肥胖对老年乳腺癌特征及预后的影响

Effect of obesity on breast cancer characteristics and prognosis in elderly

目的:探讨体质量指数(body mass index,BMI)对老年女性乳腺癌病人临床病理特征及预后的影响。方法:对668例手术治疗早期老年乳腺癌病人进行回顾性分析,评估BMI对病人无病生存期(disease free survival,DFS)和总生存期(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风险比例模型。结果:668例乳腺癌病人BMI值为24.2±3.3,其中肥胖(BMI≥25)病人302例(45.2%)。与非肥胖病人相比,肥胖病人淋巴结转移率较高(P=0.040),肿瘤T分期中T_1比例明显较低(P=0.007)。中位随访时间26.5个月。单因素分析显示BMI、淋巴结转移、组织学分级、ER和PR表达、T分期、Ki67与DFS有关(P均<0.05);淋巴结转移、ER和PR表达、T分期、Ki 67与OS有关(P均<0.05)。多因素分析显示,肥胖的老年乳腺癌病人复发风险高于非肥胖病人(HR=2.064,95%CI:1.169~3.643,P<0.05);肥胖病人与非肥胖病人相比DFS更差,而对OS无显著影响。结论:肥胖是影响早期老年乳腺癌病人预后不良的因素之一。

Objective To evaluate body mass index（BMI） is associated with clinic-pathological characteristics and the effect on prognosis in elder patients with breast cancer. Methods A total of 668 elder females with early breast cancer receiving surgery in our center were retrospectively analyzed. Kaplan-Meier method and Log-rank test were used to evaluate the association of BMI with disease free survival（DFS）, overall survival（OS）. COX model was used for univariate and multivariate analysis. Results The mean BMI was 24.2±3.3, 302（45.2%） were obese patients（BMI≥25）. Obese patients had higher lymph node metastasis rate（P=0.040） and less T_1（P=0.007） than non-obese patients. The median follow-up period was 26.5 months. It was found by univariate analysis that BMI, lymph node metastasis, histologic grade, estrogen receptor（ER） and progesterone receptor（PR） status, T stage and Ki67 value were associated with DFS（P0.05）. Lymph node metastasis, ER and PR status, T stage and Ki67 value were also associated with OS（P0.05）. Multivariate analysis demonstrated that obese patients had higher risk of recurrence compared with non-obese patients. The hazard ratio was 2.064（95%CI： 1.169-3.643, P0.05）. Obese patients had worse DFS but similar OS compared to non-obese patients. Conclusions Obesity was a negative prognostic factor in elder patients with early breast cancer.