Cespedes Feliciano Elizabeth M, Kwan Marilyn L, Kushi Lawrence H, Chen Wendy Y, Weltzien Erin K, Castillo Adrienne L, Sweeney Carol, Bernard Philip S, Caan Bette J
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Cancer. 2017 Jul 1;123(13):2535-2542. doi: 10.1002/cncr.30637. Epub 2017 Mar 13.
Studies of obesity and survival among patients with breast cancer produce conflicting results, possibly because of heterogeneity by molecular subtype.
This study examined whether the association of body mass index (BMI) at diagnosis with breast cancer recurrence and survival varied across subtypes defined by PAM50 (Prediction Analysis of Microarray 50) gene expression. Included were 1559 Kaiser Permanente Northern California members ages 18 to 79 years who had PAM50 assays and were diagnosed with American Joint Committee on Cancer stage I through III breast cancer from 1996 to 2013. Patients reported weight and height. Cox regression models were adjusted for age, menopause, race/ethnicity, stage, and chemotherapy.
Over a median of 9 years (maximum, 19 years), 378 women developed recurrent disease, and 312 died from breast cancer. Overall, BMI was not associated with breast cancer recurrence or survival when controlling for subtype (eg, the hazard ratio per 5 kg/m of BMI was 1.05 [95% confidence interval, 0.95-1.15] for breast cancer-specific death). However, associations varied by subtype. Among women with luminal A cancers, those who had class II/III obesity, but not class I obesity or overweight, had worse outcomes. When women who had a BMI ≥35 kg/m were compared with those who had a BMI from 18.5 to <25 kg/m , the hazard ratio was 2.24 (95% confidence interval,1.22-4.11) for breast cancer-specific death and 1.24 (95% confidence interval, 1.00-1.54) for recurrence. There was no association within luminal B, basal-like or human epidermal growth factor over-expressing subtypes.
Among patients who had accurately classified breast cancer subtypes based on gene expression, a BMI ≥35 kg/m was adversely associated with outcomes only among those who had luminal A cancers. Research is needed into whether tailoring recommendations for weight management to tumor characteristics will improve outcomes. Cancer 2017;123:2535-42. © 2017 American Cancer Society.
关于乳腺癌患者肥胖与生存情况的研究结果相互矛盾，这可能是由于分子亚型的异质性所致。
本研究探讨了诊断时的体重指数（BMI）与乳腺癌复发及生存之间的关联在由PAM50（50基因微阵列预测分析）基因表达定义的各亚型中是否存在差异。纳入了1559名年龄在18至79岁之间的北加利福尼亚凯撒医疗集团成员，这些成员接受了PAM50检测，并在1996年至2013年间被诊断为美国癌症联合委员会I至III期乳腺癌。患者报告了体重和身高。Cox回归模型根据年龄、绝经状态、种族/民族、分期和化疗情况进行了调整。
在中位时间为9年（最长19年）的随访中，378名女性出现了疾病复发，312名女性死于乳腺癌。总体而言，在控制亚型后，BMI与乳腺癌复发或生存无关联（例如，BMI每增加5kg/m²，乳腺癌特异性死亡的风险比为1.05[95%置信区间，0.95 - 1.15]）。然而，关联因亚型而异。在腔面A型癌症女性中，II/III级肥胖者（而非I级肥胖或超重者）预后较差。将BMI≥35kg/m²的女性与BMI为18.5至<25kg/m²的女性相比，乳腺癌特异性死亡的风险比为2.24（95%置信区间，1.22 - 4.11），复发的风险比为1.24（95%置信区间，1.00 - 1.54）。在腔面B型、基底样型或人表皮生长因子过表达亚型中无关联。
在基于基因表达准确分类乳腺癌亚型的患者中，BMI≥35kg/m²仅在腔面A型癌症患者中与预后不良相关。是否根据肿瘤特征调整体重管理建议以改善预后，仍需进一步研究。《癌症》2017年；123:2535 - 42。©2017美国癌症协会。
