Dawood Shaheenah, Broglio Kristine, Gonzalez-Angulo Ana M, Kau Shu-Wan, Islam Rabiul, Hortobagyi Gabriel N, Cristofanilli Massimo
Department of Breast Medical Oncology, Division of Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Clin Cancer Res. 2008 Mar 15;14(6):1718-25. doi: 10.1158/1078-0432.CCR-07-1479.
The purpose of this retrospective study was to determine the association and prognostic value of body mass index (BMI) at the time of initial diagnosis in patients with locally advanced breast cancer (LABC). The analysis includes the subsets of inflammatory (IBC) and noninflammatory (non-IBC LABC) breast cancer.
We identified 602 patients who had LABC treated on prospective clinical trials. BMI was divided into three groups: (a) < or =24.9 (normal/underweight), (b) 25.0 to 29.9 (overweight), and (c) > or =30 (obese). Kaplan-Meier product limit method was used to estimate survival outcomes. Cox proportional hazards were used to determine associations between survival and BMI and to test for an interaction between BMI and breast cancer type.
Eighty-two percent had non-IBC LABC and 18% had IBC. Obese patients tended to have a higher incidence of IBC compared with overweight and normal/underweight groups (P = 0.01). Median follow up was 6 years for all patients. Median overall survival (OS) and recurrence-free survival (RFS) were 8.8 and 5.9 years, respectively. Patients with LABC who were obese or overweight had a significantly worse OS and RFS (P = 0.001) and a higher incidence of visceral recurrence compared with normal/underweight patients. In a multivariable model, BMI remained significantly associated with both OS and RFS for the entire cohort. The interactions between BMI and LABC subsets and between BMI and menopausal status were not statistically significant.
Patients with LABC and high BMI have a worse prognosis. Evaluation of the biological factors associated with this observation can provide tools for additional therapeutic interventions.
本回顾性研究旨在确定局部晚期乳腺癌（LABC）患者初始诊断时体重指数（BMI）的相关性及预后价值。分析包括炎性乳腺癌（IBC）和非炎性乳腺癌（非IBC LABC）亚组。
我们纳入了602例接受前瞻性临床试验治疗的LABC患者。BMI分为三组：（a）≤24.9（正常/体重过轻），（b）25.0至29.9（超重），（c）≥30（肥胖）。采用Kaplan-Meier乘积限法估计生存结局。使用Cox比例风险模型确定生存与BMI之间的关联，并检验BMI与乳腺癌类型之间的相互作用。
82%为非IBC LABC患者，18%为IBC患者。与超重及正常/体重过轻组相比，肥胖患者IBC的发生率更高（P = 0.01）。所有患者的中位随访时间为6年。中位总生存期（OS）和无复发生存期（RFS）分别为8.8年和5.9年。与正常/体重过轻的患者相比，肥胖或超重的LABC患者OS和RFS显著更差（P = 0.001），内脏复发的发生率更高。在多变量模型中，BMI与整个队列的OS和RFS均保持显著关联。BMI与LABC亚组之间以及BMI与绝经状态之间的相互作用无统计学意义。
LABC且BMI高的患者预后较差。对与该观察结果相关的生物学因素进行评估可为额外的治疗干预提供工具。
