Body Mass Index, PAM50 Subtype, and Outcomes in Node-Positive Breast Cancer: CALGB 9741 (Alliance)
Year: 2015
Type: article
Abstract: BACKGROUND: Obesity at diagnosis is associated with poor prognosis in women with breast cancer, but few reports have been adjusted for treatment factors. METHODS: CALGB 9741 was a randomized trial of dose density and sequence of chemotherapy for node-positive breast cancer. All patients received doxorubicin, cyclophosphamide, and paclitaxel, dosed by actual body weight. Height and weight at diagnosis were abstracted from patient records, and the PAM50 assay was performed from archived specimens using the NanoString platform. Relationships between body mass index (BMI), PAM50, and recurrence-free and overall survival (RFS and OS) were evaluated using proportional hazards regression, adjusting for number of involved nodes, estrogen receptor (ER) status, tumor size, menopausal status, drug sequence, and dose density. All statistical tests were two-sided. RESULTS: Baseline height and weight were available for 1909 of 2005 enrolled patients; 1272 additionally had subtype determination by PAM50. Median baseline BMI was 27.4kg/m(2). After 11 years of median follow-up, there were 619 RFS events and 543 deaths. Baseline BMI was a statistically significant predictor of RFS (adjusted hazard ratio [HR] for each five-unit increase in BMI = 1.08, 95% confidence interval [CI] = 1.02 to 1.14, P = .01) and OS (adjusted HR = 1.08, 95% CI = 1.01 to 1.14, P = .02) BMI and molecular phenotypes were independent prognostic factors for RFS, with no statistically significant interactions detected. CONCLUSIONS: BMI at diagnosis was a statistically significant prognostic factor in a group of patients receiving optimally dosed chemotherapy. Additional research is needed to determine the impact of weight loss on breast cancer outcomes and to evaluate whether this impact is maintained across tumor subtypes.
DOI: 10.1093/jnci/djv179
Language: English
Topic: Cancer Risks and Factors
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: Alliance Statistics and Data Management Center, G1545560008, G1784070713, G1857622882, ECOG-ACRIN Network Group Operations Center, G1938688226, Network Lead Academic Participating Site: Memorial Sloan-Kettering Cancer Center, G2017411191, G2064543036, G2647518335, G2679961467, Cancer and Leukemia Group B Statistical Center, SWOG Network Group Operations Center of the NCTN, ECOG Clinical Trials, G4185274752, Biological Breast Cancer Classification by qRT-PCR, North Central Cancer Treatment Group, Cancer and Leukemia Group B, Eastern Cooperative Oncology Group Operations Office, Alliance for Clinical Trials in Oncology Operations Center, Cancer Center Support Grant, G964706321, G973482110
OpenAlex ID: W2270312817