WEIGHT LOSS IN OBESE BREAST CANCER SURVIVORS

肥胖已被证明与乳腺癌患者的不良预后相关。肥胖程度越高，生存时间越短，复发率越高。减肥是否会对肥胖乳腺癌幸存者的预后产生有利影响尚不清楚，这是我们想问的最终问题。作为第一步，需要在这一人群中建立有效的减肥方法。我们利用内部资金启动了一项试点研究，为肥胖乳腺癌幸存者开发一种个性化的减肥方法，初步数据令人鼓舞。我们希望能够将这项研究延长整整 18 个月，并分析所收集的血液样本中的癌症风险标记。已有 48 名肥胖癌症幸存者入组。在基线时，对每位女性进行了精神病学评估，并进行了有关饮食、健康、运动和心理社会因素的调查问卷。由于我们要求女性大幅改变生活方式，因此我们希望将干预措施延长一整年（而不是 6 个月），并增加 6 个月的随访时间来检查减肥的维持情况。 更好地了解行为因素对减肥的影响应该有助于我们设计一项以复发为终点的成功的大型研究。作为次要目标，我们建议分析收集的血液样本中预计会受到体重减轻影响的癌症风险标记物：氧化 DNA 损伤、胰岛素样生长因子 1 (IGF-1) 和 IGF 结合蛋白 3。这些标记物的变化程度将与已知受体重减轻影响的其他血浆指标进行比较：瘦素、葡萄糖、血脂和甘油三酯水平。这项研究应该有助于确定某些社会心理与体重减轻的程度相关，进而确定体重减轻是否与选定的乳腺癌风险标志物的变化相关。

Obesity has been shown to be associated with a poor prognosis in breast cancer patients. Survival time is decreased and recurrence rates are increased with greater obesity. Whether or not weight loss can have favorable effects on prognosis in obese breast cancer survivors is not known, and that is the ultimate question we would like to ask. As a first step, effective methods for weight loss need to be established in this population. We started a pilot study with internal funds develop an individualized approach towards weight loss in obese breast cancer survivors, and preliminary data is encouraging. We would like to be able to extend this study for a full 18 months and analyze the blood samples that are being collected for markers of cancer risk. Forty eight obese cancer survivors have been enrolled. At baseline, a psychiatric evaluation was obtained for each women and questionnaires on diet, health, exercise and psychosocial factors were administered. Since we are asking women to make large lifestyle changes, we would like to extend the intervention for a full year (instead of 6 months) and add a 6-month follow-up point to examine maintenance of weight loss. A better understanding of the influence of behavioral factors on weight loss should help us design a successful larger study with recurrence as the endpoint. As a secondary aim, we propose to analyze the blood samples collected for markers of cancer risk which are expected to be affected by weight loss: oxidative DNA damage, insulin-like growth factor 1 (IGF-1), and IGF-binding protein 3. The extent of changes in these markers will be compared with other plasma measures that are known to be affected by weight loss: leptin, glucose, lipids and triglyceride levels. This study should be useful to determine certain psychosocial are associated with extent of weight loss, and in turn whether weight loss is associated with changes in selected markers of breast cancer risk.