Loroña Nicole C, Othus Megan, Malone Kathleen E, Linden Hannah M, Tang Mei-Tzu C, Li Christopher I
Department of Epidemiology, University of Washington, Seattle, Washington.
Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington.
Cancer Epidemiol Biomarkers Prev. 2025 Jan 9;34(1):117-124. doi: 10.1158/1055-9965.EPI-24-1167.
We evaluated the association between metabolic syndrome (MetS; obesity plus two metabolic risk factors) and breast cancer outcomes according to molecular subtype.
This population-based prospective cohort consisted of 3,267 women ages 20 to 69 years diagnosed with a first primary invasive breast cancer from 2004 to 2015 in the Seattle-Puget Sound region. Breast cancer was categorized into three subtypes based on estrogen receptor (ER), progesterone receptor, and HER2 expression: luminal (ER+), triple-negative (ER-/progesterone receptor negative/HER2-), and HER2-overexpressing (H2E; ER-/HER2+) subtypes. We used time-varying Cox models to assess the association of prevalent and incident MetS with risks of recurrence, breast cancer-specific mortality (BCSM), and all-cause mortality (ACM).
MetS was associated with a greater risk of recurrence [HR, 3.24; 95% confidence interval (CI), 1.13-9.33] and BCSM (HR, 5.34; 95% CI, 2.32-12.31) only for the H2E subtype and greater risks of ACM for luminal (HR, 1.92; 95% CI, 1.37-2.68), H2E (HR, 5.09; 95% CI, 2.51-10.32), and all cases combined (HR, 1.90; 95% CI, 1.42-2.53). We also observed heterogeneity in recurrence and mortality outcomes across specific components of MetS and molecular subtypes.
MetS is associated with ACM among women with breast cancer and with BCSM among women with the H2E subtype.
These results highlight the importance of managing comorbidities to decrease the risk for adverse outcomes among breast cancer survivors.
我们根据分子亚型评估了代谢综合征（MetS；肥胖加上两个代谢风险因素）与乳腺癌预后之间的关联。
这项基于人群的前瞻性队列研究纳入了2004年至2015年在西雅图 - 普吉特海湾地区诊断出患有首次原发性浸润性乳腺癌的3267名年龄在20至69岁之间的女性。根据雌激素受体（ER）、孕激素受体和HER2表达情况，将乳腺癌分为三种亚型：管腔型（ER +）、三阴性（ER - /孕激素受体阴性/HER2 -）和HER2过表达型（H2E；ER - /HER2 +）亚型。我们使用时变Cox模型来评估现患和新发MetS与复发风险、乳腺癌特异性死亡率（BCSM）和全因死亡率（ACM）之间的关联。
仅对于H2E亚型，MetS与更高的复发风险[风险比（HR），3.24；95%置信区间（CI），1.13 - 9.33]和BCSM（HR，5.34；95% CI，2.32 - 12.31）相关；对于管腔型（HR，1.92；95% CI，1.37 - 2.68）、H2E型（HR，5.09；95% CI，2.51 - 10.32）以及所有病例合并（HR，1.90；95% CI，1.42 - 2.53），MetS与更高的ACM风险相关。我们还观察到MetS的特定组成部分和分子亚型在复发和死亡结局方面存在异质性。
MetS与乳腺癌女性的ACM相关，与H2E亚型女性的BCSM相关。
这些结果突出了控制合并症对于降低乳腺癌幸存者不良结局风险的重要性。
