HER2阳性早期乳腺癌患者的体重指数和体重变化：APHINITY试验的亚组分析。
Body mass index and weight changes in patients with HER2-positive early breast cancer: A sub-analysis of the APHINITY trial.
作者信息
Dauccia Chiara, Alice Franzoi Maria, Martel Samuel, Agbor-Tarh Dominique, Fielding Shona, Piccart Martine, Bines Jose, Loibl Sibylle, Di Cosimo Serena, Vaz-Luis Ines, Di Meglio Antonio, Del Mastro Lucia, Gombos Andrea, Desmedt Christine, Jerusalem Guy, Reaby Linda, Pienkowski Tadeus, Lambertini Matteo, Agostinetto Elisa, Azambuja Evandro de
机构信息
Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Rue Meylemeersch 90, Bruxelles 1070, Belgium; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy.
Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Rue Meylemeersch 90, Bruxelles 1070, Belgium.
出版信息
Eur J Cancer. 2025 Jun 18;223:115489. doi: 10.1016/j.ejca.2025.115489. Epub 2025 May 8.
BACKGROUND
Body mass index (BMI) may affect prognosis in patients with breast cancer (BC). We assessed the association of BMI and weight changes with outcomes of patients with HER2-positive early BC included in the APHINITY trial.
METHODS
This is an exploratory analysis of APHINITY (NCT01358877), randomized trial testing adjuvant dual vs. single HER2 blockade plus chemotherapy in HER2-positive early BC. BMI was collected at baseline and at two years after randomization. Patients were classified as underweight/normal weight (BMI<25 kg/m) and overweight/obese (BMI≥25 kg/m). The association of BMI with invasive disease-free survival (iDFS), distant recurrence-free interval (DRFI) and overall survival (OS) was investigated. Landmark approach was used to compare event for weight change ≥ 5.0 % at 2 years from baseline.
RESULTS
Of 4787 patients included, 2252 (47 %) were overweight/obese and 2535 (53 %) underweight/normal weight. Patients who were overweight/obese had more often chemotherapy discontinuation compared to underweight/normal weight patients (14 % vs. 9 %, p < 0.001). Patients who were overweight/obese exhibited worse iDFS (adjusted hazard ratio [aHR] 1.27; 95 % CI 1.06-1.52), DFRI (aHR 1.32; 95 % CI 1.06-1.64) and OS (aHR 1.38; 95 %CI 1.08-1.77) than underweight/normal weight patients. This effect on iDFS remained after adjusting for chemotherapy discontinuation (iDFS aHR 1.26, 95 % CI 1.05-1.51; DRFI aHR 1.31, 95 % CI 1.06-1.63; OS aHR 1.35 95 % CI 1.05-1.73). Weight changes at 2 years were not associated with clinical outcomes.
CONCLUSIONS
Our exploratory findings suggest that overweight/obesity at diagnosis was associated with worse survival outcomes.
背景
体重指数（BMI）可能影响乳腺癌（BC）患者的预后。我们评估了BMI和体重变化与APHINITY试验中HER2阳性早期BC患者预后的相关性。
方法
这是对APHINITY（NCT01358877）的一项探索性分析，该随机试验在HER2阳性早期BC中测试辅助双HER2阻断与单HER2阻断加化疗。在基线和随机分组后两年收集BMI。患者被分类为体重过轻/正常体重（BMI<25kg/m²）和超重/肥胖（BMI≥25kg/m²）。研究了BMI与无侵袭性疾病生存期（iDFS）、远处无复发生存期（DRFI）和总生存期（OS）的相关性。采用地标性方法比较基线后2年体重变化≥5.0%的事件。
结果
在纳入的4787例患者中，2252例（47%）超重/肥胖，2535例（53%）体重过轻/正常体重。与体重过轻/正常体重的患者相比，超重/肥胖的患者更常出现化疗中断（14%对9%，p<0.001）。超重/肥胖的患者iDFS（校正风险比[aHR]1.27；95%CI 1.06-1.52）、DFRI（aHR 1.32；95%CI 1.06-1.64）和OS（aHR 1.38；95%CI 1.08-1.77）均比体重过轻/正常体重的患者差。在调整化疗中断因素后，这种对iDFS的影响仍然存在（iDFS aHR 1.26，95%CI 1.05-1.51；DRFI aHR 1.31，95%CI 1.06-1.63；OS aHR 1.35 95%CI 1.05-1.73）。2年时的体重变化与临床结局无关。
结论
我们的探索性发现表明，诊断时超重/肥胖与较差的生存结局相关。
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