Cleveland Rebecca J, Eng Sybil M, Abrahamson Page E, Britton Julie A, Teitelbaum Susan L, Neugut Alfred I, Gammon Marilie D
Department of Epidemiology, University of North Carolina, CB 7435 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435, USA.
Cancer Epidemiol Biomarkers Prev. 2007 Sep;16(9):1803-11. doi: 10.1158/1055-9965.EPI-06-0889.
To examine the effects of prediagnostic obesity and weight gain throughout the life course on survival after a breast cancer diagnosis, we conducted a follow-up study among a population-based sample of women diagnosed with first, primary invasive, and in situ breast cancer between 1996 and 1997 (n = 1,508).
In-person interviews were conducted shortly after diagnosis to obtain information on height and weight at each decade of life from age 20 years until 1 year before diagnosis. Patients were followed to determine all-cause (n = 196) and breast cancer-specific (n = 127) mortality through December 31, 2002.
In multivariate Cox proportional hazards models, obese women had increased mortality due to breast cancer compared with ideal weight women among those who were premenopausal at diagnosis [hazard ratio (HR), 2.85; 95% confidence interval (95% CI), 1.30-6.23] and postmenopausal at diagnosis (HR, 1.91; 95% CI, 1.06-3.46). Among women diagnosed with premenopausal breast cancer, those who gained >16 kg between age 20 years and 1 year before diagnosis, compared with those whose weight remained stable (+/-3 kg), had more than a 2-fold elevation in all-cause (HR, 2.45; 95% CI, 0.96-6.27) and breast cancer-specific mortality (HR, 2.09; 95% CI, 0.80-5.48). Women diagnosed with postmenopausal breast cancer who gained more than 12.7 kg after age of 50 years up to the year before diagnosis had a 2- to 3-fold increased risk of death due to all-causes (HR, 2.69; 95% CI, 1.63-4.43) and breast cancer (HR, 2.95; 95% CI, 1.36-6.43).
These results indicate that high levels of prediagnostic weight and substantial weight gain throughout life can decrease survival in premenopausal and postmenopausal breast cancer patients.
为研究诊断前肥胖及一生中体重增加对乳腺癌诊断后生存情况的影响，我们对1996年至1997年间确诊为原发性浸润性和原位乳腺癌的1508名女性进行了一项基于人群的随访研究。
诊断后不久进行面对面访谈，以获取从20岁到诊断前1年每个十年的身高和体重信息。对患者进行随访，以确定截至2002年12月31日的全因死亡（196例）和乳腺癌特异性死亡（127例）情况。
在多变量Cox比例风险模型中，诊断时处于绝经前的肥胖女性与理想体重女性相比，因乳腺癌导致的死亡率更高[风险比（HR）为2.85；95%置信区间（95%CI）为1.30 - 6.23]，诊断时处于绝经后的肥胖女性也是如此（HR为1.91；95%CI为1.06 - 3.46）。在诊断为绝经前乳腺癌的女性中，20岁至诊断前1年体重增加超过16千克的女性与体重保持稳定（±3千克）的女性相比，全因死亡率（HR为2.45；95%CI为0.96 - 6.27）和乳腺癌特异性死亡率（HR为2.09；95%CI为0.80 - 5.48）升高超过2倍。诊断为绝经后乳腺癌且50岁后至诊断前1年体重增加超过12.7千克的女性，全因死亡（HR为2.69；95%CI为1.63 - 4.43）和乳腺癌死亡（HR为2.95；95%CI为1.36 - 6.43）风险增加2至3倍。
这些结果表明，诊断前的高体重水平以及一生中的大量体重增加会降低绝经前和绝经后乳腺癌患者的生存率。
