Dignam James J, Wieand Kelly, Johnson Karen A, Raich Peter, Anderson Stewart J, Somkin Carol, Wickerham D Lawrence
Department of Health Studies, The University of Chicago, Chicago, IL 60637, USA.
Breast Cancer Res Treat. 2006 Jun;97(3):245-54. doi: 10.1007/s10549-005-9118-3. Epub 2005 Dec 6.
Several factors may contribute to poorer prognosis for obese breast cancer patients, including unfavorable disease features, the influence of fat on estrogen availability, co-morbidity, and socio-demographic factors. Both obesity and estrogen receptor negative (ER-) tumors are more prevalent in black women than in whites in North America. We evaluated obesity and race in relation to outcomes in women with ER-breast cancer.
Among 4,077 women from National Surgical Adjuvant Breast and Bowel Project clinical trials for node-negative, ER-breast cancer, we evaluated disease-free survival (DFS) and its constituents (tumor recurrence, contralateral breast cancer (CBC), second primary cancers, deaths prior to these events) and mortality in relation to body mass index (BMI) and race, using statistical modeling to account for other prognostic factors.
Compared to those of normal weight (BMI< or =24.9), DFS hazard was greater for obese (BMI > or = 30) women [hazard ratio (HR)=1.16, 95% confidence interval (CI)=1.01-1.33]. Obesity did not increase recurrence hazard, but did influence CBC (HR=2.08, 95% CI=1.22-3.55 in postmenopausal women) and second cancers (HR=1.49, 95% CI=1.06-2.10). Mortality increased with obesity; when partitioned by likely cause, those with BMI > or = 35.0 had greater risk of non-breast cancer mortality (HR=1.86, 95% CI=1.21-2.84). Relative to whites and adjusted for BMI, black women had greater hazard for DFS (HR=1.17, 95% CI=1.00-1.38), CBC (HR=1.37, 95% CI=0.94-1.99), and non-breast cancer deaths (HR=2.10, 95% CI=1.45-3.03); risk for deaths likely due to breast cancer was closer to that in whites (HR=1.18; 95% CI=0.93-1.50).
For women with node-negative, ER-breast cancer from clinical trials, obesity did not increase recurrence risk, but was associated with greater risk for second cancers, CBC, and mortality, particularly non-breast cancer deaths. Less favorable prognosis for black women persists in clinical trials, and is in part attributable to non-breast cancer outcomes.
肥胖乳腺癌患者预后较差可能由多种因素导致，包括不良疾病特征、脂肪对雌激素可利用性的影响、合并症以及社会人口学因素。在北美，肥胖和雌激素受体阴性（ER-）肿瘤在黑人女性中比在白人女性中更为普遍。我们评估了肥胖和种族与ER-乳腺癌女性患者预后的关系。
在国家外科辅助乳腺和肠道项目针对淋巴结阴性、ER-乳腺癌的临床试验的4077名女性中，我们评估了无病生存期（DFS）及其组成部分（肿瘤复发、对侧乳腺癌（CBC）、第二原发性癌症、这些事件之前的死亡）以及与体重指数（BMI）和种族相关的死亡率，使用统计模型来考虑其他预后因素。
与体重正常（BMI≤24.9）的女性相比，肥胖（BMI≥30）女性的DFS风险更高[风险比（HR）=1.16，95%置信区间（CI）=1.01 - 1.33]。肥胖并未增加复发风险，但确实影响CBC（绝经后女性中HR=2.08，95%CI=1.22 - 3.55）和第二原发性癌症（HR=1.49，95%CI=1.06 - 2.10）。死亡率随肥胖增加；按可能的病因划分，BMI≥35.0的女性非乳腺癌死亡风险更高（HR=1.86，95%CI=1.21 - 2.84）。相对于白人并根据BMI进行调整后，黑人女性的DFS风险更高（HR=1.17，95%CI=1.00 - 1.38）、CBC风险更高（HR=1.37，95%CI=0.94 - 1.99）以及非乳腺癌死亡风险更高（HR=2.10，95%CI=1.45 - 3.03）；可能因乳腺癌导致的死亡风险与白人更接近（HR=1.18；95%CI=0.93 - 1.50）。
对于来自临床试验的淋巴结阴性、ER-乳腺癌女性患者，肥胖并未增加复发风险，但与第二原发性癌症、CBC和死亡率的更高风险相关，尤其是非乳腺癌死亡。在临床试验中，黑人女性较差的预后仍然存在，部分原因是非乳腺癌结局。
