体重指数对高危女性乳腺癌发病率的影响：来自国际乳腺介入研究的观察性研究。
The impact of body mass index on breast cancer incidence among women at increased risk: an observational study from the International Breast Intervention Studies.
机构信息
Leeds Institute of Health Science, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK.
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
出版信息
Breast Cancer Res Treat. 2021 Jul;188(1):215-223. doi: 10.1007/s10549-021-06141-7. Epub 2021 Mar 3.
BACKGROUND
We investigated the association between body mass index (BMI) and breast cancer risk in women at increased risk of breast cancer receiving tamoxifen or anastrozole compared with placebo using data from the International Breast Cancer Intervention Studies [IBIS-I (tamoxifen) and IBIS-II (anastrozole)].
METHODS
Baseline BMI was calculated from nurse assessed height and weight measurements for premenopausal (n = 3138) and postmenopausal (n = 3731) women in IBIS-I and postmenopausal women in IBIS-II (n = 3787). The primary endpoint was any breast cancer event (invasive and ductal carcinoma in situ). We used Cox proportional hazards regression to calculate hazard ratios (HRs) for risk after adjustment for covariates.
RESULTS
There were 582 (IBIS-I) and 248 (IBIS-II) breast cancer events [median follow-up = 16.2 years (IQR 14.4-17.7) and 10.9 years (IQR 8.8-13.0), respectively]. In adjusted analysis, women with a higher BMI had an increased breast cancer risk in both IBIS-I [HR = 1.06 per 5 kg/m (0.99-1.15), p = 0.114] and in IBIS-II [HR per 5 kg/m = 1.21 (1.09-1.35), p < 0.001]. In IBIS-I, the association between BMI and breast cancer risk was positive in postmenopausal women [adjusted HR per 5 kg/m = 1.14 (1.03-1.26), p = 0.01] but not premenopausal women [adjusted HR per 5 kg/m = 0.97 (0.86-1.09), p = 0.628]. There was no interaction between BMI and treatment group for breast cancer risk in either IBIS-I (p = 0.62) or IBIS-II (p = 0.55).
CONCLUSIONS
Higher BMI is associated with greater breast cancer risk in postmenopausal women at increased risk of the disease, but no effect was observed in premenopausal women. The lack of interaction between BMI and treatment group on breast cancer risk suggests women are likely to experience benefit from preventive therapy regardless of their BMI. Trial registration Both trials were registered [IBIS-I: ISRCTN91879928 on 24/02/2006, retrospectively registered ( http://www.isrctn.com/ISRCTN91879928 ); IBIS-II: ISRCTN31488319 on 07/01/2005, retrospectively registered ( http://www.isrctn.com/ISRCTN31488319 )].
背景
我们利用国际乳腺癌干预研究（IBIS-I[他莫昔芬]和 IBIS-II[阿那曲唑]）的数据，调查了在接受他莫昔芬或阿那曲唑治疗的乳腺癌高危女性中，体重指数（BMI）与乳腺癌风险之间的关系，与安慰剂相比。
方法
IBIS-I 中对 3138 名绝经前和 3731 名绝经后女性（n=3138）以及 IBIS-II 中对 3787 名绝经后女性（n=3787）进行了护士评估的身高和体重测量，以计算出基线 BMI。主要终点是任何乳腺癌事件（浸润性和导管原位癌）。我们使用 Cox 比例风险回归计算调整协变量后的风险比（HR）。
结果
IBIS-I 中有 582 例（IBIS-I）和 248 例（IBIS-II）乳腺癌事件[中位随访时间=16.2 年（IQR 14.4-17.7）和 10.9 年（IQR 8.8-13.0）]。在调整分析中，BMI 较高的女性在 IBIS-I [每 5kg/m 的 HR=1.06（0.99-1.15），p=0.114]和 IBIS-II [每 5kg/m 的 HR=1.21（1.09-1.35），p<0.001]中乳腺癌风险增加。在 IBIS-I 中，BMI 与乳腺癌风险之间的关联在绝经后女性中呈阳性[调整后每 5kg/m 的 HR=1.14（1.03-1.26），p=0.01]，但在绝经前女性中不呈阳性[调整后每 5kg/m 的 HR=0.97（0.86-1.09），p=0.628]。在 IBIS-I 或 IBIS-II 中，BMI 和治疗组之间的乳腺癌风险没有相互作用（p=0.62 和 p=0.55）。
结论
BMI 较高与绝经后乳腺癌高危女性的乳腺癌风险增加相关，但在绝经前女性中未观察到这种关联。BMI 和治疗组之间缺乏乳腺癌风险的相互作用表明，无论 BMI 如何，女性都可能从预防性治疗中获益。
试验注册
两项试验均已注册[IBIS-I：ISRCTN91879928 于 2006 年 2 月 24 日，回顾性注册（http://www.isrctn.com/ISRCTN91879928）；IBIS-II：ISRCTN31488319 于 2005 年 1 月 7 日，回顾性注册（http://www.isrctn.com/ISRCTN31488319）]。
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