Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis.
Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis.
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DOI：
10.1002/ijc.34322
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发表时间：
2023-02-15
影响因子：
6.4
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中科院分区：
文献类型：
--
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先前关于乳腺癌后诊断后体脂和死亡率的证据被分级为有限提示。为了评估体重指数(BMI)、腰围、腰臀比和体重变化与乳腺癌预后的关系，对此进行了最新的系统综述。PubMed和Embase被检索到截至2021年10月31日发表的相关研究。采用随机效应Meta分析估计汇总相对危险度(RRS)。证据由一个独立的专家小组使用预先确定的分级标准进行评判。一项随机对照试验和225项观察性研究被综述(220篇文章)。有强有力的证据(因果关系的可能性：可能)表明，较高的诊断后体重指数与全因死亡率(研究，32例 507死亡)、乳腺癌相关死亡率(39项研究，14例 死亡)和第二原发乳腺癌(11项研究，5 248例)相关。每5 kg/m2体重指数的RR值和95%可信区间分别为1.07(1.05-1.10)、1.10(1.06-1.14)和1.14(1.04-1.26)，研究间异质性很高(I2= 56%、60%、66%)，但总体上是一致的正相关关系。腰围、腰臀比、全因死亡率和乳腺癌特异性死亡率也与此呈正相关。有有限的提示证据表明，诊断后的BMI与更高的复发风险、非乳腺癌死亡和心血管死亡有关。诊断后(原因不明)体重或BMI改变的证据和所有结果都被评为有限的-没有结论。RCT显示了有意减肥对无病生存的潜在有利影响，但还需要在不同人群中进行更多的干预试验和精心设计的观察性研究，以阐明身体成分及其变化对乳腺癌预后的影响。有什么新鲜事吗？较大的体脂和成人体重增加是绝经后乳腺癌的既定危险因素，但超重对乳腺癌预后的影响尚不清楚。在这项对全球癌症更新计划的系统回顾和荟萃分析中，独立专家小组得出结论，有强有力的证据(因果关系的可能性：可能)表明，在被诊断为乳腺癌的女性中，确诊后的身体肥胖会增加全因死亡、乳腺癌特有的死亡和第二原发乳腺癌的风险。这些发现支持为乳腺癌幸存者制定生活方式建议，在他们的能力范围内避免肥胖和进行体育锻炼，并提供具体的医疗建议。
Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited‐suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist‐hip‐ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random‐effects meta‐analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre‐defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all‐cause mortality (64 studies, 32 507 deaths), breast cancer‐specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05‐1.10), 1.10 (1.06‐1.14) and 1.14 (1.04‐1.26), with high between‐study heterogeneity (I 2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist‐hip‐ratio and all‐cause and breast cancer‐specific mortality. There was limited‐suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited‐no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease‐free‐survival, but more intervention trials and well‐designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes. What's new? Greater body fatness and adult weight gain are established risk factors for postmenopausal breast cancer, but the impact of excess body weight on breast cancer outcomes remains unclear. In this systematic review and meta‐analysis of the Global Cancer Update Program, the independent expert panel concluded that there was strong evidence (likelihood of causality: probable) that postdiagnosis body fatness increases the risks of all‐cause mortality, breast cancer‐specific mortality and second primary breast cancer in women diagnosed with breast cancer. The findings support the development of lifestyle recommendations for breast cancer survivors to avoid obesity and be physically active, within the limits of their ability and specific medical advice.
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影响因子：
2.9
作者：
Zhang S;Lei R;Wu J;Shan J;Hu Z;Chen L;Ren X;Yao L;Wang J;Wang X
通讯作者：
Wang X
影响因子：
28.4
作者：
Bandera, Elisa V.;Qin, Bo;Hong, Chi-Chen
通讯作者：
Hong, Chi-Chen
影响因子：
2.1
作者：
Abdel-Rahman, Omar
通讯作者：
Abdel-Rahman, Omar
影响因子：
3.9
作者：
Artac, Mehmet;Bozcuk, Hakan;Samur, Mustafa
通讯作者：
Samur, Mustafa
影响因子：
2.2
作者：
ABE, R;KUMAGAI, N;NAKAMURA, T
通讯作者：
NAKAMURA, T