体质量指数和基于生物学受体状态的绝经前和绝经后女性乳腺癌：中国多中心研究。
Body mass index and breast cancer defined by biological receptor status in pre-menopausal and post-menopausal women: a multicenter study in China.
机构信息
Department of Environmental Health and Occupational Medicine, West China School of Public Health & No.4 West China Teaching Hospital, Sichuan University, Chengdu, China ; Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Epidemiology and Biostatistics, West China School of Public Health & No.4 West China Teaching Hospital, Sichuan University, Chengdu, China.
出版信息
PLoS One. 2014 Jan 29;9(1):e87224. doi: 10.1371/journal.pone.0087224. eCollection 2014.
BACKGROUND
Few studies have investigated the association between body mass index (BMI) and breast cancer with consideration to estrogen/progesterone/human epidermal growth factor type 2 receptor status (ER/PR/HER2) in the breast tissue among Chinese pre- and post-menopausal women.
METHODS
Four thousand two hundred and eleven breast cancer patients were selected randomly from seven geographic regions of China from 1999 to 2008. Demographic data, risk factors, pathologic features, and biological receptor status of cases were collected from the medical charts. Chi-square test, fisher exact test, rank-correlation analysis, and multivariate logistic regression model were adopted to explore whether BMI differed according to biological receptor status in pre- and post-menopausal women.
RESULTS
Three thousand two hundred and eighty one eligible cases with BMI data were included. No statistically significant differences in demographic characteristics were found between the cases with BMI data and those without. In the rank-correlation analysis, the rates of PR+ and HER2+ were positively correlated with increasing BMI among post-menopausal women (rs BMI, PR+=0.867, P=0.001; rs BMI, HER2+ =0.636, P=0.048), but the ER+ rates did not vary by increasing BMI. Controlling for confounding factors, multivariate logistic regression models with BMI<24 kg/m(2) as the reference group were performed and found that BMI ≥ 24 kg/m(2) was only positively correlated with PR+ status among post-menopausal breast cancer cases (adjusted OR=1.420, 95% CI: 1.116-1.808, Wald=8.116, P=0.004).
CONCLUSIONS
Post-menopausal women with high BMI (≥ 24 kg/m(2)) have a higher proportion of PR+ breast cancer. In addition to effects mediated via the estrogen metabolism pathway, high BMI might increase the risk of breast cancer by other routes, which should be examined further in future etiological mechanism studies.
背景
很少有研究考虑到中国绝经前和绝经后妇女乳腺组织中的雌激素/孕激素/人表皮生长因子 2 受体状态（ER/PR/HER2），来研究体重指数（BMI）与乳腺癌之间的关系。
方法
我们从 1999 年至 2008 年，从中国的 7 个地理区域中随机选择了 4211 名乳腺癌患者。从病历中收集了病例的人口统计学数据、危险因素、病理特征和生物学受体状态。采用卡方检验、Fisher 确切检验、秩相关分析和多变量 logistic 回归模型，来探讨绝经前和绝经后妇女的 BMI 是否根据生物学受体状态而有所不同。
结果
我们纳入了 3281 名具有 BMI 数据的合格病例。具有 BMI 数据的病例与没有 BMI 数据的病例在人口统计学特征方面没有统计学差异。在秩相关分析中，绝经后妇女中 PR+和 HER2+的比例与 BMI 的增加呈正相关（rs BMI，PR+=0.867，P=0.001；rs BMI，HER2+=0.636，P=0.048），但 ER+的比例并未随 BMI 的增加而变化。控制混杂因素后，以 BMI<24 kg/m2 为参考组进行多变量 logistic 回归模型分析，发现 BMI≥24 kg/m2 仅与绝经后乳腺癌病例的 PR+状态呈正相关（调整后的 OR=1.420，95%CI：1.116-1.808，Wald=8.116，P=0.004）。
结论
BMI 较高（≥24 kg/m2）的绝经后妇女患有更多的 PR+乳腺癌。除了通过雌激素代谢途径介导的作用外，高 BMI 可能通过其他途径增加乳腺癌的风险，这需要在未来的病因机制研究中进一步研究。
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