Department of Mathematics and Computer Science, University Bremen, Universitätsallee/GW1, 28359, Bremen, Germany.
Breast Cancer Res Treat. 2012 Feb;131(3):925-31. doi: 10.1007/s10549-011-1874-7. Epub 2011 Nov 13.
Obesity, defined as a body mass index (BMI) ≥30 is an independent risk factor in breast cancer and is correlated with shorter survival and enhanced recurrence rates. The present subgroup analysis of the German BRENDA-cohort aimed to investigate the correlation between BMI, recurrence-free survival (RFS) and adjuvant endocrine therapy. In this subgroup analysis, 4,636 patients were retrospectively examined using multivariate analyses. Overall 3,759 (81.1%) patients had a BMI <30 (non-obese) and 877 (18.9%) a BMI ≥30 (obese). In the group of all 3,896 (84.0%) patients with hormone-receptor-positive (HR+) breast carcinomas a significant reduction in RFS was demonstrated for those who were obese (P = 0.002; HR = 1.45 (95% CI: 1.15-1.83)), also after adjustment for Nottingham Prognostic Index (NPI) (P = 0.028; HR = 1.30 (95% CI: 1.03-1.65)). In hormone-receptor-negative (HR-) patients BMI had no influence on RFS (P = 0.380; HR = 1.20 (95% CI: 0.80-1.81)). Considering menopausal status, a significantly shorter RFS was seen in postmenopausal obese than in non-obese patients (P < 0.001; HR = 1.61 (95% CI: 1.24-2.09)), whereas the premenopausal patient group only showed a trend towards a shorter RFS (P = 0.202; HR = 1.44 (95% CI: 0.82-2.53)). The group of HR+ postmenopausal patients with normal or intermediate weight showed a non-significant statistical trend towards a survival benefit for aromatase inhibitors (AI) compared to tamoxifen (RFS: P = 0.486; HR = 1.29 (95% CI: 0.63-2.62), while obese patients tended to benefit more from tamoxifen (RFS: P = 0.289; HR = 0.65 (95% CI: 0.29-1.45)). In accordance with recently published results we demonstrated a negative effect of a high BMI on outcome in primary breast cancer. Furthermore the efficacy of AI seems dependent on BMI in contrast to tamoxifen. Prospective studies to optimise the therapy of obese breast cancer patients are urgently needed.
肥胖定义为身体质量指数（BMI）≥30，是乳腺癌的一个独立危险因素，与较短的生存时间和更高的复发率相关。德国 BRENDA 队列的本次亚组分析旨在研究 BMI、无复发生存（RFS）和辅助内分泌治疗之间的相关性。在本亚组分析中，对 4636 名患者进行了回顾性多变量分析。总体而言，3759 名（81.1%）患者 BMI<30（非肥胖），877 名（18.9%）患者 BMI≥30（肥胖）。在所有 3896 名（84.0%）激素受体阳性（HR+）乳腺癌患者中，肥胖患者的 RFS 显著降低（P=0.002；HR=1.45（95%CI：1.15-1.83）），即使在调整诺丁汉预后指数（NPI）后也是如此（P=0.028；HR=1.30（95%CI：1.03-1.65））。在激素受体阴性（HR-）患者中，BMI 对 RFS 无影响（P=0.380；HR=1.20（95%CI：0.80-1.81））。考虑到绝经状态，绝经后肥胖患者的 RFS 明显短于非肥胖患者（P<0.001；HR=1.61（95%CI：1.24-2.09）），而绝经前患者组仅显示 RFS 较短的趋势（P=0.202；HR=1.44（95%CI：0.82-2.53））。在 HR+绝经后体重正常或中等的患者中，与他莫昔芬相比，芳香化酶抑制剂（AI）显示出生存获益的非显著统计学趋势（RFS：P=0.486；HR=1.29（95%CI：0.63-2.62）），而肥胖患者似乎从他莫昔芬中获益更多（RFS：P=0.289；HR=0.65（95%CI：0.29-1.45））。与最近发表的结果一致，我们证明了高 BMI 对原发性乳腺癌结局的负面影响。此外，与他莫昔芬相比，AI 的疗效似乎取决于 BMI。迫切需要前瞻性研究来优化肥胖乳腺癌患者的治疗。
