Obesity as an independent risk factor for decreased survival in node-positive high-risk breast cancer

Christoph Scholz, U. Andergassen, P. Hepp, C. Schindlbeck, Thomas W.P. Friedl, N. Harbeck, M. Kiechle, H. Sommer, H. Hauner, K. Friese, B. Rack, W. Janni

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40 Scopus citations


Obese breast cancer patients have a higher risk of lymph node metastasis and a poorer prognosis compared to patients with normal weight. For obese women with node-positive breast cancer, an association between body weight and prognosis remains unclear. In this retrospective study, we analyzed patient data from the Phase-III ADEBAR trial, in which high-risk breast cancer patients (pT1–4, pN2–3, pM0) were randomized into a docetaxel-based versus epirubicin-based chemotherapy regimen. Patients were grouped according to their BMI value as underweight/normal weight (BMI < 25 kg/m2; n = 543), overweight (BMI 25–29.9 kg/m2; n = 482) or obese (BMI ≥ 30 kg/m2; n = 285). Overweight and obese patients were older, had larger tumors and were more likely to be postmenopausal at the time of diagnosis compared to underweight/normal-weight patients (all p < 0.001). Multivariate Cox regression analyses adjusting for age and histopathological tumor features showed that obese patients had a significantly shorter disease-free survival (DFS; HR 1.43; 95 % CI 1.11–1.86; p = 0.006) and overall survival (OS; HR 1.56; 95 % CI 1.14–2.14; p = 0.006) than non-obese patients. Subgroup analyses revealed that the differences in DFS and OS were significant for postmenopausal but not for premenopausal patients, and that the survival benefit of non-obese patients was more pronounced in women with hormone-receptor-positive disease. Obesity constitutes an independent, adverse prognostic factor in high-risk node-positive breast cancer patients, in particular for postmenopausal women and women with hormone-receptor-positive disease.

Original languageEnglish
Pages (from-to)569-576
Number of pages8
JournalBreast Cancer Research and Treatment
Issue number3
StatePublished - 4 Jun 2015
Externally publishedYes


  • Node-positive breast cancer
  • Obesity
  • Outcome


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