UCLA Schools of Public Health and Medicine, Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-6900, USA.
Breast Cancer Res Treat. 2011 Sep;129(2):549-56. doi: 10.1007/s10549-011-1505-3. Epub 2011 Apr 11.
There is increasing interest in the relationship between host lifestyle factors and the outcomes of cancer treatment. Behavioral factors, comorbid conditions, and non-cancer-related pharmaceutical exposures may affect breast cancer (BC) outcomes. We used observational data from the LACE Study cohort (women with early stage BC from the Kaiser Permanente Northern California Cancer Registry) to examine the association between beta blockers (BBs) and/or angiotensin-converting enzyme inhibitors (ACEi) and BC recurrence, BC-specific mortality, and overall mortality. Among 1,779 women, there were 292 BC recurrences, 174 BC deaths, and 323 total deaths. 23% were exposed to either a BB and/or an ACEi. These drugs were associated with older age, postmenopausal status, tamoxifen therapy, greater pre-diagnosis BMI, hypertension, and diabetes. In Cox proportional hazards models, ACEi exposure was associated with BC recurrence (HR 1.56, 95% CI 1.02, 2.39, P = 0.04), but not cause-specific or overall mortality. Combined ACEi and BB were associated with overall mortality (HR 1.94, 95% CI 1.22, 3.10, P = 0.01). BB exposure was associated with lower hazard of recurrence and cause-specific mortality. However, there was no evidence of a dose response with either medication. For recurrence and cause-specific mortality, BB combined with ACEi was associated with a lower HR for the outcome than when ACEi alone was used. These hypothesis generating findings suggest that BC recurrence and survival were associated with exposure to two commonly used classes of anti-hypertensive medications. These observations need to be confirmed and suggest that greater attention should focus on the potential role of these commonly used medications in BC outcomes.
人们越来越关注宿主生活方式因素与癌症治疗结果之间的关系。行为因素、合并症和与癌症无关的药物暴露可能会影响乳腺癌（BC）的结果。我们使用来自 LACE 研究队列的观察性数据（来自 Kaiser Permanente 北加州癌症登记处的早期 BC 女性），研究β受体阻滞剂（BBs）和/或血管紧张素转换酶抑制剂（ACEi）与 BC 复发、BC 特异性死亡率和总死亡率之间的关系。在 1779 名女性中，有 292 例 BC 复发，174 例 BC 死亡，323 例总死亡。23%的人暴露于 BB 和/或 ACEi 中。这些药物与年龄较大、绝经后状态、他莫昔芬治疗、更大的诊断前 BMI、高血压和糖尿病有关。在 Cox 比例风险模型中，ACEi 暴露与 BC 复发相关（HR 1.56，95%CI 1.02，2.39，P=0.04），但与特定原因或总死亡率无关。ACEi 和 BB 的联合使用与总死亡率相关（HR 1.94，95%CI 1.22，3.10，P=0.01）。BB 暴露与复发和特定原因死亡率的风险降低相关。然而，两种药物都没有剂量反应的证据。对于复发和特定原因的死亡率，BB 联合 ACEi 与 ACEi 单独使用相比，与结果相关的 HR 更低。这些假设生成的发现表明，BC 复发和生存与两种常用的抗高血压药物类别的暴露有关。这些观察结果需要得到证实，并表明应该更加关注这些常用药物在 BC 结果中的潜在作用。
