Association between High Body Mass Index and Prognosis in Early-Stage Breast Cancer Patients: A Systematic Review and Meta-Analysis
Abstract
A high body mass index (BMI) can indicate overweight or obesity and is a crucial risk factor for breast cancer survivors (BCS). However, the association between a high BMI and prognosis in early breast cancer (EBC) remains unclear. We aimed to assess the effect of high BMI on the prognosis of EBC. Methods: The PubMed, Embase, and Cochrane Library databases and proceedings of major oncological conferences related to the effect of BMI on the prognosis of BC were searched from October 1, 2021 to November 15, 2021. Studies reporting the hazard ratios (HRs) for disease-free survival (DFS) and overall survival (OS) of overweight or obese patients in the multivariate and univariate analyses were included. The pooled HR was computed and weighted using the generic inverse variance method. Findings: Twenty studies with 33,836 patients with EBC were included. Patients with high BMI had worse DFS (HR: 1·11, 95% confidence interval (CI): 1·07–1·16, P < 0·00001) and OS (HR: 1·25, 95% CI: 1·14–1·39, P < 0·00001). Overweight patients had worse DFS (HR: 1·17, 95% CI: 1·05–1·30, P = 0·005) and OS (HR: 1·19; 95%CI: 1·06–1·33, P = 0·003). Obese patients also had worse DFS (HR: 1·17, 95% CI: 1·06–1·30, P = 0·002) and OS (HR: 1·29, 95% CI: 1·15–1·46, P < 0·0001). Multivariate subgroup analysis showed that overweight had a negative effect on DFS (HR: 1·11, 95% CI: 1·04–1·19, P = 0·003) and OS (HR: 1·18, 95% CI: 1·06–1·32, P = 0·003). Obesity had a detrimental effect on DFS (HR: 1·13, 95% CI: 1·06–1·21, P = 0·0004) and OS (HR: 1·20, 95% CI: 1·12–1·30, P < 0·00001). Univariate subgroup analysis demonstrated that overweight was not significantly associated with DFS (HR:1·21, 95% CI: 0·99–1·49, P = 0·06) and OS (HR: 1·38, 95% CI: 0·89–2·15, P = 0·15). Obese patients had worse DFS (HR: 1·21, 95% CI: 1·06–1·38, P = 0·004) and OS (HR: 1·33, 95% CI: 1·24–1·43, P < 0·00001). Interpretation: High BMI is associated with poor DFS and OS in patients with EBC. The overweight and obesity groups had worse DFS and OS than the high BMI groups, and obese patients had the poorest OS. The patients’ prognosis and quality of life (QOL) should be improved through performance of regular physical activity (PA) and dietary management. Funding Information: Funding Central Government Guiding Local Scientific and Technological Development Funds for Qinghai Province in China. Declaration of Interests: We declare no competing interests.
Part of CIRS Nexus · Curated by Lauren Lowenstein, The Biotoxin Lady