体重指数对乳腺癌新辅助化疗病理完全缓解及预后的影响

Effects of body mass index on pathological complete response and prognosis of breast cancer patients receiving neoadjuvant chemotherapy

目的探讨体重指数(BMI)与乳腺癌新辅助化疗病理完全缓解(pCR)及预后的相关性。方法回顾性分析2013年12月-2015年11月郑州大学附属肿瘤医院收治的98例乳腺癌新辅助化疗患者的病例资料,根据BMI将患者分为正常/低体重组(N/U,BMI<25.0 kg/m^2)、超重组(OW,BMI 25.0~29.9 kg/m^2)和肥胖组(0B,BMI≥30.0 kg/m^2)。98例患者中,50例(51.0%)N/U患者,32例(32.6%)OW患者,16例(16.3%)0B患者。观察患者新辅助化疗后pCR情况,预后评价指标为无病生存率。BMI和pCR相关性的单因素分析采用x^2检验或Fisher精确概率法,多因素分析采用logistic回归分析。生存分析采用Kaplan-Meier法,并行Log-rank检验,多因素分析采用Cox比例风险回归分析。结果3组患者分子分型间差异具有统计学意义(P<0.05)。29例(29.6%)患者获得了pCR,N/U组、OW组和OB组患者的pCR率分别为36.0%(18/50)、25.0%(8/32)和18.8%(3/16),差异元统计学意义(P>0.05)。多因素logistic回归分析显示,肥胖、分子分型是乳腺癌新辅助化疗pCR的独立预测因素(P<0.05)。N/U组、OW组和OB组患者的3年元病生存率分别为84.0%、93.5%、80.4%,差异元统计学意义(P>0.05);多因素分析显示,体重指数和3年无病生存率无相关性(P>0.05)。结论体重指数过高(肥胖)是乳腺癌新辅助化疗pCR的独立预测因素,但不影响乳腺癌新辅助化疗患者的预后。

Objective To investigate the correlation of body mass index (BMI)on pathological complete response (pCR)and prognosis of breast cancer patients receiving neoadjuvant chemotherapy.Methods A retrospective analysis was performed on 98 cases of breast cancer patients in the Tumor Hospital Mfiliated to Zhengzhou University from December 2013 to November 2015.Patients were divided into normal or underweight (N/ U,BMI <25.0 kg/m^2 )group,overweight (OW,BMI 25.0-29.9 kg/m^2 )group and obese (OB,BMI ≥30.0 kg/m^2 ) group according to BMI.A total number of 50 (51.0%)patients were N/U,32 (32.6%)patients were OW,and 16 (16.3%)patients were OB.The pathological complete remission after neoadjuvant chemotherapy was observed, and the prognostic evaluation index was disease-free survival rates.Univariate analysis of BMI and pCR correlations was performed by Chi-square test or Fisher exact test,and logistic regression for multivariate analysis.Kaplan-Meier analysis and log-rank test were used to analyze survival status,and Cox proportional hazard model analysis for multivariate analysis.Results In this study,A statistically significant difference was found in the molecular subtypes of the three groups(P <0.05).Twenty-nine(29.6%)patients achieved pC R,pCR rates in N/U group,OW group and OB group were 36.0%(18/50),25.0%(8/32),and 18.8%(3/16),respectively,but the difference was not statistically significant (P >0.05).Multivariate logistic regression analysis showed that obesity and molecular subtype were independent factors of pCR in all patients (P <0.05 ).The 3-year disease free survival rates of the N/U,OW, and OB groups were 84.0%,93.5%and 80.4%,respectively (P >0.05).Multivariate survival analysis showed that the BMI was not an independent prognostic factor for the 3-year disease free survival rate (P >0.05). Conclusion Excessive BMI (obesity)is an independent predictor of pCR in breast cancer patients receiving neoadjuvant chemotherapy,but does not affect the prognosis of these patients.