Obesity and outcomes in premenopausal and postmenopausal breast cancer
Obesity and outcomes in premenopausal and postmenopausal breast cancer
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DOI：
10.1158/1055-9965.epi-05-0042
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发表时间：
2005-07-01
影响因子：
3.8
通讯作者：
Phillips, KA
中科院分区：
文献类型：
--
作者：
Loi, S;Milne, RL;Phillips, KA
目的：肥胖与绝经后乳腺癌妇女的不良结局相关。在绝经前women.Methods，协会是不太清楚：一个基于人口的样本1,360名澳大利亚妇女乳腺癌的年龄在60岁之前，47%的诊断年龄在40岁之前，和74%的绝经前，进行了前瞻性研究，中位数为5年（范围，0.2-10.8年）。肥胖定义为体重指数>= 30 kg/m2。使用考克斯比例风险生存模型估计与肥胖相关的不良临床结局的风险比（HR）。肥胖随着年龄的增长而增加（P < 0.001），并与乳腺癌复发率增加相关（P = 0.02）和死亡（P = 0.06），较大的肿瘤（P = 0.002），腋窝淋巴结受累较多（P = 0.003），但与激素受体状态（P >= 0.6）或第一周期辅助化疗剂量减少（P = 0.1）无关。校正腋窝淋巴结数量、诊断时年龄、肿瘤大小、分级和激素受体状态后，所有年龄段的肥胖女性比非肥胖女性更有可能发生疾病复发[HR，1.57; 95%置信区间（95%CI），1.11-2.22; P = 0.021]，并在随访期间死于任何原因（HR，1.56; 95% CI，1.01-2.40; P = 0.05）。在绝经前妇女中，校正HR为1.50（95% CI，1.00-2.26; P = 0.06）和1.71（95%CI，1.05-2.77; P = 0-.04）。肥胖与绝经前妇女的不良结局独立相关，绝经后妇女也是如此，这不能完全用肿瘤大小或淋巴结状态的差异来解释。鉴于肥胖在西方国家的高发病率和不断增长的发病率，有必要对改善肥胖乳腺癌患者的治疗进行更多的研究。
Purpose: Obesity is associated with adverse outcomes in postmenopausal women with breast cancer. In premenopausal women, the association is less clear.Methods: A population-based sample of 1,360 Australian women with breast cancer before the age of 60 years, 47% diagnosed before age 40, and 74% premenopausal, was studied prospectively for a median of 5 years (range, 0.2-10.8 years). Obesity was defined as a body mass index of >= 30 kg/m(2). The hazard ratio (HR) for adverse clinical outcome associated with obesity was estimated using Cox proportional hazard survival models.Results: Obesity increased with age (P < 0.001) and was associated with increased breast cancer recurrence (P = 0.02) and death (P = 0.06), larger tumors (P = 0.002), and more involved axillary nodes (P = 0.003) but not with hormone receptor status (P >= 0.6) or with first cycle adjuvant chemotherapy dose reductions (P = 0.1). Adjusting for number of axillary nodes, age at diagnosis, tumor size, grade, and hormone receptor status, obese women of all ages were more likely than nonobese women to have disease recurrence [HR, 1.57; 95% confidence interval (95% CI), 1.11-2.22; P = 0.021 and to die from any cause during follow-up (HR, 1.56; 95% CI, 1.01-2.40; P = 0.05). In premenopausal women, the adjusted HRs were 1.50 (95% Cl, 1.00-2.26; P = 0.06) and 1.71 (95% CI, 1.05-2.77; P = 0-.04), respectively.Conclusions: Obesity is independently associated with poorer outcomes in premenopausal women, as it is in postmenopausal women, and this is not entirely explained by differences in tumor size or nodal status. Given the high and increasing prevalence of obesity in western countries, more research on improving the treatment of obese breast cancer patients is warranted.