Clinical Research Papers:

Combined effect of obesity and diabetes on early breast cancer outcome: a prospective observational study

Giuseppe Buono, Anna Crispo, Mario Giuliano, Carmine De Angelis, Francesco Schettini, Valeria Forestieri, Rossella Lauria, Matilde Pensabene, Michelino De Laurentiis, Livia Silvia Adriana Augustin, Alfonso Amore, Massimiliano D’Aiuto, Raffaele Tortoriello, Antonello Accurso, Ernesta Cavalcanti, Gerardo Botti, Maurizio Montella, Sabino De Placido and Grazia Arpino _

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Oncotarget. 2017; 8:115709-115717. https://doi.org/10.18632/oncotarget.22977

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Giuseppe Buono1,*, Anna Crispo2,*, Mario Giuliano1,3, Carmine De Angelis1, Francesco Schettini1, Valeria Forestieri1, Rossella Lauria1, Matilde Pensabene1, Michelino De Laurentiis4, Livia Silvia Adriana Augustin2,5, Alfonso Amore4, Massimiliano D’Aiuto4, Raffaele Tortoriello4, Antonello Accurso6, Ernesta Cavalcanti2, Gerardo Botti2, Maurizio Montella2, Sabino De Placido1 and Grazia Arpino1

1Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy

2Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy

3Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA

4Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy

5Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Canada

6Department of Gastroenterology, Endocrinology and Surgery, University of Naples Federico II, Naples, Italy

*These authors contributed equally to this work

Correspondence to:

Grazia Arpino, email: [email protected]

Keywords: breast cancer; obesity; diabetes; combined variables; outcome

Received: August 19, 2017     Accepted: November 16, 2017     Published: December 05, 2017


Background: Previous studies suggested that obesity and diabetes were correlated with breast cancer outcome. The aim of the present study was to investigate the prognostic effect of obesity and diabetes on the outcome of early breast cancer patients.

Materials and Methods: Overall, 841 early breast cancer patients were prospectively enrolled between January 2009 and December 2013. Study population was divided into four groups: (1) patients without obesity or diabetes; (2) patients with only diabetes; (3) patients with only obesity; and (4) patients with both diabetes and obesity. Categorical variables were analyzed by the chi-square test and survival data by the log-rank test.

Results: At diagnosis, obese and diabetic patients were more likely to be older (p < 0.0001) and post-menopausal (p < 0.0001) and to have a tumor larger than 2 cm (p < 0.0001) than patients in groups 1–3. At univariate analyses, obese and diabetic patients had a worse disease-free survival (p = 0.01) and overall survival (p = 0.001) than did patients without obesity and diabetes. At multivariate analyses, the co-presence of obesity and diabetes was an independent prognostic factor for disease-free survival (hazard ratio=2.62, 95% CI 1.23–5.60) but not for overall survival.

Conclusions: At diagnosis, patients with obesity and diabetes were older, had larger tumors and a worse outcome compared to patients without obesity or diabetes. These data suggest that metabolic health influences the prognosis of patients affected by early breast cancer.

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