CUHK Institute of Health Equity, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
Breast Cancer Res Treat. 2022 Jun;193(3):649-658. doi: 10.1007/s10549-022-06526-2. Epub 2022 Apr 16.
It is well-known that obesity has an adverse impact on breast cancer prognosis; nonetheless, the prognostic role of abdominal obesity, especially its post-diagnosis change, has been understudied. This study aims to examine the prospective associations of general and abdominal obesity and their post-diagnosis changes with all-cause mortality, breast cancer-specific mortality, and breast cancer recurrence in Chinese breast cancer patients.
From 2011 to 2014, 1460 Chinese breast cancer patients were recruited and followed up at 18, 36, and 60 months after diagnosis. Body mass index (BMI), waist-to-hip ratio (WHR), and their changes between baseline and 18-month follow-up were derived. Clinical records on diagnosis, treatment, and death were also obtained. In total, 1309 women who completed the 18-month follow-up were included for Cox regression analyses, stratified by follow-up periods.
Within 18-48 months post-diagnosis, substantial WHR loss (5% or above) had reduced risk of all-cause (HR = 0.21 [95% CI 0.06-0.75]) and breast cancer-specific mortality (0.21 [0.06-0.77]) relative to stable WHR; whereas after 48 months post-diagnosis, substantial WHR gain showed elevated risks of all-cause mortality (2.67 [1.22-5.85])). Higher baseline WHR was also associated with both mortality outcomes. Nonetheless, no such associations were observed for BMI measures. Also, the effects of obesity measures on breast recurrence were less apparent.
Abdominal obesity, rather than general obesity, was linked to worse survival in Chinese breast cancer patients. Prevention on abdominal obesity and waist gain following breast cancer diagnosis may have a beneficial effect on longer-term survival over and above conventional weight management. Waist assessment and abdominal obesity control should therefore be incorporated as a vital component of the evaluation and interventions of breast cancer prognosis.
众所周知，肥胖对乳腺癌的预后有不良影响；然而，腹部肥胖的预后作用，特别是其诊断后的变化，仍研究不足。本研究旨在探讨中国乳腺癌患者的总体和腹部肥胖及其诊断后变化与全因死亡率、乳腺癌特异性死亡率和乳腺癌复发的前瞻性关联。
2011 年至 2014 年，招募了 1460 名中国乳腺癌患者，并在诊断后 18、36 和 60 个月进行随访。得出了体重指数（BMI）、腰臀比（WHR）以及它们在基线和 18 个月随访之间的变化。还获得了诊断、治疗和死亡的临床记录。共有 1309 名完成 18 个月随访的女性被纳入 Cox 回归分析，按随访时间分层。
在诊断后 18-48 个月内，与稳定的 WHR 相比，WHR 显著降低（5%或以上）降低了全因（HR=0.21 [95%CI 0.06-0.75]）和乳腺癌特异性死亡率（0.21 [0.06-0.77]）的风险；然而，在诊断后 48 个月后，WHR 显著增加与全因死亡率升高相关（2.67 [1.22-5.85]）。较高的基线 WHR 也与这两种死亡结局相关。然而，BMI 指标则没有观察到这种关联。此外，肥胖指标对乳腺癌复发的影响也不太明显。
与中国乳腺癌患者的生存不良相关的是腹部肥胖，而不是一般肥胖。在诊断出乳腺癌后，对腹部肥胖和腰围增加进行预防，可能会对长期生存产生有益的影响，超出常规的体重管理。因此，应将腰围评估和腹部肥胖控制作为评估和干预乳腺癌预后的重要组成部分。
