Body Mass Index and Hormone Receptor Status Influence Recurrence Risk in HER2-Positive Early Breast Cancer Patients

• Published in: Clinical breast cancer Vol. 20; no. 1; pp. e89 - e98
• Main Authors: Cantini, Luca, Pistelli, Mirco, Merloni, Filippo, Fontana, Andrea, Bertolini, Ilaria, De Angelis, Claudia, Bastianelli, Lucia, Della Mora, Arianna, Santinelli, Alfredo, Savini, Agnese, Maccaroni, Elena, Diodati, Lucrezia, Falcone, Alfredo, Berardi, Rossana
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2020
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers, Tumor - analysis; Biomarkers, Tumor - metabolism; Body Mass Index; Breast - pathology; Breast - surgery; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Chemotherapy, Adjuvant - statistics & numerical data; Disease-Free Survival; Early breast cancer; Female; Follow-Up Studies; HER2; Hormone receptors; Humans; Mastectomy; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Prognosis; Receptor, ErbB-2 - analysis; Receptor, ErbB-2 - antagonists & inhibitors; Receptor, ErbB-2 - metabolism; Receptors, Estrogen - analysis; Receptors, Estrogen - metabolism; Receptors, Progesterone - analysis; Receptors, Progesterone - metabolism; Retrospective Studies; Risk Assessment - methods; Time Factors; Trastuzumab; Trastuzumab - therapeutic use; Young Adult; Body mass index; Hormone receptors; Early breast cancer; HER2; Trastuzumab
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2019.06.008

A reliable risk stratification on the basis of tumor biology and host factors of HER2-positive (HER2+) early breast cancer (eBC) patients is needed. The aim of our study was to assess the prognostic role of body mass index (BMI) and hormone receptor (HR) expression in this setting. We retrospectively evaluated 238 women with stage I to III HER2+ breast cancer who completed adjuvant chemotherapy (CHT) and 1 year of treatment with trastuzumab. The end point was 3-year distant disease-free survival (3yDDFS). Survival analysis was evaluated using the Kaplan–Meier method. Multivariate analysis was performed using Cox proportional-hazards model adjusting for HR status, BMI, tumor staging, size, nodal status, and type of adjuvant CHT. Association among categorical variables was assessed using χ2 test. The early recurrence rate after 3 years resulted as 4.2% (40% HR+ patients and 60% HR− patients). Neither HR status nor BMI alone showed an association with 3yDDFS in multivariate analysis. However, the hazard ratios for patients with HR− tumors who had also BMI ≥25 (3yDDFS 86.9%; 95% confidence interval [CI], 75.0%-97.7%) were amplified compared with patients with HR+ tumors and with BMI <25 (3yDDFS 98%; 95% CI, 94.8%-100.0%) and other subgroups (P = .003). This observation was confirmed in multivariate analysis (hazard ratio, 1.79; 95% CI, 1.04-3.07; P = .03). Our real-life data highlight a different risk of eBC recurrence after grouping patients according to HR status and BMI. These results might help clinicians to identify correct treatment strategies. Patients who are HR− and have BMI ≥25 might benefit from escalation approaches, whereas those who are HR+ and have BMI <25 might be eligible for a shorter duration of adjuvant treatment with anti-HER2 agents. HER2-positive early breast cancer is a heterogenous disease. We assessed the role of body mass index (BMI) and hormone receptors (HRs) in 238 women who completed adjuvant chemotherapy and 1 year of treatment with trastuzumab. Three-year recurrence risk resulted as higher for HR-negative (HR−) patients with BMI ≥25 compared with HR+ patients with BMI <25, suggesting that this particular subpopulation of patients might benefit from escalation approaches in adjuvant treatment.