| OBJECTIVE:The aim of this study was to investigate the effect of body mass index(BMI)on the prognosis of breast cancer and complications after modified radical mastectomy for breast cancer.METHOD:We retrospectively analyzed the clinical data and follow-up information of patients who were first diagnosed with stage Ⅰ-Ⅲ breast cancer and underwent surgery from January 2015 to December 2016 in Huaihe Hospital of Henan University.The enrolled patients were classified into three groups according to their BMI as follows: normal weight(BMI < 24.0 kg/㎡),overweight(24-28.0 kg/㎡),and obese(BMI≥28.0 kg/㎡).Kaplan-Meier method was used to calculate 5-year overall survival rate and 5-year disease-free survival rate of patients in different BMI groups,Kaplan-Meier survival curves of patients in the three groups were drawn,and log-rank test was used to compare the difference in survival curves.COX proportional risk model analysis was conducted to identify predictors for breast cancer recurrence and death.Cases with other surgeons and other procedures(other than modified radical mastectomy)were excluded to ensure that all patients eventually enrolled were all underwent unilateral modified radical mastectomy by the same surgeon.The enrolled patients were divided into two groups based on their BMI as follows: the overweight obese group(BMI≥24.0 kg/㎡)and the normal weight group(BMI<24.0 kg/㎡).Using the Chi-square test/Fisher’s exact test to compare the differences between patients with different BMI and post-operative complications such as subcutaneous hydrops,lymphedema,skin flap necrosis and Axillary Web Syndrome.T test was used to compare the difference of post-operative drainage volume and indwelling catheter time between the two groups.RESULT:A total of 211 patients were collected in this study,of which 83(39.3%)were in the normal weight group,80(37.9%)were in the overweight group and 48(22.8%)were in the obese group.The 5-year overall survival rates of patients in normal weight group,overweight and obese groups were: 92.8%、89.9%、89.6%respectively,with no statistically significant difference between the three groups by Log-rank test(P>0.05);Multivariate COX regression analysis showed no correlation between BMI and 5-year overall survival(P>0.05).the 5-year disease-free survival rates of patients in normal weight group,overweight and obese groups were: 91.6%、86.2%、72.9% respectively,and the difference between the three curves was statistically significant by log-rank test(P<0.05).Multivariate COX regression analysis showed that BMI(HR=2.94,95%CI=1.09-7.96,P=0.034)and lymph node metastasis(HR=2.61,95%CI=1.14-5.96,P=0.023)were independent prognostic factors affecting 5-year progression-free survival.We further screened 116 cases of modified radical mastectomy for breast cancer performed by the same operator,divided into the overweight obese group(67 cases)and the normal body group(49 cases).There was no significant difference in preoperative basic characteristics of patients in different BMI groups(P>0.05).More incidence of postoperative subcutaneous hydrops and lymphedema in overweight obese patients compared to normal weight patients(P<0.05),with more post-operative drainage volume and indwelling catheter time(P<0.05).CONCLUSION:1、There is a correlation between BMI and breast cancer prognosis,with obese patients having a lower5-year disease-free survival rate and BMI being an independent risk factor for 5-year disease-free survival in breast cancer patients.2、More incidence of postoperative subcutaneous hydrops and lymphedema in overweight obese patients compared to normal weight patients,with more post-operative drainage volume and indwelling catheter time. |
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