Department of Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
Breast Cancer Res Treat. 2018 Jan;167(1):277-288. doi: 10.1007/s10549-017-4507-y. Epub 2017 Sep 25.
Obesity may negatively affect survival in breast cancer (BC), but studies are conflicting, and associations may vary by tumor subtypes and race/ethnicity groups.
In a retrospective review, we identified 273 women with invasive BC administered Adriamycin/Taxane-based neoadjuvant chemotherapy from 2004 to 2016 with body mass index (BMI) data at diagnosis. Obesity was defined as BMI ≥30. Associations between obesity and event-free survival (EFS), using STEEP events, and overall survival (OS), using all-cause mortality, were assessed overall and stratified by tumor subtype [[Hormone Receptor Positive (HR+)/HER2-, HER2+, and Triple-Negative Breast Cancer (TNBC])] in our diverse population.
Median follow-up was 32.6 months (range 5.7-137.8 months). Overall, obesity was associated with worse EFS (HR 1.71, 95% CI 1.03-2.84, p = 0.04) and a trend towards worse OS (p = 0.13). In HR+/HER2- disease (n = 135), there was an interaction between obesity and hormonal therapy with respect to OS but not EFS. In those receiving tamoxifen (n = 33), obesity was associated with worse OS (HR 9.27, 95% CI 0.96-89.3, p = 0.05). In those receiving an aromatase inhibitor (n = 89), there was no association between obesity and OS. In TNBC (n = 44), obesity was associated with worse EFS (HR 2.62, 95% CI 1.03-6.66, p = 0.04) and a trend towards worse OS (p = 0.06). In HER2+ disease (n = 94), obesity was associated with a trend towards worse EFS (HR 3.37, 95% CI 0.97-11.72, p = 0.06) but not OS. Race/ethnicity was not associated with survival in any subtype, and there were no interactions with obesity on survival.
Obesity may negatively impact survival, with differences among tumor subtypes.
肥胖可能对乳腺癌（BC）的生存产生负面影响，但研究结果存在冲突，并且相关性可能因肿瘤亚型和种族/族群而异。
在一项回顾性研究中，我们从 2004 年至 2016 年期间确定了 273 名接受阿霉素/紫杉烷类新辅助化疗的浸润性 BC 女性患者，这些患者在诊断时均具有体重指数（BMI）数据。肥胖定义为 BMI≥30。我们在这一多样化的人群中，根据肿瘤亚型（[激素受体阳性（HR+）/HER2-、HER2+和三阴性乳腺癌（TNBC）]），通过 STEEP 事件评估肥胖与无事件生存（EFS）之间的关联，以及通过全因死亡率评估与总生存（OS）之间的关联。
中位随访时间为 32.6 个月（范围 5.7-137.8 个月）。总体而言，肥胖与 EFS 较差相关（HR 1.71，95%CI 1.03-2.84，p=0.04），且 OS 较差的趋势具有统计学意义（p=0.13）。在 HR+/HER2-疾病（n=135）中，肥胖与激素治疗之间存在 OS 方面的交互作用，但 EFS 方面没有。在接受他莫昔芬（n=33）治疗的患者中，肥胖与 OS 较差相关（HR 9.27，95%CI 0.96-89.3，p=0.05）。在接受芳香化酶抑制剂（n=89）治疗的患者中，肥胖与 OS 之间无关联。在 TNBC（n=44）中，肥胖与 EFS 较差相关（HR 2.62，95%CI 1.03-6.66，p=0.04），且 OS 较差的趋势具有统计学意义（p=0.06）。在 HER2+疾病（n=94）中，肥胖与 EFS 较差的趋势相关（HR 3.37，95%CI 0.97-11.72，p=0.06），但与 OS 无关。在任何亚型中，种族/族群均与生存无关，并且肥胖与生存之间也无相互作用。
肥胖可能对生存产生负面影响，并且在肿瘤亚型之间存在差异。
