| Background and Objective:Breast cancer is one of the most common malignant tumors that serious damage to women's health.In some developed countries and China,it has become the most frequent female malignant tumors.Neoadjuvant chemotherapy(NAC)is considered to be the standard treatment for locally advanced breast cancer,which is used to reduce the size of the primary tumor,as well as to improve the rate of breast-conserving surgery.Previous studies suggested that the disease-free survival and overall survival of patients who obtained pathological complete response after neoadjuvant chemotherapy were significantly longer than those without pathological complete response.Therefore,pathologic complete response is an important end point of neoadjuvant chemotherapy for breast cancer.The sensitivity of patients to chemotherapy is related to a variety of factors,such as genetic polymorphism and biologic factors.In recent years,a large number of clinical studies have shown that obesity can lead to changes in microenvironment in patients,promote tumor proliferation and metastasis,and is related to chemotherapy resistance and poor prognosis.The prevalence of obesity in women is expected to rise to more than 21 percent by 2025 as residents' living standards improve.Body mass index is an internationally accepted clinical indicator of obesity.The latest research shows that 3.9% of new cancer cases worldwide are associated with high body mass index,which affects women more than men,especially breast and endometrial cancer.However,the effect of body mass index on pathologic complete response and prognosis of breast cancer patients with neoadjuvant chemotherapy is still controversial.Therefore,this study aims to explore the correlation between body mass index and pathological complete remission and prognosis of patients after neoadjuvant chemotherapy.Methods:98 women with breast cancer who were diagnosed between January 01,2013 to November 30,2015,treated with neoadjuvant chemotherapy in the Department of The Affiliated Cancer Hospital of Zhengzhou University were enrolled in the study.All the members are patients without tumor history and family history,and they are all pathologically confirmed as invasive breast cancer or invasive carcinoma with intraductal carcinoma.Phone call,outpatient review and other means were used to follow up patient's recurrence,metastasis and survival message.Univariate analysis of the associations between body mass index and pathologic complete remission were analyzed using Chi-square or fisher's exact text.Multivariate analysis were analyzed using logistic regression.Survival analysis was performed according to Kaplan-Meier method.Log-rank statistics was used to compare the subgroups.Multivariate analysis were performed using Cox proportional hazard regression model.Results:In this study,a total number of 50(51%)patients were N/U,32(32.7%)patients were OW,and 16(16.3%)patients were OB.The effective rates of chemotherapy in the N/U,OW,and OB groups were 98%,93.7%,and 75%,respectively,and the difference was statistically significant(P<0.05).There was a statistically significant difference between body mass index and heavy hair loss,gastrointestinal reactions,and bone marrow suppression(P<0.05).In 29(29.6%)patients,pCR was achieved.pCR rates in the N/U,OW,and OB groups were 36%,25%,and 18.8% respectively,while the difference was not statistically significant(P>0.05).In the multivariate logistic regression analysis,obesity and molecular typing were independent adverse prognostic feature on pCR to neoadjuvant chemotherapy for breast cancer(P<0.05).The 3-year disease-free survival rates of N/U,OW,and OB groups were 84.0%,93.5%,and 80.4% respectively,while the difference was not statistically significant(P>0.05).Multivariate Cox proportional hazard regression analysis showed that there was no correlation between body mass index and the 3-year disease-free survival rate(P>0.05).The 3-year overall survival rates of the N/U,OW,and OB groups were 95.9%,96.8%,and 80.4% respectively,and the difference was statistically significant(P<0.05).The multivariate Cox proportional hazard regression analysis showed that TNM staging and body mass index were independent factors on the 3-year overall survival rate to neoadjuvant chemotherapy for breast cancer patients(P<0.05).Conclusion:1.Body mass index was associated with the efficacy of neoadjuvant chemotherapy for breast cancer.Obesity may predict poor response to chemotherapy.Obesity was an independent adverse prognostic feature on pCR to neoadjuvant chemotherapy for breast cancer.2.The body mass index was correlated with the poor breast cancer prognosis. |
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