Impact of body mass index on pathological complete response following neoadjuvant chemotherapy in operable breast cancer: a meta-analysis

Purpose: The impact of an increased body mass index (BMI) on outcomes of neoadjuvant chemotherapy (NACT) in breast cancer remains controversial. The purpose of this study was to analyze the impact of BMI on pathological complete response (pCR) rates for operable breast cancer after NACT. Methods: We searched Medline, Embase, and Web of Science database for observational studies and randomized controlled trials that reported the association of BMI with pCR after NACT. We performed a meta-analysis to assess the impact of BMI on pCR rate. Results: We identified 13 studies including a total of 18,702 women with operable breast cancer who underwent NACT. Two studies were pooled analyses of prospective clinical trials (10,669 patients); the rest were case–control studies (8033 patients). All studies provided data of two BMI groups (BMI < 25 vs. BMI ≥ 25). Pooled analyses demonstrated that overweight/obese women were less likely to achieve pCR after NACT as compared to under-/normal weight women (odds ratio (OR) = 0.80; 95% confidence interval (CI): 0.68–0.93). Eleven studies provided data of three BMI groups (BMI < 25, 25 ≤ BMI < 30, BMI ≥ 30). Based on pooled analyses, both overweight and obese groups were less likely to achieve pCR with NACT as compared to under-/normal weight group, (OR = 0.77, 95% CI 0.65–0.93 and OR = 0.68, 95% CI 0.61–0.77, respectively). Conclusions: Overweight and obese breast cancer patients had a lower pCR rate with NACT compared to patients with under-/normal weight. Further prospective studies may help confirm this finding and investigate possible mechanisms.