| Objective:Using retrospective analysis,we investigated whether BMI influenced the prognosis and treatment outcomes after breast-conserving surgery for patients with breast cancer.Methods:Between May 2011 and June 2016,Provincial Cancer Hospital treated 510 female breast cancer patients with breast-conserving surgery.Ultimately,after screened and followed up,441 patients were enrolled,divided into two groups:a thin or normal group(BMI<24 kg/m~2)and an overweight or obese group(BMI≥24 kg/m~2).There was a comparison of the clinicopathological characteristics,treatment strategies,perioperative indicators,complications,recurrent metastases,and metabolic diseases of patients in both groups.An analysis of survival was carried out based on the Kaplan-Meier method,and survival analysis curves were plotted.It was determined that 0.05 was statistically significant and that the above factors affected patients’prognoses of breast-conserving surgery.Results:1.The clinicopathologic features of breast preservation patientsThe results indicate that 60.74%of patients who were older than 45 years were heavier,which is greater than the 44.77%in the lean or normal group(P<0.001).Menopausal status was observed in 34.81%of overweight or obese women during diagnosis and treatment,higher than 18.63%of lean normal women(P<0.001).The tumor boundaries were harder to distinguish during tumor resection for overweight and obese women(52.59%),so more glands and adipose tissues were removed surrounding the tumor compared with the normal or thin group(32.35%,P<0.001).BMI differed significantly from age,menopausal status,the weight of excised breast tissue,and metabolic diseases in subgroup statistical analyses(P<0.05).In addition,no statistically significant differences were found between the two groups in any of the other factors.2.The treatment of different BMI groupsAmong these two groups,17.1%of patients had undergone local mass resection outside the hospital,8.3%of patients had neoadjuvant chemotherapy,84.3%of patients had postoperative chemotherapy,75.0%of patients had endocrine therapy,63.1%of patients had sentinel lymph node biopsy,36.9%of patients had lymph node dissection,5.0%of patients underwent oncoplastic breast-conserving surgery,95.0%of patients had conventional breast-conserving surgery.This study compared the treatment methods of the two different BMI groups,but neither group showed statistically significant differences for local or systemic treatments.3.The perioperative indicators and complications of different BMI groupsThe results of detailed follow-up data analysis revealed that postoperative complications were different between the two groups.There was a high incidence of postoperative complications in patients with subcutaneous effusion,accounting for22.92%of all patients,with a 17.04%incidence in overweight or obese patients and a5.88%incidence in those with underweight(P<0.001).Overweight/obese individuals had 11.85%and 11.11 incidences of incisional infection and lymph node edema,respectively,compared with lean/normal individuals who had 3.59%(P<0.05)and3.92%(P<0.05).It appears that BMI and complications have a correlation.Contrary to what was expected,there were no statistically significant differences in the operative time,drainage time,or postoperative hospital stay during the comparison.4.The prognosis of different BMI groupsBased on survival analysis curves for all patients undergoing breast cancer conserving surgery,BMI was not associated with overall survival(OS)or disease-free survival(DFS).The univariate analysis of BMI did not support its use as a predictor of prognosis.The 5-year disease-free survival(DFS)of patients with breast cancer was reduced by positive axillary lymph node metastases,HER-2 overexpression,and absence of neoadjuvant chemotherapy(P<0.05).The 5-year mortality rate was higher in women with lymph node metastases that were not yet menopausal,those who had hypertension(P<0.05).An analysis of multifactor Cox regression models showed that the presence of lymph node metastases,neoadjuvant chemotherapy,and radiotherapy impacted the outcome of patients with breast-conserving surgery on progression-free survival at 5 years(P<0.05).5.Recurrence and distant metastasis in different BMI groupsThe number of patients with local recurrences exceeded 4.76%,while the number of patients with distant metastases exceeded 4.08%,with metastatic organs including:lung(2.27%),liver(1.81%),bone(2.72%),cranial(1.13%)and ovarian(0.23%),and multiple organs metastasized concurrently(2.49%).According to the study,92.16%of the lean/normal group did not progress compared to 88.89%of the overweight/obese group,but BMI was not associated with local recurrence and dissemination.Conclusions:1.The BMI was strongly correlated with age,menopausal status,surgical removal of glandular tissue,postoperative complications,and metabolic disease,irrespective of treatment method.2.The prognosis of breast cancer patients who have breast preservation does not depend on their BMI.In breast cancer patients,lymph node metastasis,HER-2overexpression,neoadjuvant chemotherapy,and radiotherapy were independently associated with 5-year survival.3.The BMI of the breast cancer patient was not associated with local recurrence or distant metastases. |
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