Rosenberg L, Czene K, Hall P
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, SE-171 77, Stockholm, Sweden.
Br J Cancer. 2009 May 5;100(9):1486-91. doi: 10.1038/sj.bjc.6605025. Epub 2009 Apr 14.
High body mass index (BMI) and use of hormone replacement therapy (HRT) increase the risk of postmenopausal breast cancer. It has been shown that BMI modifies the effect of HRT, as its influence is most pronounced in lean women. We investigated the influence of BMI and HRT on prognosis in 2640 postmenopausal women diagnosed with breast cancer in Sweden in 1993-1995, taking into account HRT and mammography before diagnosis. Logistic and Cox regression were used. In non-users of HRT, obese women (BMI >30) compared with normal weight women (BMI <25) had a similar prognosis (hazard ratio (HR) 1.1, 95% confidence interval (CI) 0.8-1.6), despite larger tumours found in obese women. Obese HRT users had less favourable tumour characteristics and poorer prognosis compared with normal weight women (HR 3.7, 95% CI 1.9-7.2). The influence of BMI on breast cancer prognosis was similar whether diagnosed by mammographic screening or not. We found a similar prognosis of postmenopausal breast cancer-specific death regardless of BMI in non-users of HRT, but among HRT users obesity was associated with a poorer breast cancer prognosis.
高体重指数（BMI）和使用激素替代疗法（HRT）会增加绝经后乳腺癌的风险。研究表明，BMI会改变HRT的效果，因为其影响在瘦女性中最为明显。我们调查了BMI和HRT对1993 - 1995年在瑞典诊断为乳腺癌的2640名绝经后女性预后的影响，同时考虑了诊断前的HRT和乳房X线摄影情况。使用了逻辑回归和Cox回归。在未使用HRT的女性中，肥胖女性（BMI>30）与正常体重女性（BMI<25）相比，预后相似（风险比（HR）为1.1，95%置信区间（CI）为0.8 - 1.6），尽管肥胖女性的肿瘤更大。与正常体重女性相比，肥胖的HRT使用者肿瘤特征较差，预后也较差（HR为3.7，95%CI为1.9 - 7.2）。无论是否通过乳房X线摄影筛查诊断，BMI对乳腺癌预后的影响相似。我们发现，在未使用HRT的女性中，无论BMI如何，绝经后乳腺癌特异性死亡的预后相似，但在HRT使用者中，肥胖与较差的乳腺癌预后相关。
