1Department of Hemato-Oncology, CISSS Montérégie Centre/Hôpital Charles Le Moyne, Université de Sherbrooke, Greenfield Park, Quebec, Canada.
2Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
J Natl Compr Canc Netw. 2021 Jan 5;19(2):181-189. doi: 10.6004/jnccn.2020.7606.
The association between obesity and prognosis in HER2-positive early breast cancer remains unclear, with limited data available. This study aimed to determine the impact of body mass index (BMI) at baseline and weight change after 2 years on outcomes of patients with HER2-positive early breast cancer.
ALTTO was a randomized phase III trial in patients with HER2-positive early breast cancer. BMI was collected at randomization and 2 years after. WHO BMI categories were used: underweight, <18.5 kg/m2; normal weight, 18.5 to <25 kg/m2; overweight, ≥25 to <30 kg/m2; and obese ≥30 kg/m2. A weight change from baseline of ≥5.0% and ≤5.0% was categorized as weight gain and weight loss. The impact of BMI at randomization and of weight change on disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) were investigated with multivariate analyses, adjusting for baseline patients and tumor characteristics.
A total of 8,381 patients were included: 187 (2.2%), 3,797 (45.3%), 2,690 (32.1%), and 1,707 (20.4%) were underweight, normal weight, overweight, and obese at baseline, respectively. Compared with normal weight, being obese at randomization was associated with a significantly worse DDFS (adjusted hazard ratio [aHR], 1.25; 95% CI, 1.04-1.50) and OS (aHR, 1.27; 95% CI, 1.01-1.60), but no significant difference in DFS (aHR, 1.14; 95% CI, 0.97-1.32). Weight loss ≥5.0% at 2 years after randomization was associated with significantly poorer DFS (aHR, 1.34; 95% CI, 1.05-1.71), DDFS (aHR, 1.46; 95% CI, 1.07-1.98), and OS (aHR, 1.83; 95% CI, 1.18-2.84). Hormone receptor and menopausal status but not anti-HER2 treatment type influenced outcomes. Toxicities were more frequent in obese patients.
In patients with HER2-positive early breast cancer, obesity at baseline is a poor prognostic factor. Weight loss during treatment and follow-up negatively impacts clinical outcomes. Dietary counseling should be part of survivorship care programs.
肥胖与 HER2 阳性早期乳腺癌的预后之间的关系尚不清楚，可用的数据有限。本研究旨在确定基线时的体重指数（BMI）和 2 年后体重变化对 HER2 阳性早期乳腺癌患者结局的影响。
ALTTO 是一项针对 HER2 阳性早期乳腺癌患者的随机 III 期试验。在随机分组时和 2 年后采集 BMI。使用世界卫生组织（WHO）BMI 类别：体重不足，<18.5kg/m2；正常体重，18.5 至<25kg/m2；超重，≥25 至<30kg/m2；肥胖≥30kg/m2。基线时体重变化≥5.0%和≤5.0%分别归类为体重增加和体重减轻。使用多变量分析，根据基线患者和肿瘤特征，研究随机分组时 BMI 和体重变化对无病生存（DFS）、远处无病生存（DDFS）和总生存（OS）的影响。
共纳入 8381 例患者：分别有 187（2.2%）、3797（45.3%）、2690（32.1%）和 1707（20.4%）例患者基线时体重不足、正常体重、超重和肥胖。与正常体重相比，随机分组时肥胖与 DDFS（调整后的危险比[aHR]，1.25；95%置信区间[CI]，1.04-1.50）和 OS（aHR，1.27；95%CI，1.01-1.60）显著更差，但 DFS 无显著差异（aHR，1.14；95%CI，0.97-1.32）。随机分组后 2 年时体重减轻≥5.0%与 DFS（aHR，1.34；95%CI，1.05-1.71）、DDFS（aHR，1.46；95%CI，1.07-1.98）和 OS（aHR，1.83；95%CI，1.18-2.84）显著更差相关。激素受体和绝经状态而非抗 HER2 治疗类型影响结局。肥胖患者的毒性更常见。
在 HER2 阳性早期乳腺癌患者中，基线时肥胖是预后不良的因素。治疗和随访期间的体重减轻对临床结局有负面影响。饮食咨询应成为生存护理计划的一部分。
