Recurrence dynamics of breast cancer according to baseline body mass index
Recurrence dynamics of breast cancer according to baseline body mass index
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DOI：
10.1016/j.ejca.2017.10.007
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发表时间：
2017-12-01
影响因子：
8.4
通讯作者：
Demicheli, Romano
中科院分区：
文献类型：
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作者：
Biganzoli, Elia;Desmedt, Christine;Demicheli, Romano
背景：在癌症随访中，除了生存概率的评估外，评估复发动态以优化疾病管理也是基本需要。虽然已经描述了肿瘤雌激素受体(ER)状态的时间依赖效应，但到目前为止，还没有任何因素被证明可以解开乳腺癌复发观察到的多峰行为。在这里，我们的目的是调查诊断时的肥胖，反映为患者体重指数(BMI)的增加，是否与乳腺癌初治后随着时间的推移复发模式有关。方法：我们从III期随机临床试验中检索了777名结节阳性乳腺癌患者中的734人的BMI，该试验比较了不同的化疗方案，平均随访时间为15.4年。结果：在ER阴性的乳腺癌患者中，超重和肥胖是导致晚期复发的主要危险因素。在绝经前ER阳性肿瘤患者的亚组中，肥胖与远期复发的早期高峰期和窄峰期相关，随后是5年随访后的另一个主要高峰期。超重患者的风险介于肥胖患者和正常体重患者之间。在雌激素受体阳性肿瘤患者的绝经后亚组中，超重患者的远处复发率明显高于其他BMI类别的患者，并且肥胖患者也观察到第二个晚期复发高峰。结论：这些结果表明患者确诊时的BMI与癌症复发的动态相关。因此，患者肥胖应该是探索晚期辅助治疗方式的核心。(C)2017爱思唯尔有限公司。保留所有权利。
Background: In cancer follow-up, in addition to the evaluation of survival probabilities, there is a fundamental need of assessing recurrence dynamics for optimal disease management. Although the time-dependent effect of the oestrogen receptor (ER) status of the tumour has already been described, so far no factor has proven to disentangle the multi-peak behaviour observed for breast cancer recurrences. Here, we aimed at investigating whether adiposity at diagnosis, reflected by increased patient's body mass index (BMI), could be associated with breast cancer recurrence patterns over time after primary cancer therapy.Methods: We retrieved BMI from 734 of 777 patients with node-positive breast cancer from a phase III randomised clinical trial, which compared different chemotherapy regimens and had a median follow-up of 15.4 years. Cumulative incidence estimation as well as piecewise exponential models were carried out to estimate the distant recurrence dynamics, in all patients, as well as in subgroups based on the ER status, with the ER-positive group being further split according to the menopausal status.Results: In patients with ER-negative breast cancer, time-dependent analyses revealed that the hazard of late relapses could mainly be attributed to the overweight and obese patients. Within the subgroup of premenopausal patients with ER-positive tumours, obesity was associated with an early high narrow peak of distant recurrences followed by another main peak after 5 years of follow-up. The risk for overweight patients was intermediate between obese and normal-weight patients. In the postmenopausal subgroup of patients with ER-positive tumours, the distant recurrence rate was significantly more elevated in the overweight patients compared to the other BMI categories, and a second late peak of recurrences was also observed for the obese patients.Conclusion: These results demonstrate that the patient's BMI at diagnosis is associated with cancer recurrence dynamics. Patient adiposity should therefore be central to the exploration of late adjuvant treatment modalities. (C) 2017 Elsevier Ltd. All rights reserved.