Impact of BMI on Locoregional Control among Saudi Patients with Breast Cancer after Breast Conserving Surgery and...

Obesity and increased body mass index (BMI) are increasing among Saudi women across all age groups with an overall prevalence of 44%. Increased BMI is associated with advanced stage breast cancer and dismal survival; however impact of BMI on locoregional control (LRC) is less studied. We aimed to evaluate the impact of BMI on LRC in Saudi patients with breast cancer after breast conserving surgery (BCS) and modified radical mastectomy (MRM).

Between February 1988 and August 2008, 112 patients with breast cancer were treated with BCS and MRM followed by adjuvant chemotherapy and radiotherapy. Median age was 47.01 years (23-76). Mean BMI was 38.1 kg/m2 (15.7-52.8); BMI < 18.5 kg/m2 (underweight) in 1 (0.9%), BMI 18.5-25 kg/m2 (normal weight) in 19 (16.9%), BMI 26-30 kg/ m2 (overweight) in 32 (28.6%), BMI 31-40 kg/m2 (obese) in 48 (42.9%) and BMI > 40 kg/m2 (morbid obese) in 12 (10.7%). Median follow up period was 9 years (5-17). Cox proportional hazard analysis was done using SPSS 19.0.

A total of ten locoregional recurrences (8.93%) were seen. The 5 and 10 years LRC were 86.4% and 86.4% respectively. Multivariate analysis showed poor LRC in BMI < 18.5 kg/m2 (HR: 4.2; 95% CI.3.8-3.6, p 0.001) and 26-30 kg/m2 (HR: 3.4; 95% CI.3.0-3.8, p 0.01). Others factors associated with poor LRC were: age less than 40 years, premenopausal status, and no adjuvant radiotherapy, and T4, N2 and N3 stages.

Underweight patients with breast cancer are more prone for locoregional recurrences as compared to obese and morbid obese patients.