Effect of Flavonoid-Rich Foods and Flavonoids on the Risk of Cancer Recurrence Among Korean Breast Cancer Survivor

Abstract Objectives Flavonoid intakes have been shown to associate with breast cancer incidence, but it is not clear the association between flavonoids and cancer recurrence. The purpose of the present study was to investigate the hypothesis that intakes of flavonoids and flavonoid-rich foods were negatively associated with cancer recurrence. Methods Among 572 women after breast cancer surgery, 66 patients had cancer recurrence during follow–up until 114 months with a median period of disease-free survival of 43 months ranged 6–103 months. Dietary data were collected using structured 24-h dietary recall, and the intake of flavonoid was calculated based on the Korea Rural Development Administration flavonoid database. Results There was no significant association of flavonoid and flavonoid-rich food intake with cancer recurrence and disease-free survival among all patients. On the other hand, among overweight and obese patients, Kaplan-Meier survival curves revealed a significant effect of dietary flavonoids (P = 0.04) and flavonoid-rich foods (P = 0.03) on disease-free survival, but not overall survival. Intakes of flavonoid (HR = 0.244, 95% CI: 0.09–0.66) and flavonoid-rich food (HR = 0.223, 95% CI: 0.08–0.59) were also negatively associated with cancer recurrence after adjusting for confounding factors in overweight and obese patients. Consumption of flavonoids and flavonoid-rich foods was lower in overweight and obese patients with cancer recurrence than those without recurrence. Conclusions To the best of our knowledge, this was the first study to examine the association between flavonoid intake and cancer recurrence/disease-free survival in breast cancer patients. The present study suggested that intakes of flavonoids and flavonoid-rich foods could have a beneficial effect on cancer recurrence among overweight and obese breast cancer survivors. Further clinical studies are needs to confirm whether supplementation of flavonoids reduces cancer recurrence. Funding Sources This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (NRF-2018R1A2B6002486).

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Association between the Dietary Inflammatory Index and Risk for Cancer Recurrence and Mortality among Patients with Breast Cancer

Nutrients ◽

10.3390/nu10081095 ◽

2018 ◽

Vol 10 (8) ◽

pp. 1095 ◽

Cited By ~ 6

Author(s):

Hyeonjeong Jang ◽

Min Chung ◽

Shin Kang ◽

Yongsoon Park

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Cancer Recurrence ◽

Disease Free Survival ◽

Dietary Inflammatory Index ◽

Free Survival ◽

Inflammatory Index ◽

Node Metastasis ◽

Disease Free ◽

Overall Mortality

The dietary inflammatory index (DII) has been associated with breast cancer incidence and survival. However, the association between DII and cancer recurrence and mortality among patients with breast cancer has not been investigated. Therefore, the present study aimed to investigate whether DII was positively associated with risk for cancer recurrence and overall mortality among patients with breast cancer. Among 511 women (51.9 ± 10.7 years; stage 0–3) who underwent breast cancer surgery, 88 had cancer recurrence, and 44 died during follow–up until 213 months (average disease free survival of 84.3 ± 42.4 months and overall survival of 69.3 ± 38.9 months). The DII assessed after surgery (5.4 ± 5.2 months after diagnosis) was significantly higher in patients with recurrence than those without recurrence, and Cox proportional hazards regression analysis showed that it was positively associated with the risk for cancer recurrence (hazard ratio (HR) 2.347, confidence interval (CI) 1.17–4.71) and overall mortality (HR 3.049, CI 1.08–8.83) after adjusting for confounding factors. Disease-free survival and overall survival rates were significantly lower in patients with higher DII scores. In addition, the DII was positively associated with the risk for cancer recurrence according to prognostic factors, such as age (<50 years), premenopausal status, body mass index (≥25 kg/m2), HR+, tumor size (>2 cm), and presence of lymph node metastasis. The present study showed that anti-inflammatory diets may decrease the risk of cancer recurrence and overall mortality in patients with breast cancer, particularly those with prognostic factors, such as younger age, premenopausal status, obesity, HR+ breast cancer, tumor size >2 cm, and presence of lymph node metastasis.

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Prognostic impact of body mass index upon cancer recurrence and survival in stage III colon cancer patients from adjuvant chemotherapy trials

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.11088 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 11088-11088

Author(s):

F. Sinicrope ◽

N. R. Foster ◽

D. J. Sargent ◽

S. R. Alberts ◽

M. J. O'Connell

Keyword(s):

Colon Cancer ◽

Cancer Recurrence ◽

Disease Free Survival ◽

Normal Weight ◽

Stage Iii ◽

Obese Patients ◽

Tumor Site ◽

Free Survival ◽

Stage Iii Colon Cancer ◽

Disease Free

11088 Background: Obesity is associated with an increased risk of colon cancer. However, the influence of body mass index (BMI) upon the prognosis of patients with established colon cancer remains unknown. Methods: We conducted a retrospective study of 1,803 patients with surgically resected stage III colon cancer who were enrolled in five randomized trials of 5-fluorouracil-based adjuvant chemotherapy conducted by the North Central Cancer Treatment Group. Patient height and weight were recorded at study entry and BMI (kg/m2) was calculated and categorized. Cancer recurrence or death were monitored during 5 years of follow-up. The score and likelihood ratio p-values were determined from univariate and multivariate Cox regression models respectively, after stratifying by study. Results: Among stage III colon cancer patients, 19% were obese (BMI 30 kg/m2), 37% were overweight (BMI, 25 to 29.9 kg/m2), 38% were of normal-weight (BMI, 20 to 24.9 kg/m2), and 6% were underweight (BMI < 20 kg/m2). Obese versus normal-weight patients showed higher rates of lymph node (LN) metastasis (>3 LNs; 38% vs. 29%, p <0.01) and tumor site was more likely to be distal versus proximal (52% vs. 45%, p= 0.03). No differences in age, gender, or histologic grade were found. In a univariate analysis, obese patients had significantly worse disease-free survival (DFS) compared with normal-weight patients (hazard ratio 1.25 (95% CI: 1.04 -1.51; p= 0.02). The 5 year DFS rates were 49% in obese patients versus 57% in normal weight subjects. Furthermore, poorer DFS was observed for obese patients after adjusting for age, sex, histologic grade, and tumor site (p= 0.03). Neither overweight nor underweight patients (vs. normal-weight) had significantly different DFS. Analysis of the predictive impact of BMI for 5-FU-based adjuvant therapy is in progress. Conclusions: Obesity (BMI 30 kg/m2) was associated with a greater number of metastatic lymph nodes and poorer disease-free survival in patients with stage III colon cancer, suggesting that obesity influences tumor progression. No significant financial relationships to disclose.

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Association between Dietary Intake of Flavonoids and Cancer Recurrence among Breast Cancer Survivors

Nutrients ◽

10.3390/nu13093049 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3049

Author(s):

Minjung Cheon ◽

Minsung Chung ◽

Yongsoon Park

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Cancer Recurrence ◽

Disease Free Survival ◽

Normal Weight ◽

Breast Cancer Surgery ◽

Obese Patients ◽

Negatively Associated ◽

Dietary Recall

Intake of flavonoids is associated with the incidence of breast cancer, but the association between the intake of flavonoids and cancer recurrence is unclear. This study aimed to investigate the hypothesis that intake of flavonoids and flavonoid-rich foods is negatively associated with cancer recurrence. Among 572 women who underwent breast cancer surgery, 66 patients had a cancer recurrence. Dietary data were collected using a structured 24-h dietary recall, and intake of flavonoids was calculated based on the Korea Rural Development Administration flavonoid database. Among overweight and obese patients, disease-free survival was associated with intake of flavonoids (p = 0.004) and flavonoid-rich foods (p = 0.003). Intake of flavonoids (hazard ratio (HR) = 0.249, 95% confidence interval (CI): 0.09–0.64) and flavonoid-rich foods (HR = 0.244, 95% CI: 0.09–0.66) was negatively associated with cancer recurrence after adjusting for confounding factors in overweight and obese patients. Consumption of flavonoids and flavonoid-rich foods was lower in overweight and obese patients with cancer recurrence than those without recurrence and in normal-weight patients. This study suggests that intake of flavonoids and flavonoid-rich foods could have beneficial effects on cancer recurrence in overweight and obese breast cancer survivors.

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Impact of body mass index (BMI) on the efficacy of zoledronic acid in premenopausal patients with hormone receptor positive breast cancer: An analysis of the ABCSG-12 trial.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.514 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 514-514

Author(s):

Georg Pfeiler ◽

Robert Konigsberg ◽

Christian Fesl ◽

Brigitte Mlineritsch ◽

Herbert Stoger ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Zoledronic Acid ◽

Disease Free Survival ◽

Normal Weight ◽

Obese Patients ◽

Free Survival ◽

Premenopausal Patients ◽

The Impact ◽

Disease Free

514 Background: Zoledronic acid (ZOL) improves disease outcome in premenopausal patients with breast cancer (BC), especially in those with low estrogen environment. Obesity is associated with increased estrogen serum levels, which might influence the efficacy of ZOL. We investigated the impact of BMI on the efficacy of ZOL in premenopausal patients with BC. Methods: ABCSG-12 examined the efficacy of ovarian suppression using goserelin (3.6 mg q28d SC) in combination with anastrozole (ANA) or tamoxifen (TAM) ± ZOL 4 mg IV q6mo) in premenopausal women with endocrine-responsive BC. BMI was calculated using the prospectively collected data on patients’ height and weight at study entry. BMI definitions of the WHO were used: normal 18.5-24.9 kg/m2, overweight: BMI 25-29.9 kg/m2, obese BMI ≥ 30 kg/m2). Disease-free survival (DFS) and overall survival (OS) were calculated by Kaplan-Meier method and results were compared by using the log-rank test and Cox proportional hazard modeling. Results: Two thirds of the patients were normal weight (1,111) and one third was overweight (391) or obese (182). Normal weight patients treated with ZOL experienced the same benefit as overweight/obese patients treated with ZOL compared to patients without ZOL regarding disease free survival (HR 0.75, 95%CI 0.53 1.05 p = 0.09 and HR 0.71, 95%CI 0.46 1.1, p=0.12, respectively) as well as overall survival (HR 0.67, 95% CI 0.37 1.22, p=0.19 and HR 0.64, 95%CI 0.32 1.28, p=0.19, respectively). No difference regarding DFS and OS could be detected between normal weight and overweight/ obese patients treated with ZOL (HR 1.05, 95%CI 0.69 1.59, p=0.83 and HR 1.27, 95%CI 0.62 2.61, p= 0.51). Comparing normal weight patients with ZOL to obese patients with ZOL, again no difference could be observed. Conclusions: The significant outcome benefit of adjuvant zoledronic acid in ABCSG-12 can be demonstrated both in normal weight and overweight/obese premenopausal patients with early breast cancer, indicating that the bone marrow microenvironment changing impact of adjuvant bisphopshonate treatment does not correlate with patients’ BMI.

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PTGS2 polymorphism rs689466 favors breast cancer recurrence in obese patients

Endocrine Related Cancer ◽

10.1530/erc-17-0374 ◽

2018 ◽

Vol 25 (3) ◽

pp. 351-365 ◽

Cited By ~ 1

Author(s):

Daniely Regina Freitas-Alves ◽

Hayra de Andrade Vieira-Monteiro ◽

Diogo Nascimento Piranda ◽

Marcelo Sobral-Leite ◽

Taiana Sousa Lopes da Silva ◽

...

Keyword(s):

Breast Cancer ◽

Postmenopausal Women ◽

Cancer Patients ◽

Triple Negative ◽

Disease Free Survival ◽

Cyclooxygenase 2 ◽

Obese Patients ◽

Breast Cancer Patients ◽

Free Survival ◽

Disease Free

Breast cancer is the leading cancer among women, and its increasing incidence is a challenge worldwide. Estrogen exposure is the main risk factor, but obesity among postmenopausal women has been shown to favor disease onset and progression. The link between obesity and mammary carcinogenesis involves elevated estrogen production and proinflammatory stimuli within the adipose tissue, with activation of the cyclooxygenase-2 pathway. Here, we evaluate the impact of the four most common cyclooxygenase-2 gene polymorphisms (rs689465, rs689466, rs20417 and rs20417), in combination with obesity, on the risk of breast cancer progression in a cohort of Brazilian breast cancer patients (N = 1038). Disease-free survival was evaluated using Kaplan–Meier curves, with multivariate Cox proportional hazards regression models for calculation of adjusted hazard ratios (HRadj). Obesity did not affect disease progression, whereas rs689466 variant genotypes increased the recurrence risk among obese patients (HRadj = 2.5; 95% CI = 1.4–4.3), either for luminal (HRadj = 2.2; 95% CI = 1.1–4.2) or HER2-like and triple-negative tumors (HRadj = 3.2; 95% CI = 1.2–8.5). Likewise, the haplotype *4, which contains variant rs689466, was associated with shorter disease-free survival among obese patients (HRadj = 3.3; 95% CI = 1.8–6.0), either in luminal (HRadj = 3.5; 95% CI = 1.6–7.3) or HER2-like and triple-negative (HRadj = 3.1; 95% CI = 1.1–8.9) tumors. Such deleterious impact of variant rs689466 on disease-free survival of obese breast cancer patients was restricted to postmenopausal women. In conclusion, cyclooxygenase-2 genotyping may add to the prognostic evaluation of obese breast cancer patients.

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Trastuzumab/Chemo Improves Disease-Free Survival in Early-Stage Breast Cancer

PsycEXTRA Dataset ◽

10.1037/e315042005-001 ◽

2005 ◽

Author(s):

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Disease Free Survival ◽

Early Stage Breast Cancer ◽

Free Survival ◽

Disease Free

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A Novel Automated Immunoassay Platform to Evaluate the Association of Adiponectin and Leptin Levels with Breast Cancer Risk

Cancers ◽

10.3390/cancers13133303 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3303

Author(s):

Debora Macis ◽

Valentina Aristarco ◽

Harriet Johansson ◽

Aliana Guerrieri-Gonzaga ◽

Sara Raimondi ◽

...

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Cox Model ◽

Disease Free Survival ◽

Postmenopausal Breast Cancer ◽

Enzyme Linked Immunosorbent Assay ◽

Baseline Serum ◽

Free Survival ◽

Disease Free

Adiponectin and leptin are adipokines secreted by the adipose tissue that are associated with several chronic diseases including cancer. We aimed to compare the immunoassay platform ELLA with an enzyme-linked immunosorbent assay (ELISA) kit and to assess whether the results of the association analyses with breast cancer risk were dependent on the assay used. We measured adiponectin and leptin with ELLA and ELISA on baseline serum samples of 116 Italian postmenopausal women enrolled in two international breast cancer prevention trials. Results were compared with Deming, Passing–Bablok regression and Bland–Altman plots. Disease-free survival was analyzed with the Cox model. There was a good correlation between the methods for adiponectin and leptin (r > 0.96). We found an increased breast cancer risk for very low adiponectin levels (HR for ELLA = 3.75; 95% CI: 1.37;10.25, p = 0.01), whereas no significant association was found for leptin levels. The disease-free survival curves were almost identical for values obtained with the two methods, for both biomarkers. The ELLA platform showed a good concordance with ELISA for adiponectin and leptin measurements. Our results support the association of very low adiponectin levels with postmenopausal breast cancer risk, irrespective of the method used. The ELLA platform is a time-saving system with high reproducibility, therefore we recommend its use for biomarker assessment.

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The role of functional polymorphisms in oxidative stress-related genes on early-stage breast cancer survival

The International Journal of Biological Markers ◽

10.1177/17246008211011177 ◽

2021 ◽

pp. 172460082110111

Author(s):

Erika Korobeinikova ◽

Rasa Ugenskiene ◽

Ruta Insodaite ◽

Viktoras Rudzianskas ◽

Jurgita Gudaitiene ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Single Nucleotide Polymorphisms ◽

Early Stage ◽

Disease Free Survival ◽

Early Stage Breast Cancer ◽

Nucleotide Polymorphisms ◽

Single Nucleotide ◽

Free Survival ◽

Disease Free

Background: Genetic variations in oxidative stress-related genes may alter the coded protein level and impact the pathogenesis of breast cancer. Methods: The current study investigated the associations of functional single nucleotide polymorphisms in the NFE2L2, HMOX1, P21, TXNRD2, and ATF3 genes with the early-stage breast cancer clinicopathological characteristics and disease-free survival, metastasis-free survival, and overall survival. A total of 202 Eastern European (Lithuanian) women with primary I–II stage breast cancer were involved. Genotyping of the single nucleotide polymorphisms was performed using TaqMan single nucleotide polymorphisms genotyping assays. Results: The CA+AA genotypes of P21 rs1801270 were significantly less frequent in patients with lymph node metastasis and larger tumor size ( P=0.041 and P=0.022, respectively). The TT genotype in ATF3 rs3125289 had significantly lower risk of estrogen receptor (ER), progesterone receptor (PR) negative, and human epidermal growth factor receptor 2 (HER2) positive status ( P=0.023, P=0.046, and P=0.040, respectively). In both, univariate and multivariate Cox analysis, TXNRD2 rs1139793 GG genotype vs. GA+AA was a negative prognostic factor for disease-free survival (multivariate hazard ratio (HR) 2.248; P=0.025) and overall survival (multivariate HR 2.248; P=0.029). The ATF3 rs11119982 CC genotype in the genotype model was a negative prognostic factor for disease-free survival (multivariate HR 5.878; P=0.006), metastasis-free survival (multivariate HR 4.759; P=0.018), and overall survival (multivariate HR 3.280; P=0.048). Conclusion: Our findings suggest that P21 rs1801270 is associated with lymph node metastasis and larger tumor size, and ATF3 rs3125289 is associated with ER, PR, and HER2 status. Two potential, novel, early-stage breast cancer survival biomarkers, TXNRD2 rs1139793 and ATF3 rs11119982, were detected. Further investigations are needed to confirm the results of the current study.

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