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Author Notes:

Corresponding author: Joseph A. Sparano, MD, Montefiore Medical Center-Weiler Division, 1825 Eastchester Road, Bronx, NY 10461; Fax: (718) 904-2892; jsparano@montefiore.org

The first author, as the principal investigator, participated in all phases of this analysis, interpretation, and article preparation.

All coauthors participated in data interpretation.

The study biostatisticians (second and third authors) conducted all analyses.

Coauthors reviewed the article contents and approved the submission version.

The contents of the article are solely the responsibility of the authors and do not necessary represent the official view of the National Center for Research Resources, NIH, or American Society of Clinical Oncology.

The authors made no disclosures.


Research Funding:

Supported in part by grants from the Department of Health and Human Services and the National Institutes of Health (NIH): CA14958 to the Albert Einstein College of Medicine, CA23318 to the ECOG statistical center, CA66636 to the ECOG data management center, CA21115 to the ECOG coordinating center and chairman’s office, CA32012 to the Southwest Oncology Group, CA11789 to the Cancer and Leukemia Group B, CA25224 to the North Central Cancer Treatment Group, CA49883 to the Indiana University School of Medicine, and CA16116 to Johns Hopkins Oncology Center.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • obesity
  • breast cancer
  • prognosis
  • hormone receptor positive
  • disparity
  • FAT

Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer

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Journal Title:



Volume 118, Number 23


, Pages 5937-5946

Type of Work:

Article | Post-print: After Peer Review


BACKGROUND: Obesity has been associated with inferior outcomes in operable breast cancer, but the relation between body mass index (BMI) and outcomes by breast cancer subtype has not been previously evaluated. METHODS: The authors evaluated the relation between BMI and outcomes in 3 adjuvant trials coordinated by the Eastern Cooperative Oncology Group that included chemotherapy regimens with doxorubicin and cyclophosphamide, including E1199, E5188, and E3189. Results are expressed as hazard ratios (HRs) from Cox proportional hazards models (HR > 1 indicates a worse outcome). All P values are 2-sided. RESULTS: When evaluated as a continuous variable in trial E1199, increasing BMI within the obese (BMI, ≥30 kg/m 2 ) and overweight (BMI, 25-29.9 kg/m 2 ) ranges was associated with inferior outcomes in hormone receptor-positive, human epidermal growth receptor 2 (HER-2)/neu-negative disease for disease-free survival (DFS; P =.0006) and overall survival (OS; P =.0007), but not in HER-2/neu-overexpressing or triple-negative disease. When evaluated as a categorical variable, obesity was associated with inferior DFS (HR, 1.24; 95% confidence interval [CI], 1.06-1.46; P =.0008) and OS (HR, 1.37; 95% CI, 1.13-1.67; P =.002) in hormone receptor-positive disease, but not other subtypes. In a model including obesity, disease subtype, and their interaction, the interaction term was significant for OS (P =.02) and showed a strong trend for DFS (P =.07). Similar results were found in 2 other trials (E5188, E3189). CONCLUSIONS: In a clinical trial population that excluded patients with significant comorbidities, obesity was associated with inferior outcomes specifically in patients with hormone receptor-positive operable breast cancer treated with standard chemohormonal therapy.

Copyright information:

© 2012 American Cancer Society.

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