Ayoub Nehad M, Yaghan Rami J, Abdo Nour M, Matalka Ismail I, Akhu-Zaheya Laila M, Al-Mohtaseb Alia H
Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology (JUST), Irbid, Jordan.
Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan.
J Obes. 2019 Mar 25;2019:3820759. doi: 10.1155/2019/3820759. eCollection 2019.
To investigate the association between obesity and breast cancer clinicopathologic characteristics at presentation along with prognostic impact among Jordanian breast cancer patients. Such data are lacking in Arabian countries.
In this retrospective study, 348 breast cancer patients were included. Analyses were conducted for associations between body mass index (BMI) and age at diagnosis, tumor clinicopathologic characteristics, and molecular subtypes. Eight prognostic factors were considered, and total prognostic scores were calculated. The analysis was stratified by menopausal status. Multivariate logistic stepwise regression analysis was conducted to identify predictors for breast cancer recurrence and death.
Mean age at diagnosis was 50.98 ± 10.96 years. Mean BMI at diagnosis was 29.52 ± 5.32 kg/m. Mean age at diagnosis was significantly higher for overweight and obese patients compared to underweight/normal patients ( < 0.001). A significant positive correlation was observed between patient age and BMI at diagnosis ( = 0.251, < 0.001). Grade of carcinoma was significantly correlated with BMI in the whole population examined (=0.003). Obese breast cancer patients had significantly higher prognostic scores compared to nonobese cases, indicating worse prognostic features at presentation (=0.034). Stratification of data analysis based on menopausal status revealed significant associations between obesity and each of tumor stage and grade among postmenopausal but not premenopausal patients (=0.019 and =0.031, respectively). Similarly, postmenopausal obese patients had significantly higher prognostic scores compared to nonobese counterparts (=0.007), indicating worse prognosis, a finding which was also absent among premenopausal breast cancer patients. No significant association between BMI with expression status of hormone receptors, HER2, lymphovascular invasion, and molecular subtypes was found among patients. BMI was a significant predictor for disease recurrence in which obese breast cancer patients had greater odds (2-fold) to develop locoregional and distant recurrence compared to nonobese cases (=0.011).
Obesity was associated with advanced stage and grade of breast carcinoma at diagnosis. The impact of BMI on clinicopathologic characteristics and prognosis was confined to postmenopausal cases. Jordanian obese breast cancer patients are at greater risk of breast cancer recurrence and reduced survival compared to their nonobese counterparts.
探讨约旦乳腺癌患者肥胖与就诊时乳腺癌临床病理特征之间的关联及其预后影响。阿拉伯国家缺乏此类数据。
在这项回顾性研究中，纳入了348例乳腺癌患者。分析了体重指数（BMI）与诊断年龄、肿瘤临床病理特征及分子亚型之间的关联。考虑了8个预后因素，并计算了总预后评分。分析按绝经状态分层。进行多变量逻辑逐步回归分析以确定乳腺癌复发和死亡的预测因素。
诊断时的平均年龄为50.98±10.96岁。诊断时的平均BMI为29.52±5.32kg/m²。超重和肥胖患者诊断时的平均年龄显著高于体重过轻/正常的患者（P<0.001）。观察到患者年龄与诊断时的BMI之间存在显著正相关（r=0.251，P<0.001）。在整个研究人群中，癌分级与BMI显著相关（P=0.003）。与非肥胖患者相比，肥胖乳腺癌患者的预后评分显著更高，表明就诊时预后特征更差（P=0.034）。基于绝经状态的数据分析分层显示，绝经后患者而非绝经前患者中，肥胖与肿瘤分期和分级均显著相关（分别为P=0.019和P=0.031）。同样，绝经后肥胖患者的预后评分显著高于非肥胖患者（P=0.007），表明预后更差，这一发现也不存在于绝经前乳腺癌患者中。患者中未发现BMI与激素受体表达状态、HER2、淋巴管浸润及分子亚型之间存在显著关联。BMI是疾病复发的显著预测因素，肥胖乳腺癌患者发生局部区域和远处复发的几率是非肥胖患者的2倍（P=0.011）。
肥胖与诊断时乳腺癌的晚期和高级别相关。BMI对临床病理特征和预后的影响仅限于绝经后病例。与非肥胖的约旦乳腺癌患者相比，肥胖患者乳腺癌复发风险更高且生存率降低。
