Institut Gustave Roussy, Villejuif, France.
Memorial Sloan Kettering Cancer Center, New York, United States.
Breast. 2020 Aug;52:23-32. doi: 10.1016/j.breast.2020.04.002. Epub 2020 Apr 11.
Evidence on how weight loss correlates to health-related quality-of-life (HRQOL) among obese breast cancer (BC) patients is limited. We aimed to evaluate associations between weight changes and HRQOL.
We included 993 obese women with stage I-II-III BC from CANTO, a multicenter, prospective cohort collecting longitudinal, objectively-assessed anthropometric measures and HRQOL data (NCT01993498). Associations between weight changes (±5% between diagnosis and post-treatment [shortly after completion of surgery, adjuvant chemo- or radiation-therapy]) and patient-reported HRQOL (EORTC QLQ-C30/B23) were comprehensively evaluated. Changes in HRQOL and odds of severely impaired HRQOL were assessed using multivariable generalized estimating equations and logistic regression, respectively.
14.1% women gained weight, 67.3% remained stable and 18.6% lost weight. Significant decreases in functional status and exacerbation of symptoms were observed overall post-treatment. Compared to gaining weight or remaining stable, obese women who lost weight experienced less of a decline in HRQOL, reporting better physical function (mean change [95%CI] for gain, stability and loss: -12.9 [-16.5,-9.3], -6.9 [-8.2,-5.5] and -6.2 [-8.7,-3.7]; p = 0.006), less dyspnea (+18.9 [+12.3,+25.6], +9.2 [+6.5,+11.9] and +3.2 [-1.0,+7.3]; p = 0.0003), and fewer breast symptoms (+22.1 [+16.8,+27.3], +18.0 [+15.7,+20.3] and +13.4 [+9.0,+17.2]; p = 0.044). Weight loss was also significantly associated with reduced odds of severe pain compared with weight gain (OR [95%CI] = 0.51 [0.31-0.86], p = 0.011) or stability (OR [95%CI] = 0.62 [0.41-0.95], p = 0.029). No associations between weight loss and worsening of other physical or psychosocial parameters were found.
This large contemporary study suggests that weight loss among obese BC patients during early survivorship was associated with better patient-reported outcomes, without evidence of worsened functionality or symptomatology in any domain of HRQOL.
关于肥胖乳腺癌（BC）患者体重减轻与健康相关生活质量（HRQOL）之间的相关性的证据有限。我们旨在评估体重变化与 HRQOL 之间的关联。
我们纳入了来自 CANTO 的 993 名肥胖的 I 期- II 期-III 期 BC 女性患者，这是一个多中心前瞻性队列研究，收集了纵向、客观评估的人体测量学指标和 HRQOL 数据（NCT01993498）。综合评估了体重变化（诊断与治疗后之间变化±5%[手术、辅助化疗或放疗后不久]）与患者报告的 HRQOL（EORTC QLQ-C30/B23）之间的关系。使用多变量广义估计方程和逻辑回归分别评估 HRQOL 的变化和严重受损 HRQOL 的可能性。
14.1%的女性体重增加，67.3%的女性体重稳定，18.6%的女性体重减轻。总体而言，治疗后功能性状态显著下降，症状恶化。与体重增加或体重稳定相比，减肥的肥胖女性的 HRQOL 下降幅度较小，报告的身体功能更好（体重增加、稳定和减轻的平均变化[95%CI]：-12.9[-16.5，-9.3]，-6.9[-8.2，-5.5]和-6.2[-8.7，-3.7]；p=0.006），呼吸困难减轻（+18.9[+12.3，+25.6]，+9.2[+6.5，+11.9]和+3.2[-1.0，+7.3]；p=0.0003），乳房症状减少（+22.1[+16.8，+27.3]，+18.0[+15.7，+20.3]和+13.4[+9.0，+17.2]；p=0.044）。与体重增加相比，体重减轻与严重疼痛的可能性降低显著相关（OR[95%CI]=0.51[0.31-0.86]，p=0.011）或稳定（OR[95%CI]=0.62[0.41-0.95]，p=0.029）。未发现体重减轻与任何 HRQOL 领域的功能或症状恶化之间存在关联。
这项大型的当代研究表明，肥胖的 BC 患者在早期生存期间体重减轻与患者报告的结果改善相关，而在任何 HRQOL 领域都没有证据表明功能或症状恶化。
