Document Type: Research Articles
Department of Surgery, Dr. Kariadi Hospital, Faculty of Medicine, University Diponegoro, Semarang, Indonesia.
Division of Surgical Oncology, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Graduate School in Medicine and Health, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.
Department of Surgery, Dr. Moewardi Hospital, Universitas Sebelas Maret, Surakarta, Indonesia.
Department of Anatomical Pathology, Dr. Sardjito Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Background: Omega-3 is a polyunsaturated fatty acid with an ability to regulate cell proliferation and apoptosis
through interaction with inflammatory mediators. The potential additional beneficial effects of Omega-3 on chemotherapy
patients with breast cancer is not yet completely revealed. Methods: A double-blind randomized control trial (RCT)
involving a total of 48 locally advanced breast cancer patients was conducted. Ki-67 and VEGF expressions, as well as
overall survival of patients receiving neoadjuvant cyclophosphamide-doxorubicin-5’fluorouracyl (CAF) chemotherapy
plus Omega-3 (intervention group) or placebo (control group), were compared. Kaplan-Meier curve and Cox-regression
tests were used to assess conditional disease-free survival (DFS) and overall survival (OS) between the two groups.
Results: Decreased Ki-67 expression was observed in the intervention group compared to control (42.4±4.8 versus
39.2±5.3; T-test p=0.032). Decreased Ki-67 expression was observed in intervention compared to control group (42.4±4.8
versus 39.2±5.3; T-test p=0.032). Decreased VEGF expression was also seen in the intervention group compared to
control (32.7±5.2 versus 29.5±5.4; T-test p=0.041). VEGF expression positively correlated with Ki-67 expression
(Spearman’s test p<0.001, R2=0.541). Overall survival in the intervention group was significantly longer in comparison
to the control group (mean survival: 30.9 ± 3.71 versus 25.9 ± 3.6 weeks, Mantel-Cox test p=0.048; HR=0.411, 95%CI:
0.201-0.840). Disease-free survival was significantly longer in the intervention group compared to the control group
(mean survival: 28.5 ± 3.3 versus 23.7 ± 3.6, respectively; Mantel-Cox test p=0.044, HR= 0.439, 95%CI: 0.222-0.869).
Conclusion: Omega-3 fatty acid supplementation improved overall survival and progression-free survival of locally
advanced breast cancer treated with CAF neoadjuvant chemotherapy and mastectomy.