体重指数与乳腺癌患者预后相关性的研究

目的 探讨体重指数(BMI)与乳腺癌发病之间的关系,并观察不同体重指数对乳腺癌患者预后的影响。方法 选取2004年1月-2005年1月间来哈尔滨医科大学肿瘤医院就诊的乳腺癌患者236例,回顾性收集其身高、体重、年龄、临床分期、淋巴结转移情况、组织病理学分级等临床资料,计算体重指数,根据BMI分成低体重组、正常组、偏胖组和肥胖组,随访至2010年1月,以乳腺癌死亡为观察终点,平均随访5.4年。结果 不同组别间患者的年龄、病理学分级、临床分期情况未见显著性差异,但淋巴结转移间有差别。随访到2010年1月,共有99人死于乳腺癌。低体重组、正常组、偏胖组和肥胖组的病死率分别为29.41%,28.33%,47.76%和53.33%;到随访结束,低体重组(54.6±2.18月)和正常组(52.6±1.76月)乳腺癌患者的生存时间无显著差别,但高于偏胖组(45.8±2.04月)和肥胖组(41.2±1.96月)。偏胖组的乳腺癌患者术后生存时间略高于肥胖组。结论 乳腺癌患者的预后与其体重有一定的关系,保持正常的体重可能减少乳腺癌的发病,提高乳腺癌患者的生存预后。     

体重指数与乳腺癌发病风险的病例对照研究

目的:探讨体重指数(BMI)与乳腺癌发病风险的关系。方法:采用1∶1匹配病例对照研究,收集2008年6月至2009年8月由中国医科大学附属第一医院确诊的女性乳腺癌患者330例及同期就诊体检中心的健康人群330例,调查患者21岁时、5年前及目前的BMI指数。采用多因素条件Logistic回归分析乳腺癌发病风险的影响因素。结果:5年前BMI指数、绝经、被动吸烟的OR值及95%可信区间分别是1.465(1.016-2.112)、2.347(1.459-3.777)和1.384(1.009-1.897)。结论:5年前超重可明显增加乳腺癌发病的危险,绝经和暴露被动吸烟是乳腺癌发病的危险因素。     

年龄因素对三阴性乳腺癌患者预后的影响

目的:分析三阴乳腺癌患者低年龄组（<35岁）和高年龄组（≥35岁）临床病理学特征及生存状态,探讨低年龄组预后的独立影响因素。方法:收集2002年1 月至2004年12月本院收治的543 例可手术三阴性乳腺癌患者的临床资料,回顾性分析低年龄组及高年龄组临床病理学特征及生存情况。采用SPSS13.0 统计软件进行分析,取P<0.05有统计学意义。结果:低年龄组占可手术三阴性乳腺癌患者的7.96%。与高年龄组相比,临床分期Ⅲ期患者占37.21%（P=0.027）,肿瘤直径>5cm者占 39.53%（P=0.000）,组织学分级Ⅲ级的患者占37.21%（P=0.015）,腋窝淋巴结阳性者占62.79%（P=0.012）,术后进行放疗的患者占53.49%（P=0.010）,5?年内出现复发转移的患者占44.19%（P=0.000）,5 年无进展生存率53.49%（P=0.000）及总生存率67.44%（P=0.000）均与高年龄组有统计学差异。单因素和多因素分析结果显示,肿瘤大小、组织学分级及淋巴结状态既是影响三阴乳腺癌患者低年龄组预后的因素也是独立的危险因素。结论:三阴性乳腺癌低年龄组具有肿瘤体积大、恶性程度高、容易转移复发、病期晚、预后差的特点,探索新的更有效的治疗手段将成为今后的研究热点。      

体重指数对子宫颈癌Ib期预后的影响

目的：探讨体重指数（BMI）对接受广泛性子宫切除术的子宫颈癌Ib期患者预后的影响。方法：回顾性分析1987年4月～1997年4月行广泛性子宫切除的子宫颈癌Ib期患者87例，根据BMI不同将其分为3组，即BMI—S组（BMI〈20）23例：BMI—M组（20≤BMI〈27）48例；BMI—L组（BMI≥27）16例。分析3组5年生存率及预后因素的关系结果：BMI—S组、BMI—M组及BMI—L组5年生存率分别为64.3％、87．9％及91．3％；BMI-S组与BMI—M组、BMI-L组之间比较。有显著性差异（P〈0．05）各组间年龄、组织学类别、细胞分化程度、淋巴结转移率、平均肿瘤直径比较，无显著性差异（P〉0.05）BMI—S组与BMI—M组、BMI—L组有深肌层浸润者分别为82．6％、50．2％、37．9％，BMI—S组与BMI—M组、BMI—L组之间比较，有显著性差异（P〈0．05）。采用COX模型多变量分析结果表明，平均肿瘤直径（P〈0．01）、有无淋巴结转移（P〈0、05）及BMI〈20（P〈0．01）是影响预后的独立因素。结论：体重指数与子宫颈癌Ib期预后有关．低体重患者预后较差．     

血清性激素水平和体重指数与绝经后女性乳腺癌发病的相关性研究

目的 探讨绝经后女性乳腺癌的发病与血清性激素水平和体重指数的关系。方法 选择2013年3月—12月在哈尔滨医科大学附属肿瘤医院乳腺外科接受手术治疗的初诊绝经后乳腺癌118例作为病例组以及60例绝经后乳腺良性病变者作为对照组,并收集所有受试对象的身高、体重等基本资料。应用酶联免疫吸附实验(ELISA)方法检测受试对象的血清雌二醇(Estradiol,E2)、雌酮(Estrone,E1)、睾酮(Testesterone,TSTO)以及雄烯二酮(Androstenedione,AED)水平,并对结果进行分析。结果 病例组血清E2、E1、AED水平显著高于对照组(P＜0.05),病例组的血清TSTO平均水平稍高于对照组,但差异无统计学意义(P＞0.05);病例组体重指数(BMI)与对照组无明显差异(P＞0.05);病例组血清E1以及总研究对象的血清E1、TSTO、AED在超重组内的水平明显高于非超重组(P＜0.05),未发现其余各组的激素水平与BMI指数具有相关性(P＞0.05)。结论 绝经后女性乳腺癌患者的血清性激素水平升高,血清E2、E1、AED水平升高可能是与绝经后女性乳腺癌的发病相关,BMI高的绝经后女性的血清性激素水平较高。     

体重指数对子宫颈癌Ⅰb期预后的影响

目的探讨体重指数(BMI)对接受广泛性子宫切除术的子宫颈癌Ⅰ b期患者预后的影响.方法回顾性分析1987年4月～1997年4月行广泛性子宫切除的子宫颈癌Ⅰ b期患者87例,根据BMI不同将其分为3组,即BMI-S组(BMI＜20)23例;BMI-M组(20≤BMI＜27)48例;BMI-L组(BMI≥27)16例.分析3组5年生存率及预后因素的关系.结果BMI-S纽、BMI-M组及BMI-L纽5年生存率分别为64.3%、87.9%及91.3%;BMI-S组与BMI-M组、BMI-L组之间比较,有显著性差异(P＜0.05).各组间年龄、组织学类别、细胞分化程度、淋巴结转移率、平均肿瘤直径比较,无显著性差异(P＞0.05).BMI-S组与BMI-M组、BMI-L组有深肌层浸润者分别为82.6%、50.2%、37.9%,BMI-S组与BMI-M组、BMI-L组之间比较,有显著性差异(P＜0.05).采用COX模型多变量分析结果表明,平均肿瘤直径(P＜0.01)、有无淋巴结转移(P＜0.05)及BMI＜20(P＜0.01)是影响预后的独立因素.结论体重指数与子宫颈癌Ⅰb期预后有关,低体重患者预后较差.     

乳腺癌患者体重指数及体位固定方式对保乳术后调强放射治疗摆位误差的影响

目的 探讨乳腺癌保乳术后调强放疗中不同体重指数(Body mass index, BMI)患者体位固定方式与摆位误差的相关性。方法 回顾性分析接受调强放疗的117例保乳术后乳腺癌患者的临床资料。根据放疗时患者不同的体位固定方式分为A、B两组,A组患者(57例)为真空袋组,B组患者(60例)为乳腺托架组。根据患者的BMI指数分为1组(<18.5 kg/m²)、2组(18.5～23.9 kg/m²)、3组(24～27.9 kg/m²)和4组(≥28 kg/m²)。比较不同BMI分组的乳腺癌患者体位固定方式与摆位误差的关系。结果 A组患者左右方向(X轴)总摆位误差小于B组(P<0.05);A3、A4组患者X及Y轴摆位误差小于B3、B4组(P<0.05)。在前后方向(Z轴)上,A组和B组之间的差异均无统计学意义(P>0.05)。结论 保乳术后接受调强放射治疗的乳腺癌患者BMI指数对摆位误差具有影响,对于超重患者(BMI≥24 kg/m²)更宜选用真空袋固定方式。     

体质指数对乳腺癌患者辅助内分泌治疗预后的影响

摘 要：［目的］ 探讨体质指数(BMI)对乳腺癌患者辅助内分泌治疗预后的影响。［方法］ 对653例乳腺癌患者进行回顾性分析,利用ROC曲线下面积方法计算出BMI的界点,并对患者进行分组,评估BMI对无病生存期(disease-free survival,DFS)及总生存(overall survival,OS)的影响。生存分析采用Kaplan-Meier法和Log-rank检验,单因素和多因素分析采用Cox比例风险模型。［结果］ 653例乳腺癌患者均为女性,其中BMI＜25.7kg/m2组患者458例(70.1%),BMI≥25.7kg/m2组195例(29.9%)。与BMI＜25.7kg/m2组患者比较,BMI≥25.7kg/m2组患者年龄较大(?字2=20.423,P＜0.001),绝经后患者所占比例多(?字2=22.261,P＜0.001)。BMI＜25.7kg/m2组患者的DFS显著地长于BMI≥25.7kg/m2组(P＜0.001)。然而,两组之间的OS差异无统计学意义(P= 0.266)。多因素分析显示,年龄、肿瘤大小、淋巴结转移、Ki-67水平、p53表达和BMI均为影响乳腺癌患者DFS的独立不良因素。［结论］超重与肥胖是影响乳腺癌患者辅助内分泌治疗预后的不良因素。     

186例术后乳腺癌患者辅助治疗期间体重变化与预后的关系

目的 探讨术后辅助治疗的乳腺癌患者在辅助治疗期间体重变化对其预后的影响。方法 收集2004年2月至2006年4月期间186例女性乳腺癌患者的临床资料。根据辅助治疗期间的体重变化将全部患者分为减少组、稳定组和增加组,比较3组的临床病理参数。采用Log-rank检验及Cox比例风险模型分析影响无病生存期（DFS）预后的因素。结果 体重变化与年龄、身体质量指数、辅助放疗、临床分期、吸烟史和消化道反应有关,而与相关疾病史和内分泌治疗无关。单因素分析显示,体重变化与DFS有关;Cox比例风险模型显示,体重变化是DFS的独立预测因素（χ2=12.107,P=0.002）。结论 对于术后辅助治疗的乳腺癌患者,辅助治疗期间体重变化是影响其预后的重要因素,体重增加将导致DFS缩短。     

Pre-diagnosis body mass index,post-diagnosis weight change,and prognosis among women with early stage breast cancer

Objective  We examined the association between body mass index (BMI) around the time of diagnosis, weight change post-diagnosis, and breast cancer prognosis in a prospective cohort study of 1,692 breast cancer survivors. Methods  Pre-diagnosis weight, weight at study entry, and height was obtained from mailed questionnaires and then weight change and BMI were calculated. After approximately seven years of follow-up, 207 recurrences, 99 deaths due to breast cancer, and 162 deaths due to any cause were reported. Delayed entry Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI), controlling for treatment and known prognostic factors. Results  Being obese one year before diagnosis was associated with an increased risk of death from any cause (HR = 1.6; 95% CI: 1.1–2.3) and a suggestion of increased risk of death from breast cancer (HR = 1.6; 95% CI: 0.9–2.7). However, weight gain up to four years after a breast cancer diagnosis was not associated with an increased risk of recurrence or death from any cause nor did moderate weight loss (5–10%) decrease risk of these outcomes. There was some evidence that women who had larger weight losses (≥10%) between pre-diagnosis and study entry had an increased risk of recurrence (HR = 1.7; 95% CI 1.0–2.6) and death due to any cause (HR = 2.1; 95% CI 1.3–3.4) compared to being weight stable. This elevated risk was more pronounced among women who were obese before diagnosis (BMI ≥ 30 kg/m²) or who had ER− or PR− tumors. Conclusion  We found that being obese before breast cancer diagnosis was associated with increased risk of recurrence and poorer survival, corroborating results from previous studies. However, weight gain after diagnosis did not confer additional risk. Body weight pre-diagnosis appears to be the strongest predictor of an adverse breast cancer prognosis.     

Analysis of the effect of age on the prognosis of breast cancer

To explore the effect of age at diagnosis on relative survival from breast cancer at different cancer stages and grades, using appropriate statistical modeling of time-varying and non-linear effects of that prognostic covariate. Data on 4,791 female invasive breast cancers diagnosed between 1990 and 1997 were obtained from a French cancer registry. The effect of age on relative survival was studied using an approach based on excess rate modeling. Different models testing non-linear and non-proportional effects of age were explored for each grade and each stage. In the whole population, the effect of age was not linear and varied with the time elapsed since diagnosis. When analyzing the different sub-groups according to grade and stage, age did not have a significant effect on relative survival in grade 1 or stage 3 tumors. In grade 2 and stage 4 tumors, the excess mortality rate increased with age, in a linear way. In grade 3 tumors, age was a time-dependent factor: older women had higher excess rates than younger ones during the first year after diagnosis whereas the inverse phenomenon was observed 5 years after diagnosis. Our findings suggest that when taking into account grade and stage, the time-varying impact of young age at diagnosis is limited to grade 3 tumors, without evidence of worst prognosis at 5 years for the youngest women.     

Recurrence dynamics of breast cancer according to baseline body mass index

BackgroundIn cancer follow-up, in addition to the evaluation of survival probabilities, there is a fundamental need of assessing recurrence dynamics for optimal disease management. Although the time-dependent effect of the oestrogen receptor (ER) status of the tumour has already been described, so far no factor has proven to disentangle the multi-peak behaviour observed for breast cancer recurrences. Here, we aimed at investigating whether adiposity at diagnosis, reflected by increased patient's body mass index (BMI), could be associated with breast cancer recurrence patterns over time after primary cancer therapy.MethodsWe retrieved BMI from 734 of 777 patients with node-positive breast cancer from a phase III randomised clinical trial, which compared different chemotherapy regimens and had a median follow-up of 15.4 years. Cumulative incidence estimation as well as piecewise exponential models were carried out to estimate the distant recurrence dynamics, in all patients, as well as in subgroups based on the ER status, with the ER-positive group being further split according to the menopausal status.ResultsIn patients with ER-negative breast cancer, time-dependent analyses revealed that the hazard of late relapses could mainly be attributed to the overweight and obese patients. Within the subgroup of premenopausal patients with ER-positive tumours, obesity was associated with an early high narrow peak of distant recurrences followed by another main peak after 5 years of follow-up. The risk for overweight patients was intermediate between obese and normal-weight patients. In the postmenopausal subgroup of patients with ER-positive tumours, the distant recurrence rate was significantly more elevated in the overweight patients compared to the other BMI categories, and a second late peak of recurrences was also observed for the obese patients.ConclusionThese results demonstrate that the patient's BMI at diagnosis is associated with cancer recurrence dynamics. Patient adiposity should therefore be central to the exploration of late adjuvant treatment modalities.     

Relationship of body mass index with aromatisation and plasma and tissue oestrogen levels in postmenopausal breast cancer patients treated with aromatase inhibitors

BackgroundRecent data have raised concern about the clinical efficacy of aromatase inhibitors in overweight and/or obese breast cancer patients. We report in vivo aromatase inhibition and plasma and tissue oestrogen levels in relation to body mass index (BMI) status among breast cancer patients treated with different aromatase inhibitors.MethodsWe compared data on in vivo aromatase inhibition (64 patients) as well as plasma and tissue oestrogen levels from patients participating in our studies to BMI values.ResultsWe found a weak positive correlation between pretreatment aromatisation level and BMI (n = 64; R = 0.236; p = 0.060) but no correlation between on-treatment aromatisation levels or percentage aromatase inhibition and BMI within patient subgroups treated with any of a panel of aromatase inhibitors. Pre-treatment levels of plasma estradiol (p < 0.001), estrone (p = 0.001) and estrone sulphate (p = 0.002) correlated to BMI. While on-treatment levels of plasma estrane sulphate correlated to BMI in patients on letrozole (R = 0.601; p = 0.001; n = 25 for all) or anastrozole (n = 12; R = 0.611; p = 0.035) therapy, letrozole suppressed plasma estrone sulphate more than anastrozole independent of BMI. No correlation between on-treatment tumour oestrogen levels and BMI was recorded.ConclusionsOur unique data do not support a lack of effective aromatase inhibition in overweight patients or therefore a need for alternative therapy. The higher levels of estrogens in overweight postmenopausal breast cancer patients before and during aromatase inhibition may be due to effects of BMI on oestrogen metabolism rather than aromatisation.     

血清瘦素水平及体质指数与乳腺癌发生的相关性研究

  目的 探讨血清瘦素水平及体质指数与乳腺癌发生的相关性，为乳腺癌的防治寻找科学依据。方法 收集术前乳腺癌患者90例，乳腺良性疾病患者32例，健康对照103例血清，采用放射免疫分析法测定瘦素水平，并进行体质指数的测量与计算。采用SPSS软件包进行统计学处理。结果 乳腺癌组血清瘦素水平与体质指数明显高于乳腺良性疾病和健康对照组，差异均具有统计学意义（P＜0.01）；三组人群瘦素水平与体质指数均呈正相关，相关系数分别为0.327（P＜0.001），0.416（P＜0.001），0.525（P＜0.001）；Logistic回归分析，血清瘦素水平的升高是乳腺癌发生的危险因素，OR值为1.14（95 %CI：1.076 ~ 1.209）。结论 血清瘦素水平、体质指数升高可能与乳腺癌发生有关。     

The effect of age on delay in diagnosis and stage of breast cancer

Background.

Young women with breast cancer are more likely to present with more advanced disease and are more likely to die as a result of breast cancer than their older counterparts. We sought to examine the relationship among young age (≤40 years), the likelihood of a delay in diagnosis, and stage.

Methods.

We examined data from women with newly diagnosed stage I–IV breast cancer presenting to one of eight National Comprehensive Cancer Network centers in January 2000 to December 2007. Delay in diagnosis was defined as time from initial sign or symptom to breast cancer diagnosis >60 days.

Results.

Among 21,818 women with breast cancer eligible for analysis, 2,445 were aged ≤40 years at diagnosis. Young women were not more likely to have a delay in diagnosis >60 days (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.98–1.19) after adjustment for type of initial sign or symptom. Young women were only modestly more likely to present with higher stage disease after a similar adjustment (OR, 1.18; 95% CI, 1.07–1.31). Women presenting with symptomatic disease, more common in younger women, were more likely to have a delay in diagnosis (OR, 3.31; 95% CI, 3.08–3.56) and higher stage (OR, 4.31; 95% CI 4.05–4.58).

Conclusion.

Young age is not an independent predictor of delay in diagnosis of breast cancer and only modestly is associated with higher stage disease. Presenting with symptoms of breast cancer predicts delay and higher stage at diagnosis.     

Lack of evidence for effect modification by estrogen of association between body mass index and colorectal cancer risk among postmenopausal women

Objective Previous studies of the association between body mass index (BMI) and colorectal cancer among women found increased risk only among women who were premenopausal or used hormone replacement therapy (HRT). These results led to the hypothesis that BMI may increase risk more strongly among women with higher levels of circulating estrogen. We examined the association between BMI and colorectal cancer incidence by use of HRT, and number of postmenopausal years without HRT, a measure of duration of exposure to lower levels of estrogen. Methods During follow-up from 1992–2003, 814 incident colorectal cancer cases were identified among 73,842 postmenopausal women in the Cancer Prevention Study-II Nutrition Cohort. Information on BMI and other risk factors was obtained from questionnaires completed at enrollment in 1992–1993 and during follow-up. Hazard ratios were calculated using proportional hazards modeling. Results The association between BMI and colorectal cancer incidence was similar among never–users of HRT (hazard ratio 1.13, 95% confidence interval 1.02–1.25 per 5-unit increase in BMI) and current-users of HRT (hazard ratio 1.08, 95% confidence interval 0.92–1.27 per 5-unit increase in BMI). Among women not currently using HRT, the association between BMI and colorectal cancer did not differ by postmenopausal years without HRT. Conclusions Our results do not support the hypothesis that BMI increases risk of colorectal cancer more strongly among women with higher levels of estrogen.     

体质量指数与结直肠癌预后的关系

目的:探讨体质量指数与结直肠癌患者预后的关系.方法:回顾性分析2010年1月至2011年12月新疆医科大学附属肿瘤医院收治的353例行根治手术的结直肠癌患者临床病理资料.将患者分为低体重组(BMI<18.5kg/m2)、正常体重组(18.5kg/m2≤BMI<23kg/m2)、超重组(23kg/m2≤BMI<27.5kg/m2)、肥胖组(BMI≥27.5kg/m2).比较四组临床因素,分析BMI与结直肠癌患者5年生存率的关系.结果:BMI与患者术前CA199有统计学差异(P=0.020),对5年生存率无显著影响(P=0.254).民族、pT分期、术前放化疗、肿瘤分化程度均是结直肠癌独立预后因素(P<0.05).结论:BMI对结直肠癌患者的预后无显著影响.     

Impact of body mass index on estradiol depletion by aromatase inhibitors in postmenopausal women with early breast cancer

Background:

Body mass index (BMI) has an impact on survival outcome in patients treated with aromatase inhibitors (AIs). Obesity is associated with an increased body aromatisation and may be a cause of insufficient estradiol depletion.

Methods:

Sixty-eight postmenopausal oestrogen receptor-positive patients with early breast cancer were prospectively included in this study. Follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol were analysed immediately in the clinical routine lab and in a dedicated central lab before (T1) and 3 months after start with aromatase inhibitors (T2).

Results:

A total of 40 patients were normal or overweight (non-obese: BMI 18.5–29.9 kg m⁻²) and 28 were obese (BMI⩾30 kg m⁻²). Aromatase inhibitors significantly suppressed estradiol serum levels (T1: 19.5 pg ml⁻¹, T2: 10.5 pg ml⁻¹, P<0.01) and increased FSH serum levels (T1: 70.2 mIU ml⁻¹, T2: 75.7 mIU ml⁻¹, P<0.05). However, after 3 months of AI treatment, estradiol levels of obese patients were nonsignificantly higher compared with non-obese patients (12.5 pg ml⁻¹ vs 9.0 pg ml⁻¹, P=0.1). This difference was reflected by significantly lower FSH serum levels in obese compared with non-obese patients (65.5 mIU ml⁻¹ vs 84.6 mIU ml⁻¹, P<0.01). The significant effects of BMI on FSH serum levels could be detected both in the routine as well as in the dedicated central lab.

Conclusion:

Aromatase inhibitors are less efficient at suppressing estradiol serum levels in obese when compared with non-obese women.