Chlebowski R T, Rose D, Buzzard I M, Blackburn G L, Insull W, Grosvenor M, Elashoff R, Wynder E L
UCLA School of Medicine, Torrance 90509.
Breast Cancer Res Treat. 1992 Jan;20(2):73-84. doi: 10.1007/BF01834637.
Management of localized breast cancer now commonly involves a breast-sparing approach combined with systemic adjuvant therapy resulting in improved cosmetic results and patient survival. Reducing dietary fat intake represents a conceptually new approach to further improve outcome of patients with resected breast cancer. The rationale supporting evaluation of dietary fat reduction in the management of patients with localized breast cancer is based on: (1) epidemiologic observations (along with biochemical and hormonal correlates) of major differences in stage-by-stage survival of patients with localized breast cancer comparing outcome in countries with low fat (Japan) versus high fat (U.S.A.) dietary intakes; (2) relationships between dietary fat intake and factors prognostic of clinical outcome in patients with established breast cancer; (3) effects of weight gain (especially that associated with adjuvant chemotherapy) on breast cancer clinical outcome; (4) in vivo animal studies demonstrating adverse influence of increased dietary fat intake (especially linoleic acid) on growth and metastatic spread of mammary cancer; (5) direct adverse effects of increased linoleic acid on human breast cancer growth in vitro; (6) plausible mechanisms which could mediate the effects of dietary fat intake reduction on breast cancer growth and metastatic spread; (7) demonstration of adherence to dietary fat reduction regimens in ongoing clinical feasibility studies including those involving postmenopausal patients with resected breast cancer; and (8) favorable sample size requirements for definitive assessment of dietary fat intake reduction influence on breast cancer growth and metastases (using as endpoints relapse-free survival and overall survival) in postmenopausal breast cancer patients with localized disease.
目前，局部乳腺癌的治疗通常采用保乳方法并结合全身辅助治疗，从而改善了美容效果并提高了患者生存率。减少饮食中的脂肪摄入量是一种从概念上来说全新的方法，旨在进一步改善接受乳腺癌切除术患者的治疗效果。支持在局部乳腺癌患者管理中评估减少饮食脂肪摄入量的理论依据基于以下几点：（1）流行病学观察结果（以及生化和激素相关性），即比较低脂饮食国家（日本）和高脂饮食国家（美国）局部乳腺癌患者逐阶段生存率的主要差异；（2）饮食脂肪摄入量与已确诊乳腺癌患者临床结局的预后因素之间的关系；（3）体重增加（尤其是与辅助化疗相关的体重增加）对乳腺癌临床结局的影响；（4）体内动物研究表明，饮食脂肪摄入量增加（尤其是亚油酸）对乳腺癌生长和转移扩散具有不利影响；（5）亚油酸增加对体外人乳腺癌生长的直接不利影响；（6）可能介导减少饮食脂肪摄入量对乳腺癌生长和转移扩散影响的合理机制；（7）在正在进行的临床可行性研究中，包括对绝经后接受乳腺癌切除术的患者进行的研究，证明了对减少饮食脂肪摄入量方案的依从性；（8）对于明确评估减少饮食脂肪摄入量对局部疾病绝经后乳腺癌患者乳腺癌生长和转移的影响（以无复发生存期和总生存期为终点）所需的合适样本量。
