cancer patients from four institutions were retrospectively collected. Univariate and multivariate logistic analysis was developed to determine the association between BMI and therapeutic response. A meta-analysis of published literature was then conducted to confirm the effect of overweight/obesity on pCR for patients treated with neoadjuvant targeted therapy. Restricted cubic spline (RCS) adjusted for confounding factors demonstrated a decrease pCR with increasing BMI (OR = 0.937, P = 0.045). Patients were then categorized into under/normal weight (n = 299) and overweight/obesity (n = 192). Overweight/obese patients were independently associated with a poor therapeutic response. In the subgroup analysis, a significant negative impact of overweight/obesity on pCR can be observed both in single-targeted (OR = 0.556; P = 0.02) and dual-targeted (OR = 0.392; P = 0.021) populations. Six eligible studies involving 984 neoadjuvant targeted therapy treated HER2 positive breast cancer patients were included in the meta-analysis. The meta-analysis also demonstrated that overweight/obesity was significantly associated with a poor response to neoadjuvant anti-HER2 therapy (OR = 0.68; P = 0.007). Our result show that overweight and obese HER2 positive breast cancer patients are less likely to achieve pCR after neoadjuvant targeted therapy.
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Affiliation(s)
- Lili Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Fan Wu
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Xiaobin Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Yazhen Chen
- Department of Breast Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, 363000, Zhangzhou, Fujian, P.R. China
| | - Lin Deng
- Department of Oncology, No. 900 Hospital of The Joint Logistic Support Force, Fuzhou, China
| | - Qindong Cai
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Long Wu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wenhui Guo
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Minyan Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Yan Li
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Wenzhe Zhang
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Xuan Jin
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Hanxi Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Qian Nie
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China
| | - Xiong Wu
- Department of Breast Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, 363000, Zhangzhou, Fujian, P.R. China.
| | - Yuxiang Lin
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China.
| | - Chuan Wang
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China.
| | - Fangmeng Fu
- Department of Breast Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, 350001, Fuzhou, Fujian Province, China.
- Breast Cancer Institute, Fujian Medical University, 350001, Fuzhou, Fujian Province, China.
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Anti-Inflammatory Mechanisms of Dietary Flavones: Tapping into Nature to Control Chronic Inflammation in Obesity and Cancer. Int J Mol Sci 2022; 23:ijms232415753. [PMID: 36555392 PMCID: PMC9779861 DOI: 10.3390/ijms232415753] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Flavones are natural phytochemicals broadly distributed in our diet. Their anti-inflammatory properties provide unique opportunities to control the innate immune system and inflammation. Here, we review the role of flavones in chronic inflammation with an emphasis on their impact on the molecular mechanisms underlying inflammatory diseases including obesity and cancer. Flavones can influence the innate immune cell repertoire restoring the immune landscape. Flavones impinge on NF-κB, STAT, COX-2, or NLRP3 inflammasome pathways reestablishing immune homeostasis. Devoid of adverse side effects, flavones could present alternative opportunities for the treatment and prevention of chronic inflammation that contributes to obesity and cancer.
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Paxton RJ, Bui C, Fullwood D, Daniel D, Stolley M, Oliver JS, Wang K, Dubay JW. Are Physical Activity and Sedentary Behavior Associated With Cancer-Related Symptoms in Real Time?: A Daily Diary Study. Cancer Nurs 2022; 45:E246-E254. [PMID: 33156014 PMCID: PMC10597574 DOI: 10.1097/ncc.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few studies have examined the real-time and dynamic relationship between lifestyle behaviors and treatment-related symptoms. OBJECTIVE The aim of this study was to examine the associations of daily physical activity and sedentary behavior with symptom burden, pain interference, and fatigue among patients who were undergoing active cancer treatment. METHODS A total of 22 (mean age = 57 years; 73% women; 55% Black) cancer patients were recruited from a local hospital and reported a daily diary of physical activity, sedentary behavior, symptom burden, pain interference, and fatigue over 10 days. Adjusted mixed-effects models were used to examine all associations. RESULTS Body mass index moderated the relationship between physical activity and symptom burden (γ = 0.06, P < .01) and physical activity and fatigue (γ = 0.09, P < .05). On days where physical activity was higher than average, symptom burden and fatigue scores were lower among patients who had lower body mass index values. Also, age moderated the relationship between sedentary behavior and symptom burden (γ = -0.04, P < .05); on days where patients sat more, symptom burden was lower among patients who were younger than the average age. CONCLUSIONS Overall, these data indicate that treatment-related symptoms vary daily within cancer patients and that physical activity may alleviate treatment-related symptoms for leaner patients. Larger samples and objective assessments of physical activity and sedentary behavior are needed to validate our results. IMPLICATIONS FOR PRACTICE Oncology nurses may be in the best position to promote physical activity during treatment as a strategy to manage symptom burden.
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Affiliation(s)
- Raheem J Paxton
- Author Affiliations: Department of Community Medicine and Population Health (Dr Paxton); Life Research Institute (Dr Bui); Capstone College of Nursing (Dr Oliver); and Department of Social Work (Ms Wang), University of Alabama, Tuscaloosa; Department of Aging and Geriatric, University of Florida, Gainesville (Dr Fullwood); DCH Manderson Cancer Center (Ms Daniel and Dr Dubay); and Medical College of Wisconsin (Dr Stolley), Milwaukee
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Study protocol for an open labelled randomised controlled trial of perioperative oral nutrition supplement in breast and colorectal cancer patients undergoing elective surgery. Trials 2021; 22:767. [PMID: 34732233 PMCID: PMC8565021 DOI: 10.1186/s13063-021-05716-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/12/2021] [Indexed: 01/04/2023] Open
Abstract
Background While it is well established that perioperative use of oral nutrition supplement (ONS) improves nutrition status among severely malnourished surgical cancer patients, the evidence requires further substantiation for non-severely malnourished patients with cancer. This protocol paper presents the rationale and design of a randomised controlled trial to evaluate the effectiveness of preoperative as well as an extended 90-day postoperative use of ONS on nutritional and clinical outcomes among patients undergoing elective surgery for breast and colorectal cancer. Methods Patients with primary breast and colorectal cancer undergoing elective surgery are recruited from two tertiary hospitals. Eligible patients are assigned into one of the three intervention arms: (i) Group SS will receive ONS in addition to their normal diet up to 14 days preoperatively and postoperatively up to discharge; (ii) Group SS-E will receive ONS in addition to their normal diet up to 14 days preoperatively, postoperatively up to discharge and for an extended 90 days after discharge; and (iii) Group DS will receive ONS in addition to their normal diet postoperatively up to discharge from the hospital. The ONS is a standard formula fortified with lactium to aid in sleep for recovery. The primary endpoints include changes in weight, body mass index (BMI), serum albumin and prealbumin levels, while secondary endpoints are body composition (muscle and fat mass), muscle strength (handgrip strength), energy and protein intake, sleep quality, haemoglobin, inflammatory markers (transferrin, high sensitivity C-reactive protein, interleukin-6), stress marker (saliva cortisol), length of hospital stay and postoperative complication rate. Discussion This trial is expected to provide evidence on whether perioperative supplementation in breast and colorectal cancer patients presenting with high BMI and not severely malnourished but undergoing the stress of surgery would be beneficial in terms of nutritional and clinical outcomes. Trial registration ClinicalTrial.gov NCT04400552. Registered on 22 May 2020, retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05716-5.
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Li Q, Tong Y, Liu S, Yang K, Liu C, Zhang J. Association between body mass index and short-term mortality in patients with intra-abdominal infections: a retrospective, single-centre cohort study using the Medical Information Mart for Intensive Care database. BMJ Open 2021; 11:e046623. [PMID: 34389563 PMCID: PMC8365805 DOI: 10.1136/bmjopen-2020-046623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to determine the relationship between the body mass index (BMI) and short-term mortality of patients with intra-abdominal infection (IAI) using the Medical Information Mart for Intensive Care (MIMIC-III) database. DESIGN Retrospective cohort study. SETTING Adult intensive care units (ICUs) at a tertiary hospital in the USA . PARTICIPANTS Adult IAI ICU patients from 2001 to 2012 in the MIMIC-III database. INTERVENTIONS In univariate analysis, we compared the differences in the characteristics of patients in each BMI group. Cox regression models were used to evaluate the relationships between BMI and short-term prognosis. PRIMARY AND SECONDARY OUTCOME MEASURES 90-day survival. RESULTS In total, 1161 patients with IAI were included. There were 399 (34.4%) patients with a normal BMI (<25 kg/m2), 357 (30.8%) overweight patients (25-30 kg/m2) and 405 (34.9%) obese patients (>30 kg/m2) who tended to be younger (p<0.001) and had higher Sequential Organ Failure Assessment scores (p<0.05). The mortality of obese patients at 90 days was lower than that of patients with a normal BMI (20.74% vs 23.25%, p<0.05), but their length of stay in the ICU was higher (4.9 days vs 3.6 days, p<0.001); however, their rate of mechanical ventilation utilisation was higher (61.48% vs 56.86%, p<0.05). In the Cox regression model, we also confirmed that BMI was a protective factor in patients with IAIs, and the adjusted mortality rate of patients with a higher BMI was 0.97 times lower than that of patients with a lower BMI (p<0.001, HR=0.97, 95% CI 0.96 to 0.99). CONCLUSIONS IAI patients with an overweight or obese status might have lower 90-day mortality than patients with a normal BMI.
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Affiliation(s)
- Qinglin Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yingmu Tong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Sinan Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kaibo Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jingyao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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diFlorio-Alexander RM, Song Q, Dwan D, Austin-Strohbehn JA, Muller KE, Kinlaw WB, MacKenzie TA, Karagas MR, Hassanpour S. Fat-enlarged axillary lymph nodes are associated with node-positive breast cancer in obese patients. Breast Cancer Res Treat 2021; 189:257-267. [PMID: 34081259 PMCID: PMC8302552 DOI: 10.1007/s10549-021-06262-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Obesity associated fat infiltration of organ systems is accompanied by organ dysfunction and poor cancer outcomes. Obese women demonstrate variable degrees of fat infiltration of axillary lymph nodes (LNs), and they are at increased risk for node-positive breast cancer. However, the relationship between enlarged axillary nodes and axillary metastases has not been investigated. The purpose of this study is to evaluate the association between axillary metastases and fat-enlarged axillary nodes visualized on mammograms and breast MRI in obese women with a diagnosis of invasive breast cancer. METHODS This retrospective case-control study included 431 patients with histologically confirmed invasive breast cancer. The primary analysis of this study included 306 patients with pre-treatment and pre-operative breast MRI and body mass index (BMI) > 30 (201 node-positive cases and 105 randomly selected node-negative controls) diagnosed with invasive breast cancer between April 1, 2011, and March 1, 2020. The largest visible LN was measured in the axilla contralateral to the known breast cancer on breast MRI. Multivariate logistic regression models were used to assess the association between node-positive status and LN size adjusting for age, BMI, tumor size, tumor grade, tumor subtype, and lymphovascular invasion. RESULTS A strong likelihood of node-positive breast cancer was observed among obese women with fat-expanded lymph nodes (adjusted OR for the 4th vs. 1st quartile for contralateral LN size on MRI: 9.70; 95% CI 4.26, 23.50; p < 0.001). The receiver operating characteristic curve for size of fat-enlarged nodes in the contralateral axilla identified on breast MRI had an area under the curve of 0.72 for predicting axillary metastasis, and this increased to 0.77 when combined with patient and tumor characteristics. CONCLUSION Fat expansion of axillary lymph nodes was associated with a high likelihood of axillary metastases in obese women with invasive breast cancer independent of BMI and tumor characteristics.
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Affiliation(s)
| | - Qingyuan Song
- Department of Biomedical Data Science, Dartmouth College, 1 Medical Center Drive, HB 7261, Lebanon, NH, 03756, USA
| | - Dennis Dwan
- Department of Internal Medicine, Carney Hospital, 2100 Dorchester Ave, Dorchester, MA, 02124, USA
| | - Judith A Austin-Strohbehn
- Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Kristen E Muller
- Department of Pathology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - William B Kinlaw
- Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Todd A MacKenzie
- Department of Biomedical Data Science, Dartmouth College, 1 Medical Center Drive, HB 7261, Lebanon, NH, 03756, USA
| | - Margaret R Karagas
- Department of Epidemiology, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Saeed Hassanpour
- Department of Biomedical Data Science, Dartmouth College, 1 Medical Center Drive, HB 7261, Lebanon, NH, 03756, USA.
- Department of Epidemiology, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
- Department of Computer Science, Dartmouth College, Hanover, NH, 03755, USA.
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Zhao C, Hu W, Xu Y, Wang D, Wang Y, Lv W, Xiong M, Yi Y, Wang H, Zhang Q, Wu Y. Current Landscape: The Mechanism and Therapeutic Impact of Obesity for Breast Cancer. Front Oncol 2021; 11:704893. [PMID: 34350120 PMCID: PMC8326839 DOI: 10.3389/fonc.2021.704893] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 12/22/2022] Open
Abstract
Obesity is defined as a chronic disease induced by an imbalance of energy homeostasis. Obesity is a widespread health problem with increasing prevalence worldwide. Breast cancer (BC) has already been the most common cancer and one of the leading causes of cancer death in women worldwide. Nowadays, the impact of the rising prevalence of obesity has been recognized as a nonnegligible issue for BC development, outcome, and management. Adipokines, insulin and insulin-like growth factor, sex hormone and the chronic inflammation state play critical roles in the vicious crosstalk between obesity and BC. Furthermore, obesity can affect the efficacy and side effects of multiple therapies such as surgery, radiotherapy, chemotherapy, endocrine therapy, immunotherapy and weight management of BC. In this review, we focus on the current landscape of the mechanisms of obesity in fueling BC and the impact of obesity on diverse therapeutic interventions. An in-depth exploration of the underlying mechanisms linking obesity and BC will improve the efficiency of the existing treatments and even provide novel treatment strategies for BC treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Haiping Wang
- Department of Plastic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Zhang
- Department of Plastic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiping Wu
- Department of Plastic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
AbstractThe world is in the grip of an obesity pandemic, with tripling of obesity rates since 1975; it is predicted that one-third of people on Earth will be obese by 2025. The health consequences of obesity are primarily thought to be related to cardiometabolic disorders such as diabetes and cardiovascular diseases. It is less well appreciated that obesity has been related to at least 13 different cancers and in future, (with increasing control over tobacco misuse and infections), obesity will be the main cause of cancers. While this is an area of active research, there are large gaps in the definition of what is an obesity related cancer (JRC) and more importantly, what are the underlying mechanisms. To an extent, this is due to the controversy on what constitutes “unhealthy obesity” which is further related to the causes of obesity. This narrative review examines the causes and measurement of obesity, the types of obesity-related cancers and possible mechanisms. The information has wide implications ranging from prevention, screening, prognosis and therapeutic strategies. Obesity related cancers should be an area of high-priority research. Oncologists can contribute by spreading awareness and instituting management measures for individual patients in their care.
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Affiliation(s)
- Ajit Venniyoor
- National Oncology Centre, The Royal Hospital, Muscat, Sultanate of Oman
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Rosato L, Lavorini E, Balzi D, Mondini G, Panier Suffat L. Morbidity and mortality analysis in general surgery operations. Is there any room for improvement? Minerva Surg 2021; 77:229-236. [PMID: 34160169 DOI: 10.23736/s2724-5691.21.08737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this work is to examine the performance of surgeries, by evaluating the results. The evaluation of the results, with particular attention to complications, is the corner stone to identify the causes leading to correction of any predisposing factors and reducing risks, to improve quality of care. METHODS We performed a retrospective analysis of 952 consecutive patients who had elective or emergency surgery from November 1, 2018 to October 31, 2019. We classified surgical intervention according to their complexity. The Clavien Dindo classification was used to categorize the complications. We performed a stepwise multivariate logistic-regression analysis, with the presence of post-operative complications as dependent variable and age, gender, BMI, ASA, type of surgery procedures, complexity of surgery, operative time as covariates. RESULTS A total of 952 surgical procedures were included in this study. Abdominal procedures were the most frequent type of surgery performed (52.1%). Post-operative complications occurred in 120 surgical procedures (12.6%), these are related to the increase of the ASA score and the longer average operative time, with an increase of developing complication of 5% for each additional 10 minutes of surgery. CONCLUSIONS many factors influence postoperative morbidity and mortality. Particular attention was due to complication's evaluation, about all in abdominal surgery and high complexity procedures. We argue that key factors which influence the favourable surgical outcome are: compliance with standardized safety procedures, volume of activity of the structure, presence of interdisciplinary care groups, and ability of health professionals in recognizing and promptly treating complications.
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Affiliation(s)
- Lodovico Rosato
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, School of Medicine, University of Turin, Ivrea, Turin, Italy
| | - Eugenia Lavorini
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, School of Medicine, University of Turin, Ivrea, Turin, Italy
| | - Daniela Balzi
- Epidemiology Unit, AUSL Tuscany Center, Florence, Italy
| | - Guido Mondini
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, Ivrea, Turin, Italy -
| | - Luca Panier Suffat
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, Ivrea, Turin, Italy
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Kulkarni A, Bowers LW. The role of immune dysfunction in obesity-associated cancer risk, progression, and metastasis. Cell Mol Life Sci 2021; 78:3423-3442. [PMID: 33464384 PMCID: PMC11073382 DOI: 10.1007/s00018-020-03752-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Abstract
Obesity has been linked to an increased risk of and a worse prognosis for several types of cancer. A number of interrelated mediators contribute to obesity's pro-tumor effects, including chronic adipose inflammation and other perturbations of immune cell development and function. Here, we review studies examining the impact of obesity-induced immune dysfunction on cancer risk and progression. While the role of adipose tissue inflammation in obesity-associated cancer risk has been well characterized, the effects of obesity on immune cell infiltration and activity within the tumor microenvironment are not well studied. In this review, we aim to highlight the impact of both adipose-mediated inflammatory signaling and intratumoral immunosuppressive signaling in obesity-induced cancer risk, progression, and metastasis.
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Affiliation(s)
- Aneesha Kulkarni
- Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, 47906, USA
| | - Laura W Bowers
- Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, 47906, USA.
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Abstract
Background: Gene expression profiles from early-onset breast cancer and normal tissues were
analyzed to explore the genes and prognostic factors associated with breast cancer. Methods: GSE109169 and GSE89116 were obtained from the database of Gene Expression Omnibus. We
firstly screened the differentially expressed genes between tumor samples and normal
samples from patients with early-onset breast cancer. Based on database for annotation,
visualization and intergrated discovery (DAVID) tool, functional analysis was
calculated. Transcription factor-target regulation and microRNA-target gene network were
constructed using the tool of transcriptional regulatory relatitionships unraveled by
sentence-based text mining (TRRUST) and miRWalk2.0, respectively. The prognosis-related
survival information was compiled based on The Cancer Genome Atlas breast cancer
clinical data. Results: A total of 708 differentially expressed genes from GSE109169 data sets and 358
differentially expressed genes from GSE89116 data sets were obtained, of which 122
common differentially expressed genes including 102 uniformly downregulated genes and 20
uniformly upregulated genes were screened. Protein–protein interaction network with a
total of 83 nodes and 157 relationship pairs was obtained, and genes in protein–protein
interaction, such as peroxisome proliferator-activated receptor γ,
FGF2, adiponectin, and PCK1, were recognized as key
nodes in protein–protein interaction. In total, 66 transcription factor–target
relationship pairs were obtained, and peroxisome proliferator-activated receptor γ was
the only one downregulated transcription factor. MicroRNA-target gene network contained
368 microRNA-target relationship pairs. Moreover, 16 differentially expressed genes,
including 2 upregulations and 14 downregulations, were related to a significant
correlation with the prognosis, including SQLE and peroxisome
proliferator-activated receptor γ. Conclusions: SQLE and peroxisome proliferator-activated receptor γ might be
important prognostic factors in breast cancers, and adiponectin might be important in
breast cancer pathogenesis regulated by peroxisome proliferator-activated receptor
γ.
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Affiliation(s)
- Zhun Yu
- Department of Breast, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Qi He
- Department of Breast, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Guoping Xu
- Department of Breast, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
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Rasmy A, Sorour Y. Effect of Obesity on Neoadjuvant Systemic Therapy Outcomes in Patients with Early Breast Cancer: A Retrospective Institutional Study. Asian Pac J Cancer Prev 2020; 21:683-691. [PMID: 32212794 PMCID: PMC7437318 DOI: 10.31557/apjcp.2020.21.3.683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/10/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Obesity and overweight are usually considered as poor prognostic factors in early breast cancer. Body mass index (BMI) is a significant predictive factor for lower pathologic complete response (pCR) rates after neo-adjuvant systemic therapy (NST). The relationship between obesity and breast cancer prognosis varies according to patient and tumor characteristics such as menopausal status and tumor subtype, respectively. PATIENTS AND METHODS Between March 2010 and October 2013, 80 patients with early breast cancer who had received standard NST from KFSH Saudi Arabia were included in this study. For statistical analysis, the study participants were categorized into two groups based on their BMI, as normal (BMI < 25 kg/m2) and obese groups (BMI ≥ 25 kg/m2). pCR was defined as non-invasive cancer in the breast/axillary tissue. RESULTS The median age of our patients was 48 (range, 38-68) years. Invasive ductal carcinoma (IDC) subtype was identified in 93.8% of the cases. Additionally, 26 (32.5%) and 33 (41.25%) patients were diagnosed with stage II and stage IIIA breast cancer, respectively. Lymphovascular invasion was detected in 32.5%, whereas intermediate and high-grade malignancy were found in 61.25% and 32.5% of the patients, respectively. Forty-four patients (55%) were obese. pCR was achieved in 56 patients (70%), and the comparison between patients with and without pCR revealed that those in the former group had significantly lower tumor grades. Significantly, lower relapse and mortality rates were distinguished in patients who achieved pCR than in those who did not. Additionally, comparison between normal and obese patients revealed that a high number of patients in both groups were post-menopausal (p = 0.001). However, survival analysis indicated the absence of significant differences in disease-free survival between the two groups based on BMI (p = 0.19). Conversely, patients with normal BMI had significantly better overall survival than obese patients (p = 0.029), with a higher mortality rate noted in the obese group (16.7% vs 2.3%, p = 0.037). CONCLUSIONS In the present study, 58.3% of patients that failed to achieve pCR had BMI above the normal level; they moreover had higher relapse rates and lower survival compared with normal BMI patients. This finding needs to be verified through further prospective studies to determine if BMI is a risk factor for breast cancer.
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Affiliation(s)
- Ayman Rasmy
- Medical Oncology, Zagazig University, Zagazig,
- Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo, Egypt,
- Medical Oncology, King Saud Medical City, Riyadh,
| | - Yasser Sorour
- Department of Adult Oncology, Oncology Center, King Fahd Specialist Hospital, Saudi Arabia.
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