Research Article

The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors

Number: Advanced Online Publication Early Pub Date: October 23, 2026

The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors

Abstract

Objective: In obese breast cancer patients, aromatase inhibitors may be less effective, possibly because of increased aromatase enzyme activity in peripheral adipose tissue and higher estradiol levels. The aim of this study was to evaluate the effect of body composition on prognosis in patients with early-stage breast cancer receiving aromatase inhibitors in adjuvant endocrine therapy.

Methods: Our study included patients with radiologically and histopathologically confirmed early-stage breast cancer who were admitted to Dicle University Faculty of Medicine, Department of Medical Oncology, between January 2001 and March 2017. We included postmenopausal women who had body fat percentage data and received adjuvant aromatase inhibitor therapy for hormone receptor-positive breast cancer. 

Results: Prognostic factors’ effects on DFS were evaluated by multivariate analysis. The analysis showed that age (p=0.637), BMI (p=0.336), lymph node positivity (p=0.114), stage (p=0.216), grade (p=0.201), lymphatic invasion (p=0.819), ER positivity (p=0.608), and Her-2 positivity (p=0.941) had no effect on prognosis. In multivariable Cox regression analysis, comorbidity status (HR: 0.70, 95% CI: 0.42–0.91, p=0.03) and body fat percentage ≥45% versus <45% (HR: 3.15, 95% CI: 1.23–8.07, p=0.01) were independently associated with DFS.

Conclusion: In early-stage aromatase inhibitor-treated breast cancer patients, body fat percentage was shown to be a more valuable measure than BMI and an independent prognostic factor.

Keywords

Postmenopausal breast cancer, Aromatase inhibitors, Body fat percentage

Ethical Statement

The study was approved by the Dicle University Medical Faculty Ethics Committee for Noninterventional Studies (Date: April 17, 2017; Decision No: 106).

References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33. doi:10.3322/caac.21708.
  2. Tsang JYS, Tse GM. Molecular classification of breast cancer. Adv Anat Pathol. 2020;27(1):27-35. doi:10.1097/PAP.0000000000000232.
  3. Sung H, Siegel RL, Torre LA, Pearson-Stuttard J, Islami F, Fedewa SA, et al. Global patterns in excess body weight and the associated cancer burden. CA Cancer J Clin. 2019;69(2):88-112. doi:10.3322/caac.21499.
  4. Momenimovahed Z, Salehiniya H. Epidemiological characteristics of and risk factors for breast cancer in the world. Breast Cancer (Dove Med Press). 2019;11:151-64. doi:10.2147/BCTT.S176070.
  5. Chan DSM, Vieira AR, Aune D, Bandera EV, Greenwood DC, McTiernan A, et al. Body mass index and survival in women with breast cancer: systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25(10):1901-14. doi:10.1093/annonc/mdu042.
  6. Morris PG, Hudis CA, Giri D, Morrow M, Falcone DJ, Zhou XK, et al. Inflammation and increased aromatase expression occur in the breast tissue of obese women with breast cancer. Cancer Prev Res (Phila). 2011;4(7):1021-9. doi:10.1158/1940-6207.CAPR-11-0110.
  7. Sestak I, Distler W, Forbes JF, Dowsett M, Howell A, Cuzick J. Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol. 2010;28(21):3411-5. doi:10.1200/JCO.2009.27.2021.
  8. Ewertz M, Gray KP, Regan MM, Ejlertsen B, Price KN, Thürlimann B, et al. Obesity and risk of recurrence or death after adjuvant endocrine therapy with letrozole or tamoxifen in the breast international group 1-98 trial. J Clin Oncol. 2012;30(32):3967-75. doi:10.1200/JCO.2011.40.8666.
  9. Seynaeve C, Hille E, Hasenburg A, Rea D, Markopoulos C, Hozumi Y, et al. The impact of body mass index on the efficacy of adjuvant endocrine therapy in postmenopausal hormone-sensitive breast cancer patients: exploratory analysis from the TEAM study. Cancer Res. 2010;70(24 Suppl):S2-3. doi:10.1158/0008-5472.SABCS10-S2-3.
  10. Sini V, Lunardi G, Cirillo M, Turazza M, Bighin C, Giraudi S, et al. Body mass index and circulating oestrone sulphate in women treated with adjuvant letrozole. Br J Cancer. 2014;110(5):1133-8. doi:10.1038/bjc.2014.2.
APA
Kalkan, Z., Oruç, Z., Urakçı, Z., Küçüköner, M., Kaplan, M. A., & Işıkdoğan, A. (2026). The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors. DAHUDER Medical Journal, Advanced Online Publication. https://doi.org/10.56016/dahudermj.2017769
AMA
1.Kalkan Z, Oruç Z, Urakçı Z, Küçüköner M, Kaplan MA, Işıkdoğan A. The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors. DAHUDER MJ. 2026;(Advanced Online Publication). doi:10.56016/dahudermj.2017769
Chicago
Kalkan, Ziya, Zeynep Oruç, Zuhat Urakçı, Mehmet Küçüköner, Muhammed Ali Kaplan, and Abdurrahman Işıkdoğan. 2026. “The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors”. DAHUDER Medical Journal, no. Advanced Online Publication. https://doi.org/10.56016/dahudermj.2017769.
EndNote
Kalkan Z, Oruç Z, Urakçı Z, Küçüköner M, Kaplan MA, Işıkdoğan A (October 1, 2026) The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors. DAHUDER Medical Journal Advanced Online Publication
IEEE
[1]Z. Kalkan, Z. Oruç, Z. Urakçı, M. Küçüköner, M. A. Kaplan, and A. Işıkdoğan, “The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors”, DAHUDER MJ, no. Advanced Online Publication, Oct. 2026, doi: 10.56016/dahudermj.2017769.
ISNAD
Kalkan, Ziya - Oruç, Zeynep - Urakçı, Zuhat - Küçüköner, Mehmet - Kaplan, Muhammed Ali - Işıkdoğan, Abdurrahman. “The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors”. DAHUDER Medical Journal. Advanced Online Publication (October 1, 2026). https://doi.org/10.56016/dahudermj.2017769.
JAMA
1.Kalkan Z, Oruç Z, Urakçı Z, Küçüköner M, Kaplan MA, Işıkdoğan A. The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors. DAHUDER MJ. 2026. doi:10.56016/dahudermj.2017769.
MLA
Kalkan, Ziya, et al. “The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors”. DAHUDER Medical Journal, no. Advanced Online Publication, Oct. 2026, doi:10.56016/dahudermj.2017769.
Vancouver
1.Ziya Kalkan, Zeynep Oruç, Zuhat Urakçı, Mehmet Küçüköner, Muhammed Ali Kaplan, Abdurrahman Işıkdoğan. The Prognostic Value of Body Fat Percentage in Early-Stage Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors. DAHUDER MJ. 2026 Oct. 1;(Advanced Online Publication). doi:10.56016/dahudermj.2017769