Metabolic abnormalities and survival among patients with non-metastatic breast cancer.
Metabolic abnormalities and survival among patients with non-metastatic breast cancer.
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DOI：
10.1186/s12885-022-10430-9
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发表时间：
2022-12-29
期刊：
影响因子：
3.8
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中科院分区：
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关于代谢异常对乳腺癌预后影响的研究受到样本量小和在单个时间点（通常在癌症诊断和治疗之前）评估实验室值的限制。在这个基于人群的队列中，根据癌症治疗调整了时间更新的实验室检查值，以评估代谢风险因素（葡萄糖、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯）与乳腺癌生存率之间的相关性。从2005年到2015年，在Kaiser Permanente诊断出患有I-III期乳腺癌的13，434名妇女被纳入其中。从诊断到2019年或死亡的所有门诊空腹血糖、HDL-C、LDL-C和甘油三酯值均从电子病历中提取。使用考克斯比例风险模型评估乳腺癌特异性死亡率风险，该模型针对代谢实验室、人口统计学、体重指数、糖尿病、血脂异常和抗高血压药物、肿瘤特征（分期、ER和HER 2受体状态）和癌症治疗（化疗、他莫昔芬和芳香化酶抑制剂的使用）进行了校正。诊断时的平均（SD）年龄为62.3（11.8）岁。在平均8.6年的随访中，有2,876名患者死亡，其中1,080人死于乳腺癌。低HDL-C（≤ 45 vs.> 45 mg/dL）患者的乳腺癌特异性死亡率较高（HR，1.77; 95% CI，1.53-2.05），空腹血糖升高（> 99 vs. 60-99 mg/dL）的患者也是如此（HR，1.19; 95% CI，1.03-1.37）。甘油三酯和LDL-C水平升高与乳腺癌特异性死亡率无关。高空腹血糖和低HDL-C在癌症诊断后随时间的评估与较高的乳腺癌死亡率相关，与癌症治疗和其他代谢危险因素的变化无关。未来的研究应该解决是否药物或生活方式治疗乳腺癌诊断后的血糖和血脂可以优化生存结局。在线版本包含补充材料，可通过10.1186/s12885-022-10430-9获得。
Research on the impact of metabolic abnormalities on breast cancer prognosis is limited by small samples and assessment of laboratory values at a single time point, often prior to cancer diagnosis and treatment. In this population-based cohort, time-updated laboratory values were adjusted for cancer treatment to assess the association between metabolic risk factors (glucose, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides) and breast cancer survival. 13,434 women diagnosed with stage I-III breast cancer from 2005-15 at Kaiser Permanente were included. All outpatient fasting glucose, HDL-C, LDL-C, and triglyceride values from diagnosis through 2019 or death were extracted from electronic medical records. Risk of breast cancer-specific mortality was evaluated with Cox proportional hazards models adjusted for metabolic labs, demographics, body mass index, diabetes, dyslipidemia and anti-hypertensive medications, tumor characteristics (stage, ER and HER2 receptor status) and cancer treatment (use of chemotherapy, tamoxifen, and aromatase inhibitors). Mean (SD) age at diagnosis was 62.3 (11.8) years. Over a median follow-up of 8.6 years, 2,876 patients died; 1,080 of breast cancer. Patients with low HDL-C (≤ 45 vs. > 45 mg/dL) had higher breast cancer-specific mortality (HR, 1.77; 95% CI, 1.53-2.05), as did those with elevated fasting glucose (> 99 vs. 60-99 mg/dL) (HR, 1.19; 95% CI, 1.03-1.37). Elevated levels of triglycerides and LDL-C were not associated with breast cancer-specific mortality. High fasting glucose and low HDL-C evaluated over time after cancer diagnosis were associated with higher breast cancer mortality independent of cancer treatments and changes in other metabolic risk factors. Future studies should address whether pharmacologic or lifestyle treatment of glucose and lipids after breast cancer diagnosis can optimize survival outcomes. The online version contains supplementary material available at 10.1186/s12885-022-10430-9.
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