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Kong YH, Huang JY, Ding Y, Chen SH, Li QS, Xiong Y. The effect of BMI on survival outcome of breast cancer patients: a systematic review and meta-analysis. Clin Transl Oncol 2024:10.1007/s12094-024-03563-9. [PMID: 39012453 DOI: 10.1007/s12094-024-03563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE The main goal of the present research is to explore the potential link of body mass index (BMI) with different survival metrics in breast cancer patients. Our aim is to offer the latest and most thorough meta-analysis, assessing the strength and reliability of the connection that BMI has with prognostic indicators in this disease. PATIENTS AND METHODS As of January 2024, we conducted a systematic literature search across PubMed, Embase, Web of Science, and the Cochrane Library databases. Our search aimed to identify studies examining BMI as an exposure factor, with breast cancer patients constituting the study population, and utilizing adjusted hazard ratio (HR) as the data type of interest. RESULTS The evidence synthesis incorporated a total of 61 eligible articles involving 201,006 patients. Being underweight posed a risk factor for overall survival (OS) in breast cancer patients compared to normal weight (HR 1.15, 95% CI 0.98-1.35; P = 0.08). Overweight or obesity, in comparison to normal weight, was a risk factor for OS (HR 1.18, 95% CI 1.14-1.23; P < 0.00001), disease-free survival (DFS) (HR 1.11, 95% CI 1.08-1.13; P < 0.00001), relapse-free survival (RFS) (HR 1.14, 95% CI 1.06-1.22; P = 0.03), and breast cancer-specific survival (BCSS) (HR 1.18, 95% CI 1.11-1.26; P < 0.00001), but not for progression-free survival (PFS) (HR 0.91, 95% CI 0.76-1.10; P = 0.33). Notably, in subgroup analyses, overweight patients achieved prolonged PFS (HR 0.80, 95% CI 0.64-0.99; P = 0.04), and compared to the obese population, the overweight cohort exhibited a significant difference in OS (HR 1.11, 95% CI 1.05-1.16; P < 0.00001) and DFS (HR 1.06, 95% CI 1.03-1.10; P = 0.0004), with a considerably stronger association. Furthermore, compared to HER- patients, HER + patients exhibited a greater predictive value for OS (HR 1.23, 95% CI 1.10-1.37; P = 0.0004), RFS (HR 1.30, 95% CI 1.03-1.64; P < 0.00001), and DFS (HR 1.10, 95% CI 1.03-1.17; P = 0.003). CONCLUSIONS The results of our meta-analysis reveal a notable association between BMI and various survival measures in breast cancer prognosis. These findings provide a solid basis for predicting breast cancer outcomes and implementing more effective therapeutic approaches.
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Affiliation(s)
- Yu-Huan Kong
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Jing-Yi Huang
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Ye Ding
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Shu-Hua Chen
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Qiu-Shuang Li
- Center of Clinical Evaluation and Analysis, Zhejiang Provincial Hospital of Chinese Medicine), The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
| | - Yang Xiong
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
- Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
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Kayan Tapan T, Çelebi F, Yaghouti K, Ağaçayak F, İlgün S, Soybir G, Alço G, Ak N, Ordu Ç, Özkurt E, Ünal Ç, Kurt S, Öztürk A, İyigün Z, Duymaz T, Özmen V. The Relationship of Pathological Response and Visceral Muscle and Fat Volume in Women With Breast Cancer Who Received Neoadjuvant Chemotherapy. Eur J Breast Health 2024; 20:117-121. [PMID: 38571683 PMCID: PMC10985580 DOI: 10.4274/ejbh.galenos.2024.2023-12-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024]
Abstract
Objective Differences in individual muscle/fat volumes may change the effectiveness of chemotherapy. In this study, the relationship between trunkal muscle and fat volume and body mass index (BMI) obtained before receiving neoadjuvant chemotherapy (NCT) in patients with breast cancer and complete pathological response (pCR) was investigated. Materials and Methods The volumes of psoas, abdominal and paraspinal muscles, and trunkal subcutaneous and visceral fat were calculated using CoreSlicer AI 2.0 opensource program from the F-18 fluorodeoxyglucose positron emission tomography/computed tomography (CT) and CT images before NCT and postoperative pCR rates to NCT were recorded. Muscle/fat volumes and BMI prior to NCT were compared in terms of pathological pCR rates. Patients were followed up regularly for recurrence and survival. Results Ninety-three patients were included with median (range) values for age, BMI, and body weights of 48 (28-72) years, 27 (16.8-51.6) kg/m2, and 71.94 (43-137) kg, respectively. The median follow-up time was 18.6 (6.7-59.6) months. No significant correlation was found between total muscle or fat volumes of patients with and without pCR. BMI [26.2 (16.8-51.6) kg/m2 vs. 24.6 (20.3-34.3) kg/m2, p = 0.03] and pCR rates in patients with low right-psoas muscle volume [11.74 (7.03-18.51) vs. 10.2 (6.71-13.36), p = 0.025] were significantly greater. A significant relationship was found between right psoas muscle volume and disease-free survival (DFS) (11.74 cm3 (7.03-18.51) vs. 10.2 cm3 (6.71-13.36), p = 0.025). However, no significant relationship was detected between total muscle-fat volume, BMI and overall survival and DFS (p>0.05). Conclusion This is the first published study investigating the relationship between the pCR ratio and body muscle and fat volume measured by CoreSlicer AI 2.0 in patients with breast cancer who received NCT. No correlation was found between the pCR ratio and total muscle plus fat volume. However, these results need to be validated with larger patient series.
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Affiliation(s)
- Tuba Kayan Tapan
- Department of Nutrition and Dietetic, Demiroğlu Bilim University Faculty of Health Sciences, İstanbul, Turkey
| | - Filiz Çelebi
- Department of Radiology, Yeditepe University Faculty of Medicine, İstanbul, Turkey
| | - Kourosh Yaghouti
- Clinic of Radiology, Gayrettepe Florance Nightingale Hospital, İstanbul, Turkey
| | - Filiz Ağaçayak
- Clinic of Radiology, İstanbul Florance Nightingale Hospital, İstanbul, Turkey
| | - Serkan İlgün
- Clinic of Breast Surgeon, Mater Dei Hospital, Central Region, Malta
| | - Gürsel Soybir
- Clinic of General Surgeon, Şişli Memorial Hospital, İstanbul, Turkey
| | - Gül Alço
- Clinic of Radiation Oncology, Gayrettepe Florance Nightingale Hospital, İstanbul, Turkey
| | - Naziye Ak
- Clinic of Oncology, Gayrettepe Florance Nightingale Hospital, İstanbul, Turkey
| | - Çetin Ordu
- Clinic of Oncology, Gayrettepe Florance Nightingale Hospital, İstanbul, Turkey
| | - Enver Özkurt
- Clinic of Breast Surgeon, İstanbul Florance Nightingale Hospital, İstanbul, Turkey
| | - Çağlar Ünal
- Clinic of Oncology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Sevgi Kurt
- Clinic of Plastic Surgeon, Gayrettepe Florance Nightingale Hospital, İstanbul, Turkey
| | - Alper Öztürk
- Department of General Surgeon, Biruni University Hospital, Biruni University Faculty of Medicine, İstanbul, Turkey
| | - Zeynep İyigün
- Department of Physical Therapy and Rehabilitation, Göztepe Medicalpark Hospital, Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | - Tomris Duymaz
- Department of Physical Therapy and Rehabilitation, İstanbul Bilgi University Faculty of Health Sciences, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, Breast Surgery, Surgical Oncology, İstanbul University-İstanbul Faculty of Medicine, İstanbul, Turkey
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Chan DS, Vieira R, Abar L, Aune D, Balducci K, Cariolou M, Greenwood DC, Markozannes G, Nanu N, Becerra‐Tomás N, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:572-599. [PMID: 36279884 PMCID: PMC10092239 DOI: 10.1002/ijc.34322] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/29/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.
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Affiliation(s)
- Doris S.M. Chan
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Katia Balducci
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Margarita Cariolou
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Nutrition, Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
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McNeil J. Energy balance in cancer survivors at risk of weight gain: a review. Eur J Nutr 2023; 62:17-50. [PMID: 35984493 DOI: 10.1007/s00394-022-02975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/29/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The study of energy balance [i.e., energy intake (EI) and energy expenditure (EE)] is a powerful tool for understanding body weight regulation and may contribute to our understanding of rapid weight gain risk in certain cancer survivors post-diagnosis. The purpose of this review was to summarize studies that assessed longitudinal, prospective changes in components of energy balance from diagnosis/start of treatment to any duration of follow-up in cancer survivors with prior evidence of weight gain (breast, prostate, thyroid, gynecologic, testicular, and acute lymphoblastic leukemia) RESULTS: The available literature suggests that energy balance components may be altered in cancer survivors who have a heightened risk of weight gain post-diagnosis. The evidence for EI was overall inconsistent. Conversely, decreases in resting and physical activity EE during the active phases of treatment (e.g., chemotherapy, hypothyroid state) were commonly noted, which then slowly rebounded towards baseline levels at the end of treatment and during follow-up assessments. Much of this evidence is based on data collected from breast cancer survivors, which highlights a paucity of data currently available on other cancer types. CONCLUSIONS While there is growing acknowledgement that weight management interventions in cancer survivors are needed, it is important to recognize that changes in both behavioral (EI, physical activity EE) and passive (resting EE, thermic effect of food) components of energy balance may occur post-diagnosis. This information can help to inform weight management interventions which often entail modifications in diet and/or physical activity.
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Affiliation(s)
- Jessica McNeil
- Department of Kinesiology, School of Health and Human Sciences, University of North Carolina Greensboro, 351D Coleman Building, 1408 Walker avenue, Greensboro, NC, 27412-5020, USA.
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Samaroo K, Hosein A, Olivier LK, Ali J. Breast Cancer in the Caribbean. Cureus 2021; 13:e17042. [PMID: 34522520 PMCID: PMC8428164 DOI: 10.7759/cureus.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/22/2022] Open
Abstract
Breast cancer (BC) is one of the leading causes of death among women globally. In the Caribbean, there is a higher mortality rate compared with North American and European countries which have higher incidence rates. We conducted a literature review to examine the BC dynamic in the Caribbean and determine the areas where further investigations are needed. The PubMed database was used for identifying relevant studies using a combination of specific keyword searches. All studies focusing on BC within the defined Caribbean population were selected for this review. A total of 117 papers were included. The data were organized and presented under the following headings and reported according to the country where available: BC incidence and mortality, patient demographics, clinicopathology, genetics, behavioral risks, diagnosis and treatment, and BC control. Our review uncovered major variability in the incidence, management, etiology, and mortality of BC among Caribbean countries. Low-resource countries are burdened by more advanced disease with expected poorer BC outcomes (i.e., shorter periods of disease-free survival). Countries with established national cancer registries seem to have a better approach to the management of BC. The introduction of cancer treatment programs in association with international nonprofit groups has shown tremendous improvement in quality, accessible cancer care for patients, particularly in low- and middle-income settings. BC research is relatively limited in the Caribbean, lacking in both scope and consistency. The unique Caribbean BC population of diverse ethnicities, environmental influence, immigrants, socioeconomic status, and sociocultural practices allows an optimal opportunity for epidemiological investigations that can provide deeper insights into the status of BC.
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Affiliation(s)
- Kristy Samaroo
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Amalia Hosein
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Lyronne K Olivier
- General Surgeon/Breast Surgical Oncologist, Sangre Grande General Hospital, Port of Spain, TTO
| | - Jameel Ali
- Surgery, University of Toronto, Toronto, CAN
- Breast Unit, St. James Medical Complex, Port of Spain, TTO
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Qi A, Li Y, Yan S, Sun H, Zhao M, Chen Y. Effect of postoperative chemotherapy on blood glucose and lipid metabolism in patients with invasive breast cancer. Gland Surg 2021; 10:1470-1477. [PMID: 33968698 DOI: 10.21037/gs-21-141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Chemotherapy can lead to abnormal metabolism and affect the quality of life of patients after operation. Here we explore the effect of postoperative chemotherapy on blood glucose and lipid metabolism in patients with invasive breast cancer and thus provide evidence for the prevention and treatment of blood glucose and lipid disorders after surgery. Methods From January 2019 to December 2020, data from 141 patients with invasive breast cancer in our hospital were retrospectively collected. The levels of fasting blood glucose and blood lipid profiles [including total cholesterol, triglyceride, high-density lipoprotein (HDL), and low-density lipoprotein (LDL)] were compared before and after chemotherapy. Meanwhile, the metabolic risk factors for abnormal blood glucose and lipid profiles were analyzed. Results Fasting blood glucose levels significantly increased after treatment (5.21±0.89 vs. 4.87±0.71 mmol/L, P=0.000), as did those of triglyceride (1.81±1.02 vs. 1.26±0.67 mmol/L, P=0.000), while HDL significantly decreased (1.11±0.29 vs. 1.32±0.33 mmol/L, P=0.000). There were no significant differences in the levels of total cholesterol and LDL before and after treatment (P>0.05). Multivariate logistic regression analysis showed that anthracycline-based chemotherapy was a protective factor for elevated fasting blood glucose [P=0.035, 95% CI: 0.248 (0.068-0.908)], whereas receiving >6 cycles of chemotherapy was a risk factor for elevated fasting blood glucose (P=0.026, 95% CI: 4.036 (1.178-13.825)]. Conclusions Postoperative chemotherapy can lead to the elevated triglyceride and fasting blood glucose and decreased HDL in patients with breast cancer. Anthracycline-based chemotherapy is a protective factor for the increase of fasting blood glucose, and more than 6 cycles of chemotherapy is a risk factor for the increase of fasting blood glucose.
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Affiliation(s)
- Aiying Qi
- Department of General Surgery, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yanping Li
- Department of General Surgery, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Susu Yan
- Department of General Surgery, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Huiying Sun
- Department of General Surgery, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Meiling Zhao
- Department of General Surgery, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yuhui Chen
- Department of General Surgery, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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