Chen Yuan, Shuji Ogino, Kimmie Ng, Zhi Rong Qian, Douglas A. Rubinson, and Brian M. Wolpin, Dana-Farber Cancer Institute; Ying Bao, Shuji Ogino, Kimmie Ng, Meir J. Stampfer, Edward L. Giovannucci, and Brian M. Wolpin, Brigham and Women's Hospital, Harvard Medical School; and Chen Wu, Peter Kraft, Shuji Ogino, Meir J. Stampfer, and Edward L. Giovannucci, Harvard School of Public Health, Boston, MA.
J Clin Oncol. 2013 Nov 20;31(33):4229-34. doi: 10.1200/JCO.2013.51.7532. Epub 2013 Oct 21.
Although obesity is associated with increased incidence of pancreatic cancer, studies have not prospectively evaluated prediagnostic body mass index (BMI) and survival.
We analyzed survival by prediagnostic BMI assessed in 1986 among 902 patients from two large prospective cohorts diagnosed from 1988 to 2010. We estimated hazard ratios (HRs) for death using Cox proportional hazards models, with adjustment for age, sex, race/ethnicity, smoking, diagnosis year, and stage. We evaluated the temporal association of BMI with survival by grouping reported BMI by 2-year lag-time intervals before diagnosis.
The multivariable-adjusted HR for death was 1.53 (95% CI, 1.11 to 2.09) comparing patients with BMI ≥ 35 kg/m(2) with those with BMI < 25 kg/m(2) (P trend = .001), which was similar after adjustment for stage. The association of BMI with survival was stronger with longer lag times between reported BMI and cancer diagnosis. Among patients with BMI collected 18 to 20 years before diagnosis, HR for death was 2.31 (95% CI, 1.48 to 3.61; P trend < .001), comparing obese with healthy-weight patients. No statistically significant differences were seen by cohort, smoking status, or stage, although the association was stronger among never-smokers (HR, 1.61; 95% CI, 1.01 to 2.57; P trend = .002) than ever-smokers (HR, 1.36; 95% CI, 0.86 to 2.15; P trend = .63), comparing BMI ≥ 35 kg/m(2) with BMI < 25 kg/m(2). Higher prediagnostic BMI was associated with more advanced stage at diagnosis, with 72.5% of obese patients presenting with metastatic disease versus 59.4% of healthy-weight patients (P = .02).
Higher prediagnostic BMI was associated with statistically significantly decreased survival among patients with pancreatic cancer from two large prospective cohorts.
尽管肥胖与胰腺癌发病率的增加有关，但研究尚未前瞻性评估诊断前的体重指数（BMI）与生存情况。
我们分析了来自两个大型前瞻性队列的 902 名患者在 1986 年评估的诊断前 BMI 与生存情况。我们使用 Cox 比例风险模型估计死亡的风险比（HR），并根据年龄、性别、种族/民族、吸烟状况、诊断年份和分期进行调整。我们通过将报告的 BMI 按诊断前 2 年的时间间隔分组来评估 BMI 与生存之间的时间关联。
与 BMI<25kg/m2的患者相比，BMI≥35kg/m2的患者死亡的多变量调整 HR 为 1.53（95%CI，1.11 至 2.09）（P趋势=0.001），而调整分期后结果相似。报告的 BMI 与癌症诊断之间的时间间隔越长，BMI 与生存的关联就越强。在 BMI 采集距离诊断前 18 至 20 年的患者中，死亡的 HR 为 2.31（95%CI，1.48 至 3.61；P趋势<0.001），比较肥胖与健康体重患者。未发现按队列、吸烟状况或分期的统计学显著差异，尽管从不吸烟者的关联更强（HR，1.61；95%CI，1.01 至 2.57；P 趋势=0.002），而与从不吸烟者相比（HR，1.36；95%CI，0.86 至 2.15；P 趋势=0.63），BMI≥35kg/m2与 BMI<25kg/m2 相比。较高的诊断前 BMI 与诊断时更晚期的分期相关，72.5%的肥胖患者存在转移性疾病，而健康体重患者为 59.4%（P=0.02）。
来自两个大型前瞻性队列的胰腺癌患者，较高的诊断前 BMI 与统计学上显著降低的生存相关。
