体重指数与激素受体或人表皮生长因子受体2的表达在乳腺癌生存方面的关系。
Relationship between body mass index and the expression of hormone receptors or human epidermal growth factor receptor 2 with respect to breast cancer survival.
作者信息
Jeon Ye Won, Kang Su Hwan, Park Min Ho, Lim Woosung, Cho Se Heun, Suh Young Jin
机构信息
Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University, 93 Joongboo-Daero Paldal-gu, Suwon, 442-723, Kyunggi-do, Republic of Korea.
Department of Surgery, Yeungnam University College of Medicine, 170 Hyunchung-ro, Nam-gu, Deagu, 705-703, Republic of Korea.
出版信息
BMC Cancer. 2015 Nov 6;15:865. doi: 10.1186/s12885-015-1879-4.
BACKGROUND
The association between body mass index (BMI) at the time of breast cancer diagnosis and the prognosis of breast cancer patients remains controversial. Furthermore, the association between BMI and prognosis with respect to different breast cancer subtypes is not clearly defined.
METHODS
We analyzed data from 41,021 invasive breast cancer patients between January 1988 and February 2008 from the Korean Breast Cancer Registry (KBCR) database. Overall survival (OS) and breast cancer-specific survival (BCSS) were analyzed using the Kaplan-Meier method and Cox's proportional hazard regression model among all patients and specific breast cancer subtypes with respect to BMI categories.
RESULTS
A U-shaped association between BMI and mortality was observed in the total cohort. Underweight and obese individuals exhibited worse OS (hazard ratio, 1.23 [95 % confidence interval {CI}, 1.05 to 1.44] and 1.29 [1.13 to 1.48], respectively) and BCSS (1.26 [1.03 to 1.54] and 1.21 [1.02 to 1.43], respectively) than normal-weight individuals. In the estrogen receptor (ER) and/or progesterone receptor (PR)+/human epidermal growth factor receptor 2 (HER2) - subgroup, obese individuals exhibited worse OS (1.48 [1.18 to 1.85]) and BCSS (1.31 [1.13 to 1.52]) than normal-weight individuals. Conversely, in the ER and PR-/HER2+ subgroup, underweight individuals exhibited worse OS (1.68 [1.12 to 2.47]) and BCSS (1.79 [1.11 to 2.90]) than normal-weight individuals.
CONCLUSIONS
We observed a U-shaped relationship between BMI at diagnosis and poor OS and BCSS among all breast cancer patients. However, obesity in the ER and/or PR+/HER2- subgroup and underweight in the ER and PR-/HER2+ subgroup were poor prognostic factors. Therefore, BMI at diagnosis and breast cancer subtype should be considered simultaneously in various treatment decision processes and surveillance schedules.
背景
乳腺癌诊断时的体重指数（BMI）与乳腺癌患者预后之间的关联仍存在争议。此外，BMI与不同乳腺癌亚型预后之间的关联尚未明确界定。
方法
我们分析了韩国乳腺癌登记处（KBCR）数据库中1988年1月至2008年2月期间41021例浸润性乳腺癌患者的数据。在所有患者以及按BMI类别划分的特定乳腺癌亚型中，使用Kaplan-Meier方法和Cox比例风险回归模型分析总生存期（OS）和乳腺癌特异性生存期（BCSS）。
结果
在整个队列中观察到BMI与死亡率之间呈U形关联。体重过轻和肥胖个体的总生存期（风险比分别为1.23 [95%置信区间{CI}，1.05至1.44]和1.29 [1.13至1.48]）和乳腺癌特异性生存期（分别为1.26 [1.03至1.54]和1.21 [1.02至1.43]）均比正常体重个体差。在雌激素受体（ER）和/或孕激素受体（PR）阳性/人表皮生长因子受体2（HER2）阴性亚组中，肥胖个体的总生存期（1.48 [1.18至1.85]）和乳腺癌特异性生存期（1.31 [1.13至1.52]）比正常体重个体差。相反，在ER和PR阴性/HER2阳性亚组中，体重过轻个体的总生存期（1.68 [1.12至2.47]）和乳腺癌特异性生存期（1.79 [1.11至2.90]）比正常体重个体差。
结论
我们观察到所有乳腺癌患者诊断时的BMI与不良总生存期和乳腺癌特异性生存期之间呈U形关系。然而，ER和/或PR阳性/HER2阴性亚组中的肥胖以及ER和PR阴性/HER2阳性亚组中的体重过轻是不良预后因素。因此，在各种治疗决策过程和监测计划中应同时考虑诊断时的BMI和乳腺癌亚型。
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