BMI与中国女性三阴型乳腺癌发病风险的分析

目的 探讨不同绝经状态下，体重指数(BMI)与中国女性三阴型乳腺癌发病风险的关系及对应的敏感界值。方法 采用匹配病例对照研究设计，病例和对照按年龄和绝经状态1∶2匹配，于2010年至2014年序贯收集四川省肿瘤医院391名原发性三阴型乳腺癌新发病例，同期收集成都市妇女儿童中心医院社区来源的健康对照782名。采用结构式问卷调查收集研究对象的一般人口学特征、身高、体重、生殖生育因素、现患及既往疾病史等信息。在不同绝经状态下，采用不同BMI分类标准（WHO四分类、亚洲四分类、中国四分类）估计BMI水平与三阴型乳腺癌的关联度，统计方法采用Logistic回归分析。结果 调整了年龄、初潮年龄、初产年龄、初潮和初产年龄的时间间隔等信息后，WHO二分类划分标准提示，高BMI与绝经前、后TNBC发病呈正相关（aOR绝经前= 2.19，95%CI:1.40～3.43；aOR绝经后=2.05，95%CI:1.29～3.27）。绝经前TNBC，WHO四分类中超重（BMI:25.0～29.9 kg/m2）和肥胖（BMI≥30.0 kg/m2）的aOR分别为:1.97（95%CI:1.23～3.15）和5.45（95%CI:1.07～27.74）；绝经后TNBC，中国四分类中肥胖（BMI≥28.0 kg/m2）的aOR为2.14（95%CI:1.02～4.48）。连续性BMI的趋势分析显示，不同绝经状态下随着BMI增高乳腺癌发病风险增大（Pfor trend ＜0.05）。结论 对于中国女性，高BMI是三阴型乳腺癌发病的危险因素，且绝经前后应采用不同的BMI敏感界值（BMI绝经前 ≥25.0 kg/m2，BMI绝经后≥28kg/m2）来估计三阴型乳腺癌的发病风险。

Analyzing BMI and Risk of Triple-Negative Breast Cancer in Chinese women

Objective This study was to explore the correlation between BMI and the risk of triple-negative breast cancer, and to detect the sensitive values in different menopausal status among Chinese females. Methods 391 patients newly diagnosed with primary breast carcinomas were selected sequentially from Sichuan Provincial Tumor Hospital. 782 healthy female controls were identified through health physical examination records in Maternal and Child Care Service Center. General demographic data, heights, weights, reproductive factors, and disease history information were investigated by a structured questionnaire. The association between BMI and risk of TNBC in different menopausal status was analyzed in different BMI-classification criterions (WHO criterion, Asian criterion, Chinese criterion). Multiple Logistic regression models were used to estimate the OR values and its 95%CI. Results This study found that after adjusting age, age at menarche and first birth, the time interval between age at menarche and first birth, the high BMI (WHO 2-classification criterion) was positively related to TNBC (premenopausal: a OR=2.19, 95%CI: 1.40-3.43; postmenopausal: a OR=2.05, 95%CI: 1.29-3.27). In premenopausal TNBC, the results showed that the aOR values of WHO 4-classification criterion (overweight: 25.0～29.9kg/m2, obesity: ≥30.0kg/m2) were respectively 1.97 (95%CI: 1.23～3.15) and 5.45 (95%CI:1.07～27.74). In postmenopausal TNBC, the aOR values of the Chinese 4-classification criterion (obesity:≥28.0kg/m2) was 2.14 (95%CI: 1.02～4.48). The trend analysis of continuous BMI showed that BMI was positively associated with increasing risk of TNBC in different menopausal status (Pfor trend ＜0.05). Conclusion The high BMI was the risk factor of TNBC, and different BMI sensitive values (BMIpre～≥25.0kg/m2, BMIpost～≥28kg/m2) should be used to detect the risk of TNBC in different menopausal status among Chinese women.