Weight Gain during Neoadjuvant Chemotherapy is Associated with Worse Outcome among the Patients with Operable Breast Cancer
Weight Gain during Neoadjuvant Chemotherapy is Associated with Worse Outcome among the Patients with Operable Breast Cancer
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DOI：
10.4048/jbc.2019.22.e37
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发表时间：
2019-09-01
影响因子：
2.4
通讯作者：
Wu, Beiwen
中科院分区：
文献类型：
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作者：
Fang, Qiong;Huang, Jiahui;Wu, Beiwen
目的：本研究的目的是确定初始体重和体重变化的影响，在新辅助化疗（NAC）的病理完全缓解（pCR）和长期生存在中国的可手术乳腺cancer.Methods：我们进行了一项回顾性研究，使用数据从409名女性患者接受NAC的II或III期乳腺癌和完整的记录体重指数（BMI）之前和之后NAC。BMI < 25 kg/m2被归类为正常体重/体重不足（NW/UW）; 25.0-29.9 kg/m2被归类为超重（OW）; >= 30 kg/m2被归类为肥胖（OB）。BMI变化定义为NAC第一周期第1天与手术前一天之间的BMI差异。NAC后BMI增加或减少> 2 kg/m2被认为是显著的，否则被认为是稳定的。研究终点包括pCR率、无病生存期（DFS）和总生存期（OS）。结果：中位随访时间为43.2（8.9-93.6）个月。NAC前的平均BMI为23.40 +/- 3.04 kg/m2，NAC后为23.66 +/- 3.02 kg/m2（t =-3.604，p < 0.001）。NW/UW组和OW/OB组的pCR率分别为25.3%和24.1%（p = 0.811），BMI增加组（23.3%）和BMI稳定/丢失组（25.1%）的pCR率相似（p = 0.787）。初始BMI是DFS的独立预后因素（风险比，1.69; 95%置信区间[CI]，1.13-2.53; p = 0.011），但不适用于OS，而BMI增加是DFS和DFS的独立预后因素。（危险比，2.09; 95%CI，1.28-3.42; p = 0.003）和OS（危险比，1.97; 95%CI，1.04-3.74; p = 0.039）。初始BMI和NAC期间的BMI变化与pCR无关，但与生存率相关。
Purpose: This study was aimed at identifying the influence of initial weight and weight change during neoadjuvant chemotherapy (NAC) on pathologic complete response (pCR) and long-term survival in Chinese patients with operable breast cancer.Methods: We conducted a retrospective study using data from 409 female patients who received NAC for stage II or III breast cancer and had complete record of body mass index (BMI) before and after NAC. BMI of < 25 kg/m(2) was categorized as normal weight/underweight (NW/UW); 25.0-29.9 kg/m(2) was categorized as overweight (OW); >= 30 kg/m(2) was categorized as obese (OB). BMI change was defined as the difference in BMI between day 1 of the first cycle of NAC and the day before surgery. A BMI gain or loss of > 2 kg/m(2) following NAC was considered to be significant, else was considered stable. The study end points included pCR rates, disease-free survival (DFS), and overall survival (OS).Results: The median follow-up time was 43.2 (8.9-93.6) months. The average BMI was 23.40 +/- 3.04 kg/m(2) before NAC and 23.66 +/- 3.02 kg/m(2) after NAC (t = -3.604, p < 0.001). The pCR rate was 25.3% in the NW/UW group and 24.1% in the OW/OB group (p = 0.811), and was similar between the BMI-gain (23.3%) and the BMI-stable/loss (25.1%) groups (p = 0.787). Initial BMI was an independent prognostic factor for DFS (hazard ratio, 1.69; 95% confidence interval [CI], 1.13-2.53; p = 0.011) but not for OS, while BMI-gain was an independent prognostic factor for both DFS (hazard ratio, 2.09; 95% CI, 1.28-3.42; p = 0.003) and OS (hazard ratio, 1.97; 95% CI, 1.04-3.74; p = 0.039).Conclusion: BMI increased after NAC in Chinese breast cancer patients. Initial BMI and BMI change during NAC were not associated with pCR but were reversely associated with survival.