Loi Sherene, Milne Roger L, Friedlander Michael L, McCredie Margaret R E, Giles Graham G, Hopper John L, Phillips Kelly-Anne
Peter MacCallum Cancer Centre, 723 Swanston Street, Carlton, Victoria 3053, Australia.
Cancer Epidemiol Biomarkers Prev. 2005 Jul;14(7):1686-91. doi: 10.1158/1055-9965.EPI-05-0042.
Obesity is associated with adverse outcomes in postmenopausal women with breast cancer. In premenopausal women, the association is less clear.
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 > or =30 kg/m2. The hazard ratio (HR) for adverse clinical outcome associated with obesity was estimated using Cox proportional hazard survival models.
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 > or = 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 = 0.02] 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% CI, 1.00-2.26; P = 0.06) and 1.71 (95% CI, 1.05-2.77; P = 0.04), respectively.
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.
肥胖与绝经后乳腺癌女性的不良预后相关。在绝经前女性中，这种关联尚不清楚。
对1360名年龄在60岁以下的澳大利亚乳腺癌女性进行基于人群的抽样研究，其中47%在40岁前被诊断出，74%为绝经前女性，前瞻性研究中位时间为5年（范围0.2 - 10.8年）。肥胖定义为体重指数≥30kg/m²。使用Cox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）。
肥胖随年龄增加（P < 0.001），并与乳腺癌复发增加（P = 0.02）、死亡（P = 0.06）、肿瘤较大（P = 0.002）及腋窝淋巴结受累更多（P = 0.003）相关，但与激素受体状态（P≥0.6）或首个周期辅助化疗剂量减少（P = 0.1）无关。调整腋窝淋巴结数量、诊断时年龄、肿瘤大小、分级和激素受体状态后，各年龄段肥胖女性比非肥胖女性更易出现疾病复发[HR，1.57；95%置信区间（95%CI），1.11 - 2.22；P = 0.02]，且在随访期间死于任何原因的可能性更大（HR，1.56；95%CI，1.01 - 2.40；P = 0.05）。在绝经前女性中，调整后的HR分别为1.50（95%CI，1.00 - 2.26；P = 0.06）和1.71（95%CI，1.05 - 2.77；P = 0.04）。
与绝经后女性一样，肥胖与绝经前女性较差的预后独立相关，且这不能完全由肿瘤大小或淋巴结状态的差异来解释。鉴于西方国家肥胖患病率高且不断上升，有必要对改善肥胖乳腺癌患者的治疗进行更多研究。
