Nelson Sandahl H, Brasky Theodore M, Patterson Ruth E, Laughlin Gail A, Kritz-Silverstein Donna, Edwards Beatrice J, Lane Dorothy, Rohan Thomas E, Ho Gloria Y F, Manson JoAnn E, LaCroix Andrea Z
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, Ohio.
Cancer Epidemiol Biomarkers Prev. 2017 Jul;26(7):1100-1106. doi: 10.1158/1055-9965.EPI-16-1005. Epub 2017 Mar 14.
To examine associations of prediagnosis high-sensitivity C-reactive protein (hsCRP) with breast cancer incidence and postdiagnosis survival and to assess whether associations are modified by body mass index (BMI). A prospective analysis of the Women's Health Initiative was conducted among 17,841 cancer-free postmenopausal women with baseline hsCRP measurements. Cox proportional hazards models were used to examine associations between hsCRP concentrations and (i) breast cancer risk ( cases = 1,114) and (ii) all-cause mortality after breast cancer diagnosis. HRs are per 1 SD in log hsCRP. hsCRP was not associated with breast cancer risk overall [HR = 1.05; 95% confidence interval (CI), 0.98-1.12]; however, an interaction between BMI and hsCRP was observed ( = 0.02). A 1 SD increase in log hsCRP was associated with 17% increased breast cancer risk (HR = 1.17; 95% CI, 1.03-1.33) among lean women (BMI < 25), whereas no association was observed among overweight/obese (BMI ≥ 25) women. Prediagnosis hsCRP was not associated with overall mortality (HR, 1.04; 95% CI, 0.88-1.21) after breast cancer diagnosis; however, an increased mortality risk was apparent among leaner women with higher hsCRP levels (HR, 1.39, 95% CI, 1.03-1.88). Prediagnosis hsCRP levels are not associated with postmenopausal breast cancer incidence or survival overall; however, increased risks are suggested among leaner women. The observed effect modification is in the opposite direction of a previous case-control study finding and warrants further investigation. Associations of higher CRP levels with incident breast cancer and survival after breast cancer may depend on BMI. .
研究诊断前高敏C反应蛋白（hsCRP）与乳腺癌发病率及诊断后生存率之间的关联，并评估这些关联是否会因体重指数（BMI）而改变。对女性健康倡议组织中的17841名无癌症的绝经后女性进行了前瞻性分析，这些女性有基线hsCRP测量值。采用Cox比例风险模型来研究hsCRP浓度与（i）乳腺癌风险（病例数 = 1114）和（ii）乳腺癌诊断后的全因死亡率之间的关联。HRs是对数hsCRP每增加1个标准差的值。总体而言，hsCRP与乳腺癌风险无关[HR = 1.05；95%置信区间（CI），0.98 - 1.12]；然而，观察到BMI与hsCRP之间存在相互作用（P = 0.02）。在瘦女性（BMI < 25）中，对数hsCRP每增加1个标准差，乳腺癌风险增加17%（HR = 1.17；95% CI，1.03 - 1.33），而在超重/肥胖（BMI≥25）女性中未观察到关联。诊断前hsCRP与乳腺癌诊断后的总体死亡率无关（HR，1.04；95% CI，0.88 - 1.21）；然而，hsCRP水平较高的瘦女性中死亡风险增加（HR，1.39，95% CI，1.03 - 1.88）。诊断前hsCRP水平总体上与绝经后乳腺癌发病率或生存率无关；然而，瘦女性中提示存在增加的风险。观察到的效应修饰与先前一项病例对照研究的结果方向相反，值得进一步研究。较高的CRP水平与乳腺癌发病及乳腺癌后生存之间的关联可能取决于BMI。
