Adıyaman University, Training and Research Hospital, Clinics of Medical Oncology, Adıyaman, Turkey.
Gaziantep University, School of Medicine, Department of Medical Oncology, Gaziantep, Turkey.
Curr Probl Cancer. 2019 Dec;43(6):100461. doi: 10.1016/j.currproblcancer.2019.01.002. Epub 2019 Jan 23.
The positive energy balance and insulin resistance caused by weight gain, physical inactivity, poor dietary quality are linked to a decreased breast cancer (BC)-specific survival. The aim of the present study was to assess whether or not hepatosteatosis, which reflect underlying insulin resistance, has a predictive value on recurrence in patients with nonmetastatic BC.
All diagnosed nonmetastatic BC patients between 2005 and 2016 were included in this retrospective analysis. Patients' medical characteristics included for analysis were age, menopausal status, presence of obesity, diabetes, dyslipidemia, and tumor features. Liver parenchyma was evaluated by ultrasonography, and then patients divided into 2 groups according to final follow-up findings; group 1: without hepatosteatosis or presence of grade 1 steatosis; group 2: presence of grades 2 and 3 hepatosteatosis. Survival distributions were estimated with the Kaplan-Meier method and compared between groups with the log-rank statistic.
Four hundred twenty-four patients included in this study. The median follow-up period of all patients was 6.7 years (range, 0.6-13 years). The mean age was 48.2 ± 0.5 years. Of total, 154 (36.3%) patients experienced recurrence. In total, 171 (40.6%) patients had grades 2 and 3 hepatosteatosis, and the remaining had no, or grade 1 hepatosteatosis during last follow-up or at recurrence. The clinicopathologic characteristics of the participants were well balanced between the 2 groups. Younger age (odds ratio [OR]: 2.19; 95% confidence interval [CI]: 1.3-3.8, P = 0.005), and higher tumor stage (OR: 7.52; 95% CI: 1.2-48.5, P = 0.035 for stage Ia vs stage IIIC) were associated with recurrence of BC during the entire follow-up in multivariate analysis. Hepatosteatosis predicted late recurrence after 5 years in nonmetastatic BC after adjusted for age, diabetes, tumor stage, grade, and luminal type (OR: 2.45; 95% CI: 1.1-5.6, P = 0.034) and the hazard ratio was 0.40 (95% CI: 0.18-0.88, P = 0.023 adjusted value) for relapse-free survival after 5 years.
Higher degree of hepatosteatosis may predict recurrence after 5 years in BC survivors.
体重增加、身体活动减少和饮食质量差导致的正能平衡和胰岛素抵抗与乳腺癌（BC）特异性生存降低有关。本研究旨在评估非转移性 BC 患者中是否存在肝脂肪变性（反映潜在的胰岛素抵抗）是否对复发有预测价值。
本回顾性分析纳入了 2005 年至 2016 年间所有诊断为非转移性 BC 的患者。分析中包括患者的医学特征，如年龄、绝经状态、肥胖、糖尿病、血脂异常和肿瘤特征。通过超声评估肝脏实质，并根据最终随访结果将患者分为 2 组：组 1：无肝脂肪变性或存在 1 级脂肪变性；组 2：存在 2 级和 3 级肝脂肪变性。使用 Kaplan-Meier 方法估计生存分布，并通过对数秩检验比较组间差异。
本研究纳入了 424 名患者。所有患者的中位随访时间为 6.7 年（范围 0.6-13 年）。平均年龄为 48.2±0.5 岁。共有 154 名（36.3%）患者出现复发。共有 171 名（40.6%）患者在最后一次随访或复发时存在 2 级和 3 级肝脂肪变性，其余患者无肝脂肪变性或存在 1 级肝脂肪变性。两组患者的临床病理特征分布均衡。多变量分析显示，年龄较小（比值比 [OR]：2.19；95%置信区间 [CI]：1.3-3.8，P=0.005）和较高的肿瘤分期（OR：7.52；95%CI：1.2-48.5，P=0.035 期 Ia 与期 IIIC）与整个随访期间 BC 的复发相关。在校正年龄、糖尿病、肿瘤分期、分级和腔型后，肝脂肪变性可预测非转移性 BC 患者 5 年后的晚期复发（OR：2.45；95%CI：1.1-5.6，P=0.034），5 年后无复发生存率的危险比为 0.40（95%CI：0.18-0.88，P=0.023）。
较高程度的肝脂肪变性可能预示着 BC 幸存者 5 年后的复发。
