Ishizuka Yumiko, Horimoto Yoshiya, Morita Midori, Kawamura Yukino, Sekine Katsutoshi, Obayashi Sayaka, Kojima Yuki, Tokuda Emi, Higuchi Toru, Shimomura Akihiko
Department of Breast Oncology, Juntendo University Faculty of Medicine, Tokyo, Japan.
Division of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Cancer Diagn Progn. 2023 Nov 3;3(6):678-686. doi: 10.21873/cdp.10272. eCollection 2023 Nov-Dec.
BACKGROUND/AIM: The number of older patients with breast cancer has been increasing and a major challenge is to develop optimal treatment strategies for these patients, who often have comorbidities. Obesity is reportedly a poor prognostic factor in breast cancer, however there is limited research on underweight patients. Clarifying the relationship between physique and prognosis may contribute to the establishment of optimal treatment strategies for older patients with breast cancer.
This retrospective study examined clinicopathological data from a multicenter collaborative database on 1,076 patients aged 70 years or older who had undergone curative surgery. According to the body mass index (BMI), patient physique was defined as underweight (<18.5 kg/m), normal (18.5-24.9 kg/m) or obese (≥25 kg/m). In this study, we explored the relationship between the physique of patients with breast cancer and outcomes.
Underweight patients had a significantly lower rate of chemotherapy administration (p=0.017) and a higher rate of presence of other cancer (p=0.022). During the observation period (median of 75.2 months), 133 patients (12%) developed recurrent disease and 131 patients (12%) died. Age, BMI, tumor size, progesterone receptor and the presence of other cancer were independent factors relating to overall survival (p<0.001, p=0.027, p=0.002, p=0.008 and p=0.005, respectively). Patients with a low BMI had a significantly shorter overall survival, but there was no association with disease-free survival in this subset of patients.
Overall survival was shorter in underweight older patients with breast cancer. Our data indicate that being underweight should be considered both in treatment decisions and in future studies of outcomes for older patients with breast cancer.
背景/目的：老年乳腺癌患者数量一直在增加，一项主要挑战是为这些常伴有合并症的患者制定最佳治疗策略。据报道，肥胖是乳腺癌的不良预后因素，然而对体重过轻患者的研究有限。阐明体质与预后之间的关系可能有助于为老年乳腺癌患者建立最佳治疗策略。
这项回顾性研究检查了一个多中心协作数据库中1076例70岁及以上接受根治性手术患者的临床病理数据。根据体重指数（BMI），将患者体质定义为体重过轻（<18.5kg/m）、正常（18.5 - 24.9kg/m）或肥胖（≥25kg/m）。在本研究中，我们探讨了乳腺癌患者体质与预后之间的关系。
体重过轻的患者化疗给药率显著较低（p = 0.017），其他癌症的发生率较高（p = 0.022）。在观察期（中位时间为75.2个月）内，133例患者（12%）出现疾病复发，131例患者（12%）死亡。年龄、BMI、肿瘤大小、孕激素受体以及其他癌症的存在是与总生存期相关的独立因素（分别为p < 0.001、p = 0.027、p = 0.002、p = 0.008和p = 0.005）。BMI较低的患者总生存期显著较短，但在该组患者中与无病生存期无关联。
体重过轻的老年乳腺癌患者总生存期较短。我们的数据表明，在治疗决策以及未来对老年乳腺癌患者预后的研究中都应考虑体重过轻这一因素。
