Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599, USA.
Breast Cancer Res Treat. 2020 Feb;179(3):709-720. doi: 10.1007/s10549-019-05501-8. Epub 2019 Nov 16.
Weight gain after breast cancer (BC) diagnosis is a well-known phenomenon; however, it is not a universal phenomenon and identification of patients at highest risk for weight gain is needed. This study investigates weight trajectories in early BC patients at 2 years post-primary treatment, examining potential contributing factors such as age, race, and receipt of chemotherapy, anti-HER-2 therapy, and endocrine treatment (ET).
A single institution cohort of newly diagnosed women age 21 and older with early breast cancer patients (Stage 0-3) were identified by retrospective chart review (diagnosis year 1995 to 2016). Log-binomial regression models for net weight changes at 2 years post-primary treatment including patient demographic, clinical, and treatment characteristics.
The final sample of 625 patients included 29% who were non-White and 37% who were pre-menopausal at diagnosis. Body mass index (BMI) at diagnosis was calculated and found to be normal in 33% (BMI 18 to < 25), overweight in 27% (BMI 25 to < 30), and obese in 40% (BMI 30 and higher). At 2 years, compared to weight at diagnosis, 31% had lost > 2 kg, 34% had stable weight ± 2 kg, and 35% had gained > 2 kg. Factors associated with > 2 kg weight gain were menopausal status (pre-menopausal HR 1.65, 95% CI 1.34-2.04, p < .0001), receiving any chemotherapy (HR 1.36, 95% CI 1.04-1.77), and anthracycline-based chemotherapy followed by ET (HR 1.60, CI 1.01-2.45). Anti-HER-2 therapy and transition from pre- to post-menopausal during the 2-year study period were not significant factors in weight gain. In multivariate analysis, menopausal status remained the only significant variable related to weight gain when adjusted for treatment. For all treatment combinations, pre-menopausal women had significantly more weight gain.
Weight gain, weight loss, and stable weight in women with early breast cancer vary greatly by treatment plan. However, pre-menopausal patients have the highest risk for weight gain.
乳腺癌（BC）诊断后的体重增加是一种众所周知的现象；然而，这并不是普遍现象，需要确定体重增加风险最高的患者。本研究调查了 2 年后接受原发性治疗的早期 BC 患者的体重轨迹，检查了潜在的促成因素，如年龄、种族以及接受化疗、抗 HER-2 治疗和内分泌治疗（ET）的情况。
通过回顾性图表审查，确定了一个单一机构队列中年龄在 21 岁及以上的新诊断为早期乳腺癌患者（分期 0-3 期）。使用对数二项式回归模型，分析包括患者人口统计学、临床和治疗特征在内的 2 年后原发性治疗后净体重变化。
最终的 625 名患者样本中，29%是非白人，37%在诊断时处于绝经前状态。诊断时的体重指数（BMI）计算结果显示，33%为正常体重（BMI 18 至 <25），27%为超重（BMI 25 至 <30），40%为肥胖（BMI 30 及以上）。2 年后，与诊断时的体重相比，31%的患者体重减轻了>2 公斤，34%的患者体重稳定在±2 公斤，35%的患者体重增加了>2 公斤。与体重增加>2 公斤相关的因素是绝经状态（绝经前 HR 1.65，95%CI 1.34-2.04，p<0.0001）、接受任何化疗（HR 1.36，95%CI 1.04-1.77）和接受蒽环类药物为基础的化疗后加用 ET（HR 1.60，CI 1.01-2.45）。抗 HER-2 治疗和在 2 年研究期间从绝经前过渡到绝经后状态不是体重增加的显著因素。在多变量分析中，当调整治疗因素时，绝经状态仍然是与体重增加相关的唯一显著变量。对于所有治疗组合，绝经前妇女的体重增加明显更多。
患有早期乳腺癌的女性的体重增加、体重减轻和体重稳定差异很大，这取决于治疗方案。然而，绝经前患者的体重增加风险最高。
