Borugian Marilyn J, Sheps Samuel B, Kim-Sing Charmaine, Olivotto Ivo A, Van Patten Cheri, Dunn Bruce P, Coldman Andrew J, Potter John D, Gallagher Richard P, Hislop T Gregory
Cancer Control Research Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
Am J Epidemiol. 2003 Nov 15;158(10):963-8. doi: 10.1093/aje/kwg236.
High insulin levels have been associated with increased risk of breast cancer and poorer survival after a breast cancer diagnosis. Waist-to-hip ratio (WHR) is a marker for insulin resistance and hyperinsulinemia. In this study, the authors tested the hypothesis that elevated WHR is directly related to breast cancer mortality. For identification of modifiable factors affecting survival, data were collected on 603 patients with incident breast cancer who visited the Vancouver Cancer Centre of the British Columbia Cancer Agency (Vancouver, British Columbia, Canada) in 1991-1992, including body measurements and information on demographic, medical, reproductive, and dietary factors. These patients were followed for up to 10 years. Cox proportional hazards regression models were used to relate the variables to breast cancer mortality (n = 112). After adjustment for age, body mass index, family history, estrogen receptor (ER) status, tumor stage at diagnosis, and systemic treatment (chemotherapy or tamoxifen), WHR was directly related to breast cancer mortality in postmenopausal women (for highest quartile vs. lowest, relative risk = 3.3, 95% confidence interval: 1.1, 10.4) but not in premenopausal women (relative risk = 1.2, 95% confidence interval: 0.4, 3.4). Stratification according to ER status showed that the increased mortality was restricted to ER-positive postmenopausal women. Elevated WHR was confirmed as a predictor of breast cancer mortality, with menopausal status and ER status at diagnosis found to be important modifiers of that relation.
高胰岛素水平与乳腺癌风险增加及乳腺癌诊断后较差的生存率相关。腰臀比（WHR）是胰岛素抵抗和高胰岛素血症的一个指标。在本研究中，作者检验了这样一个假设，即升高的WHR与乳腺癌死亡率直接相关。为了确定影响生存的可改变因素，收集了1991年至1992年期间前往不列颠哥伦比亚癌症机构温哥华癌症中心（加拿大不列颠哥伦比亚省温哥华）就诊的603例新发乳腺癌患者的数据，包括身体测量数据以及人口统计学、医学、生殖和饮食因素方面的信息。对这些患者进行了长达10年的随访。采用Cox比例风险回归模型将变量与乳腺癌死亡率（n = 112）相关联。在调整了年龄、体重指数、家族史、雌激素受体（ER）状态、诊断时的肿瘤分期和全身治疗（化疗或他莫昔芬）后，WHR与绝经后女性的乳腺癌死亡率直接相关（最高四分位数与最低四分位数相比，相对风险 = 3.3，95%置信区间：1.1，10.4），但与绝经前女性无关（相对风险 = 1.2，95%置信区间：0.4，3.4）。根据ER状态分层显示，死亡率增加仅限于ER阳性的绝经后女性。升高的WHR被确认为乳腺癌死亡率的一个预测指标，发现绝经状态和诊断时的ER状态是该关系的重要调节因素。
