ORIGINAL ARTICLE
Correlation between obesity and prognostic/predictive parameters with emphasis on the importance of lymph node metastases in patients with invasive breast carcinoma
 
More details
Hide details
 
Submission date: 2016-10-08
 
 
Final revision date: 2017-01-29
 
 
Acceptance date: 2017-01-30
 
 
Publication date: 2017-05-23
 
 
Pol J Pathol 2017;68(1):33-39
 
KEYWORDS
TOPICS
ABSTRACT
We aimed to evaluate whether obese women experience more advanced invasive breast carcinoma (IBC) with a higher number of involved lymph nodes, higher range of axillary lymph node ratio (LNR) and presence and size of extracapsular extension as it may have an impact on prognosis and management. 245 patients diagnosed with IBC were divided into normal weight (NW), overweight (OW) and obese (OB) groups. Patients were divided into high range of LNR (LNR over or equal to 0.2) and low LNR (LNR less than 0.2). The extracapsular extension dimensions were measured on the original slides of each case and grouped into ≤ 1 mm and > 1 mm. 84 patients (33.07%) were OW, 72 (29.38%) OB and 91 (37.14%) NW. 45.7% of cases had macrometastasis in the axillary lymph nodes. NW patients had significantly fewer metastatic lymph nodes (p = 0.05) than in the OW/OB groups. There was no statistically significant difference between BMI groups according to the LNR (p = 0.66). Out of 111 cases with macrometastasis, 58 cases (52.25%) had extracapsular extension (ECE) (11.7% NW, 24.32% OW and 16.22% OB). Significantly more OW patients presented extranodal invasion (p = 0.04). We found no statistically significant relationship between the extracapsular extension diameter and BMI groups (p = 0.1).
REFERENCES (35)
1.
Flegal KM, Carroll MD, Ogden CL, et a. Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010; 303: 235-241.
 
2.
Roman G, Bala C, Creteanu G, et al. Obesity and health-related lifestyle factors in the general population in Romania: a cross sectional study. Acta Endocrinologica (Buc) 2015; 11: 64-71.
 
3.
Ferlay J, Shin HR, Bray F, et al. (eds.). GLOBOCAN 2008 v 1.2. Cancer incidence and mortality worldwide: IARC Cancer Base No. 10, International Agency for Research on Cancer (http://globocan.iarc.fr) Lyon 2008.
 
4.
Anghel R, Minea L, Dediu, et al. Ghidul de management al cancerului mamar; Monitorul Oficial. Partea I, Nr. 608 bis, September 2009.
 
5.
Joergensen LE, Gunnarsdottir KA, C. Lanng C, et al. Multifocality as a prognostic factor in breast cancer patients registered in Danish Breast Cancer Cooperative Group (DBCG) 1996- 2001. Breast 2008, 17: 587-591.
 
6.
Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74-108.
 
7.
Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371: 569-578.
 
8.
Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2010; 123: 627-635.
 
9.
Lakhani S, Ellis IO, Schnitt SJ, et al. World Health Organization classification of tumors of the breast. IARC Press; Lyon 2012; 13-77.
 
10.
Perry N, Broeders M, De Wolf C, et al. European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis. 4th edition. Office for Official Publications of the European Communities, Luxemburg 2006; 219-313.
 
11.
Rosen PP. Invasive Duct Carcinoma: Assessment of Prognosis, Morphologic Prognostic markers and Tumor Growth Rate. In: Rosen’s Breast Pathology. 3rd ed. Lippincot Williams & Wilkins, Philadelphia 2009; 358-459.
 
12.
Vinh-Hung V, Nguyen NP, Cserni G, et al. Prognostic value of nodal ratios in node-positive breast cancer: a compiled update. Future Oncol 2009; 5: 1585-1603.
 
13.
Martin FT, O’Fearraigh C, Hanley C, et al. The prognostic significance of nodal ratio on breast cancer recurrence and its potential for incorporation in a new prognostic index. Breast J 2013; 19: 388-393.
 
14.
Nottegar A, Veronese N, Senthil M, et al. Extra-nodal extension of sentinel lymph node metastasis is a marker of poor prognosis in breast cancer patients: A systematic review and an exploratory meta-analysis. Eur J Surg Oncol 2016; 42: 919-925.
 
15.
Drinka E, Allen P, McBride A, et al. Metastatic Tumor Volume and Extranodal Tumor Extension: Clinical Significance in Patients With Stage II Breast Cancer. Arch Pathol Lab Med 2015; 139: 1288-1294.
 
16.
Kaviani A, Neishaboury MR, Mohammadzadeh N, et al. Effects of obesity on presentation of breast cancer, lymph node metastases and patient survival: a retrospective review. Asian Pacific J Cancer Prev 2013; 14: 2225-2229.
 
17.
World Health Organization. Obesity. Preventing and managing the global epidemic. Report of a WHO consultation on obesity. WHO/NUT/NCD/981, WHO, Geneva. 1998.
 
18.
Ellis IO, Elston CW. Histologic grade. In: O’Malley FP, Pinder SE, editors. Breast pathology. Elsevier, Philadelphia 2006; 225-233.
 
19.
Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progester- one receptors in breast cancer. J Clin Oncol 2010; 28: 2784-2795.
 
20.
Hammond ME. ASCO-CAP guidelines for breast predictive factor testing: an update. Appl Immunohistochem Mol Morphol 2011; 19: 499-500.
 
21.
Wolff AC, Hammond ME, Schwartz JN, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Arch Pathol Lab Med 2007; 131: 18-43.
 
22.
Dowsett M, Nielsen TO, A’Hern R, et al. Assessment of Ki67 in breast cancer: recommendations from the International Ki67 in Breast Cancer working group. J Natl Cancer Inst 2011; 103: 1656-1664.
 
23.
Goldhirsch A, Wood WC, Coates AS, et al. Panel members. Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 2011; 22: 1736-1747.
 
24.
Gallus S, Lugo A, Murisic B, et al. Overweight and obesity in 16 European countries. Eur J Nutr 2015; 54: 679-689.
 
25.
Neuhouser ML, Aragaki AK, Prentice RL, et al. Overweight, Obesity, and Postmenopausal Invasive Breast Cancer Risk: A Secondary Analysis of the Women’s Health Initiative Randomized Clinical Trials. JAMA Oncol 2015; 1: 611-621.
 
26.
Scholz C, Andergassen U, Hepp P, et al. Obesity as an independent risk factor for decreased survival in node-positive high-risk breast cancer. Breast Cancer Res Treat 2015; 151: 569-576.
 
27.
Ewertz M, Jensen MB, Gunnarsdóttir KÁ, et al. Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 2011; 29: 25-31.
 
28.
Biglia N, Peano E, Sgandurra P, et al. Body mass index (BMI) and breast cancer: impact on tumor histopathologic features, cancer subtypes and recurrence rate in pre and postmenopausal women. Gynecol Endocrinol 2013; 29: 263-267.
 
29.
Haakinson DJ, Leeds SG, Dueck AC, et al. The impact of obesity on breast cancer: a retrospective review. Ann Surg Oncol 2012; 19: 3012-3018.
 
30.
Deglise C, Bouchardy C, Burri M, et al. Impact of obesity on diagnosis and treatment of breast cancer. Breast Cancer Res Treat 2010; 120: 185-193.
 
31.
Daling JR, Malone KE, Doody DR, et al. Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma. Cancer. 2001; 92: 720-729.
 
32.
Carmichael AR, Bates T. Obesity and breast cancer: a review of the literature. Breast 2004; 13: 85-92.
 
33.
Eichholzer M, Huang DJ, Modlasiak A, et al. Impact of body mass index on prognostically relevant breast cancer tumor characteristics. Breast Care 2013; 8: 192-198.
 
34.
Pierobon M, Frankenfeld CL. Obesity as a risk factor for triple-negative breast cancers: a systematic review and meta-analysis. Breast Cancer Res Treat 2013; 137: 307-314.
 
35.
Bandera EV, Chandran U, Hong CC, et al. Obesity, body fat distribution, and risk of breast cancer subtypes in African American women participating in the AMBER Consortium. Breast Cancer Res Treat 2015; 150: 655-666.
 
eISSN:2084-9869
ISSN:1233-9687
Journals System - logo
Scroll to top