Abstract
Triple-negative breast cancer (TNBC) is an uncommon but aggressive subtype of breast cancer. Obesity has been associated with an increased risk of breast cancer and worse prognosis. Some studies suggest that obese patients are less likely to achieve pathologic complete response (pCR) to neoadjuvant chemotherapy (NCT) and experience worse overall survival. Ki-67 is a proliferation marker that correlates with tumor aggressiveness. The goal of this study was to examine the impact of weight change during NCT for TNBC on pathologic response and Ki-67 reduction. Retrospective review identified 173 TNBC patients treated between 2004 and 2011. Data were collected on patient demographics, pre- and post-NCT body mass index (BMI), Ki-67, and pCR. Data analysis was performed using the two-tailed Student's t-test, analysis of variance (ANOVA), and Fisher's exact test. Sixty-six patients met final study criteria. Forty-three patients lost weight during chemotherapy and 23 gained weight. Patients in the weight gain group were significantly younger (P = 0.0013). There was no significant difference between the two groups in terms of Ki-67 reduction (P = 0.98) or pCR (P = 0.58). When patients were separated into normal weight (BMI<25 kg/m2), overweight (BMI ≥ 25 and <30 kg/m2), and obese (BMI ≥ 30 kg/m2), there was no significant difference in Ki-67 among those groups either before or after NCT. The degree of obesity did not have a significant impact on Ki-67 reduction. Weight change during NCT does not appear to correlate with Ki-67 change or achieving pCR in TNBC. This may reflect the nature of this subtype of breast cancer that is less responsive to the hormonal effects that adipose tissue exerts on cancer cell proliferation.
Highlights
Triple-negative breast cancer (TNBC) is characterized by the absence of estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) receptors
Even though the underlying mechanism remains unclear, it has been proposed that the increased circulating levels of estrogen, insulin, insulin-like growth factor (IGF), and other hormonal factors in obese patients may promote proliferation of breast cancer cells [10,11,12]
Simmons Cancer Center (SCC) is a National Cancer Institute’s designated cancer center that serves primarily insured patients. Both Parkland Memorial Hospital (PMH) and SCC are affiliated with University of Texas Southwestern (UTSW) Medical Center and are accredited members of the Commission on Cancer
Summary
Triple-negative breast cancer (TNBC) is characterized by the absence of estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) receptors. It represents a distinct subtype of breast cancer found in 15–20% of invasive breast cancers diagnosed in the United States. It is more common in African–Americans and in premenopausal women [1]. Even though the underlying mechanism remains unclear, it has been proposed that the increased circulating levels of estrogen, insulin, insulin-like growth factor (IGF), and other hormonal factors in obese patients may promote proliferation of breast cancer cells [10,11,12]
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