Playdon Mary C, Bracken Michael B, Sanft Tara B, Ligibel Jennifer A, Harrigan Maura, Irwin Melinda L
Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT (MCP, MLI, MBB, MH); Yale Cancer Center, New Haven, CT (MLI, TBS); Dana-Farber Cancer Institute, Boston, MA (JAL).
J Natl Cancer Inst. 2015 Sep 30;107(12):djv275. doi: 10.1093/jnci/djv275. Print 2015 Dec.
Overweight and obesity are associated with breast cancer mortality. However, the relationship between postdiagnosis weight gain and mortality is unclear. We conducted a systematic review and meta-analysis of weight gain after breast cancer diagnosis and breast cancer-specific, all-cause mortality and recurrence outcomes.
Electronic databases identified articles up through December 2014, including: PubMed (1966-present), EMBASE (1974-present), CINAHL (1982-present), and Web of Science. Language and publication status were unrestricted. Cohort studies and clinical trials measuring weight change after diagnosis and all-cause/breast cancer-specific mortality or recurrence were considered. Participants were women age 18 years or older with stage I-IIIC breast cancer. Fixed effects analysis summarized the association between weight gain (≥5.0% body weight) and all-cause mortality; all tests were two-sided.
Twelve studies (n = 23 832) were included. Weight gain (≥5.0%) compared with maintenance (<±5.0%) was associated with increased all-cause mortality (hazard ratio [HR] = 1.12, 95% confidence interval [CI] = 1.03 to 1.22, P = .01, I(2) = 55.0%). Higher risk of mortality was apparent for weight gain ≥10.0% (HR = 1.23, 95% CI = 1.09 to 1.39, P < .001); 5% to 10.0% weight gain was not associated with all-cause mortality (P = .40). The association was not statistically significant for those with a prediagnosis body mass index (BMI) of less than 25 kg/m(2) (HR = 1.14, 95% CI = 0.99 to 1.31, P = .07) or with a BMI of 25 kg/m(2) or higher (HR = 1.00, 95% CI = 0.86 to 1.16, P = .19). Weight gain of 10.0% or more was not associated with hazard of breast cancer-specific mortality (HR = 1.17, 95% CI = 1.00 to 1.38, P = .05).
Weight gain after diagnosis of breast cancer is associated with higher all-cause mortality rates compared with maintaining body weight. Adverse effects are greater for weight gains of 10.0% or higher.
超重和肥胖与乳腺癌死亡率相关。然而，诊断后体重增加与死亡率之间的关系尚不清楚。我们对乳腺癌诊断后的体重增加以及乳腺癌特异性、全因死亡率和复发结局进行了系统评价和荟萃分析。
通过电子数据库检索截至2014年12月的文章，包括：PubMed（1966年至今）、EMBASE（1974年至今）、CINAHL（1982年至今）和Web of Science。语言和发表状态不受限制。纳入测量诊断后体重变化以及全因/乳腺癌特异性死亡率或复发的队列研究和临床试验。参与者为年龄18岁及以上的I-IIIC期乳腺癌女性。固定效应分析总结了体重增加（≥5.0%体重）与全因死亡率之间的关联；所有检验均为双侧检验。
纳入12项研究（n = 23832）。与体重维持（<±5.0%）相比，体重增加（≥5.0%）与全因死亡率增加相关（风险比[HR] = 1.12，95%置信区间[CI] = 1.03至1.22，P = 0.01，I² = 55.0%）。体重增加≥10.0%时，死亡风险更高（HR = 1.23，95% CI = 1.09至1.39，P < 0.001）；体重增加5%至10.0%与全因死亡率无关（P = 0.40）。对于诊断前体重指数（BMI）小于25 kg/m²的患者（HR = 1.14，95% CI = 0.99至1.31，P = 0.07）或BMI为25 kg/m²及以上的患者（HR = 1.00，95% CI = 0.86至1.16，P = 0.19），该关联无统计学意义。体重增加10.0%或更多与乳腺癌特异性死亡风险无关（HR = 1.17，95% CI = 1.00至1.38，P = 0.05）。
与维持体重相比，乳腺癌诊断后体重增加与更高的全因死亡率相关。体重增加10.0%或更高时，不良影响更大。
