Association of Body Mass Index, Central Obesity, and Body Composition With Mortality Among Black Breast Cancer Survivors
Association of Body Mass Index, Central Obesity, and Body Composition With Mortality Among Black Breast Cancer Survivors
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DOI：
10.1001/jamaoncol.2021.1499
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发表时间：
2021-06-04
期刊：
影响因子：
28.4
通讯作者：
Hong, Chi-Chen
中科院分区：
文献类型：
--
作者：
Bandera, Elisa V.;Qin, Bo;Hong, Chi-Chen
肥胖对黑人女性的影响不成比例，与其他种族/民族的女性相比，她们在被诊断为乳腺癌后死亡的风险也更高。然而，很少有研究评估黑人乳腺癌存活者中肥胖指标与死亡率的相关性。目的评估黑人女性乳腺癌诊断后肥胖指标与生存率的相关性。设计、背景和参与者：这项基于人群的前瞻性队列研究包括1891名自认为非裔美国人或黑人、年龄20至75岁的0至IV期乳腺癌女性。新泽西州癌症登记处被用来识别居住在新泽西州10个县的妇女，她们从2006年3月1日到2020年2月29日被招募，并被跟踪到2020年9月2日。研究人员在乳腺癌确诊后大约10个月的面谈中收集了肥胖测量数据，包括体重指数、体脂分布(腰围和腰臀比)和身体成分(体脂百分比和脂肪质量指数)。乳腺癌诊断的平均年龄(SD)为54.5岁(10.8岁)。在中位数为5.9年(范围为0.5-14.8年)的随访期间，286例死亡被确认；其中175例死亡(61.2%)与乳腺癌有关。共有1060名女性(56.1%)患有肥胖症，1291名女性(68.3%)患有中心性肥胖。肥胖程度越高，尤其是腰臀比越高，存活率越低。与腰臀比最低四分之一的女性相比，腰臀比最高四分之一的女性死于任何原因的风险增加61%(风险比，1.61；95%可信区间，1.12-2.33)，乳腺癌死亡风险增加68%(风险比，1.68；95%可信区间，1.04-2.71)。在腰围(HR，分别为1.74[95%CI，1.26-2.41]和1.64[95%CI，1.08-2.48])、体脂百分比(HR，1.53[95%CI，1.09-2.15和1.81[95%CI，1.17-2.80])和脂肪质量指数(HR，1.57[95%CI，1.17-2.80])最高四分位数的女性中，全因死亡和乳腺癌相关死亡的风险同样高。1.11-2.22]和1.74[95%可信区间，1.10-2.75]；然而，体重指数(HR，1.26[95%CI，0.89-1.79]和1.33[95%CI，0.84-2.10])的风险较小。在按雌激素受体状态、绝经状态和年龄分层的分析中，在患有雌激素受体阴性肿瘤的女性(HR，2.24；95%CI，1.14-4.41)、绝经后女性(HR，2.15；95%CI，1.28-3.61)和确诊时60岁或以上的女性(HR每增加0.10-U，HR 1.76；95%可信区间1.37-2.26)。结论在这项以人群为基础的队列研究中，中心性肥胖和较高的肥胖度与黑人乳腺癌幸存者中较高的全因死亡率和乳腺癌特异性死亡率相关。对身体脂肪分布和身体成分的简单测量被发现是识别乳腺癌诊断后死亡风险较高的黑人女性的有用工具。
IMPORTANCE Obesity disproportionately affects Black women, who also have a higher risk of death after a breast cancer diagnosis compared with women of other racial/ethnic groups. However, few studies have evaluated the association of measures of adiposity with mortality among Black breast cancer survivors.OBJECTIVE To assess the association of measures of adiposity with survival after a breast cancer diagnosis among Black women.DESIGN, SETTING, AND PARTICIPANTS This prospective population-based cohort study comprised 1891 women with stage 0 to IV breast cancer who self-identified as African American or Black and were ages 20 to 75 years. The New Jersey State Cancer Registry was used to identify women living in 10 counties in New Jersey who were recruited from March 1, 2006, to February 29, 2020, and followed up until September 2, 2020.EXPOSURES Measures of adiposity, including body mass index, body fat distribution (waist circumference and waist-to-hip ratio), and body composition (percent body fat and fat mass index), were collected during in-person interviews at approximately 10 months after breast cancer diagnosis.MAIN OUTCOMES AND MEASURES All-cause and breast cancer-specific mortality.RESULTS Among 1891 women, the mean (SD) age at breast cancer diagnosis was 54.5 (10.8) years. During a median follow-up of 5.9 years (range, 0.5-14.8 years), 286 deaths were identified; of those, 175 deaths (61.2%) were associated with breast cancer. A total of 1060 women (56.1%) had obesity, and 1291 women (68.3%) had central obesity. Higher adiposity, particularly higher waist-to-hip ratio, was associated with worse survival. Women in the highest quartile of waist-to-hip ratio had a 61% increased risk of dying from any cause (hazard ratio [HR], 1.61; 95% CI, 1.12-2.33) and a 68% increased risk of breast cancer death (HR, 1.68; 95% CI, 1.04-2.71) compared with women in the lowest quartile. The risks of all-cause and breast cancer-specific death were similarly high among women in the highest quartile for waist circumference (HR, 1.74 [95% CI, 1.26-2.41] and 1.64 [95% CI, 1.08-2.48], respectively), percent body fat (HR, 1.53 [95% CI, 1.09-2.15] and 1.81 [95% CI, 1.17-2.80]), and fat mass index (HR, 1.57 [95% CI, 1.11-2.22] and 1.74 [95% CI, 1.10-2.75]); however, the risk was less substantial for body mass index (HR, 1.26 [95% CI, 0.89-1.79] and 1.33 [95% CI, 0.84-2.10]). In analyses stratified by estrogen receptor status, menopausal status, and age, a higher waist-to-hip ratio was associated with a higher risk of all-cause death among women who had estrogen receptor-negative tumors (HR, 2.24; 95% CI, 1.14-4.41), women who were postmenopausal (HR, 2.15; 95% CI, 1.28-3.61), and women who were 60 years or older at diagnosis (HR per 0.10-U increase, 1.76; 95% CI, 1.37-2.26).CONCLUSIONS AND RELEVANCE In this population-based cohort study, central obesity and higher adiposity were associated with higher all-cause and breast cancer-specific mortality among Black breast cancer survivors. Simple measures of body fat distribution and body composition were found to be useful tools for identifying Black women with a higher risk of death after a breast cancer diagnosis.