Lester and Sue Smith Breast Center, Department of Medicine, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston; Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston.
Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston; James P. Wilmot Cancer Center, Department of Medicine, University of Rochester, Rochester.
Ann Oncol. 2013 Oct;24(10):2506-2514. doi: 10.1093/annonc/mdt224. Epub 2013 Jun 21.
To determine the relationship between obesity, diabetes, and survival in a large cohort of breast cancer patients receiving modern chemotherapy and endocrine therapy.
We identified 6342 patients with stage I-III breast cancer treated between 1996 and 2005. Patients were evaluated according to body mass index (BMI) category and diabetes status.
In a multivariate model adjusted for body mass index, diabetes, medical comorbidities, patient- and tumor-related variables, and adjuvant therapies, relative to the normal weight, hazard ratios (HRs) for recurrence-free survival (RFS), overall survival (OS), and breast cancer-specific survival (BCSS) for the overweight were 1.18 [95% confidence interval (CI) 1.02-1.36], 1.20 (95% CI 1.00-1.42), and 1.21 (95% CI 0.98-1.48), respectively. HRs for RFS, OS, and BCSS for the obese were 1.13 (95% CI 0.98-1.31), 1.24 (95% CI 1.04-1.48), and 1.23 (95% CI 1.00-1.52), respectively. Subset analyses showed these differences were significant for the ER-positive, but not ER-negative or HER2-positive, groups. Relative to nondiabetics, HRs for diabetics for RFS, OS, and BCSS were 1.21 (95% CI 0.98-1.49), 1.39 (95% CI 1.10-1.77), and 1.04 (95% CI 0.75-1.45), respectively.
In patients receiving modern adjuvant therapies, obesity has a negative impact on RFS, OS, and BCSS; and diabetes has a negative impact on RFS and OS. Control of both may be important to improving survival in obese and diabetic breast cancer patients.
在接受现代化疗和内分泌治疗的大量乳腺癌患者中，确定肥胖、糖尿病与生存之间的关系。
我们确定了 1996 年至 2005 年间接受治疗的 I-III 期乳腺癌患者 6342 例。根据体重指数（BMI）类别和糖尿病状态对患者进行评估。
在调整 BMI、糖尿病、合并症、患者和肿瘤相关变量以及辅助治疗的多变量模型中，与正常体重相比，超重患者的无复发生存率（RFS）、总生存率（OS）和乳腺癌特异性生存率（BCSS）的风险比（HR）分别为 1.18（95%置信区间[CI] 1.02-1.36）、1.20（95%CI 1.00-1.42）和 1.21（95%CI 0.98-1.48）。肥胖患者的 RFS、OS 和 BCSS 的 HR 分别为 1.13（95%CI 0.98-1.31）、1.24（95%CI 1.04-1.48）和 1.23（95%CI 1.00-1.52）。亚组分析显示，这些差异在 ER 阳性组而不是 ER 阴性或 HER2 阳性组中具有统计学意义。与非糖尿病患者相比，糖尿病患者的 RFS、OS 和 BCSS 的 HR 分别为 1.21（95%CI 0.98-1.49）、1.39（95%CI 1.10-1.77）和 1.04（95%CI 0.75-1.45）。
在接受现代辅助治疗的患者中，肥胖对 RFS、OS 和 BCSS 有负面影响；糖尿病对 RFS 和 OS 有负面影响。控制这两者可能对改善肥胖和糖尿病乳腺癌患者的生存至关重要。
