Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
Ann Surg Oncol. 2012 Sep;19(9):3012-8. doi: 10.1245/s10434-012-2320-8. Epub 2012 Mar 27.
Obesity has been linked to many adverse health consequences, including breast cancer; however, the impact on clinical presentation, tumor characteristics, and survival outcomes has yet to be clearly defined.
Retrospective review of a prospectively collected database of patients treated at a single institution for invasive breast cancer from 2000-2008 comparing two groups: nonobese (body mass index of <30) and obese (body mass index of ≥ 30) patients. Continuous variables, categorical variables, and survival data were analyzed.
Of 1352 total patients, 76% were classified as nonobese and 24% were obese. When comparing age, obese patients presented less frequently than nonobese patients <50 years old (10% vs. 90%), and when comparing patients >50 years old (18% vs. 82%, P = 0.0019). Obese patients were more likely to present with disease detected by imaging when compared to nonobese patients (67% vs. 56%, P = 0.0006). Obese patients had larger tumors (1.7 cm vs. 1.4 cm, P < 0.001) and higher rates of lymph node (LN) metastases (31% vs. 25%, P = 0.026). On multivariate analysis, obesity was associated with nonpalpable tumors, larger tumors, a higher incidence of LN metastasis, lower incidence of Her2 positivity, lower incidence of multifocality, and less likely to undergo reconstruction after mastectomy.
Obese patients clinically present at older ages with mammographically detected breast cancer at more advanced stages than nonobese patients. Strategies to encourage screening among the obese patient population are important.
肥胖与许多不良健康后果有关，包括乳腺癌；然而，其对临床表现、肿瘤特征和生存结果的影响尚未明确界定。
回顾性分析了 2000 年至 2008 年在一家机构接受浸润性乳腺癌治疗的患者的前瞻性收集数据库，比较了两组患者：非肥胖组（体重指数<30）和肥胖组（体重指数≥30）。分析了连续变量、分类变量和生存数据。
在 1352 例总患者中，76%被归类为非肥胖患者，24%为肥胖患者。比较<50 岁的患者时，肥胖患者比非肥胖患者较少出现（10%比 90%，P=0.0019）；比较>50 岁的患者时，肥胖患者比非肥胖患者更有可能通过影像学发现疾病（67%比 56%，P=0.0006）。与非肥胖患者相比，肥胖患者的肿瘤更大（1.7 厘米比 1.4 厘米，P<0.001），淋巴结（LN）转移的发生率更高（31%比 25%，P=0.026）。多变量分析显示，肥胖与不可触及的肿瘤、更大的肿瘤、更高的 LN 转移发生率、更低的 Her2 阳性率、更低的多灶性发生率以及乳房切除术后重建的可能性较低相关。
肥胖患者的临床表现年龄较大，且通过乳房 X 线照相术发现的乳腺癌比非肥胖患者更处于晚期。鼓励肥胖患者进行筛查的策略非常重要。
