体重和体重变化对不同乳腺癌辅助疗法的影响不同
2017年3月31日，欧洲肿瘤内科学会《肿瘤学年鉴》在线发表加拿大（不列颠哥伦比亚癌症中心、维多利亚女王大学、加拿大癌症研究协作组、麦吉尔大学、犹太总医院、圣约翰地区医院、麦克马斯特大学、朱拉文斯基癌症中心、卡尔加里大学、多伦多大学、森尼布鲁克奥德特癌症中心）、美国（哈佛大学、麻省总医院、梅奥医院）的研究报告，发现患者入组时已经增加的体重指数（BMI）和BMI变化将对不同乳腺癌全身辅助疗法的临床转归产生不同影响。
该研究对化疗（MA.5、MA.21）、内分泌疗法（MA.12、MA.14、MA.27）和曲妥珠单抗（HERA/MA.24）的研究数据进行了分析，主要指标为BMI变化对5年无乳腺癌间期（BCFI）的影响，次要指标包括1年和3年的BMI变化、BMI变化对疾病相关生存（DSS）和总生存（OS）的影响、入组时BMI的影响。分层分析包括研究疗法和复合研究分层因素。
结果发现：
在绝经前、中、后早期化疗研究2793例患者中，入组时BMI对任何终点指标均无影响，入组5年后BMI增加对BCFI亦无显著影响（P=0.85），尽管入组1年后BCFI（P=0.03）和DSS（P=0.07）较差。3年、5年的BMI增加与较好的DSS（P=0.01、0.01）和OS（P=0.003、0.05）有相关性。
在绝经前内分泌疗法研究（MA.12）672例患者中，入组时BMI较高患者的1年后BCFI（P=0.02）、1年和5年后DSS（P=0.05和0.004）、5年后OS（P=0.01）较差。BMI增加不影响5年后的BCFI（P=0.90），尽管与1年后的BCFI较差有相关性（P=0.01）。
在绝经后内分泌疗法研究（MA.14、MA.27）8236例患者中，入组时BMI对任何终点转归无显著影响；1年或3年后，BMI变化并不影响BCFI或DSS，尽管BMI平均增加0.3与1年后的OS较好有相关性（P=0.02）。
在曲妥珠单抗研究（HERA/MA.24）1395例患者中，入组时BMI和BMI变化对转归无显著影响。
因此，入组时BMI较高和入组后BMI增加，仅对绝经前内分泌疗法研究患者的转归有不利影响。对化疗、曲妥珠单抗靶向疗法研究患者的转归无显著不利影响。
Ann Oncol. 2017 Mar 31. [Epub ahead of print]
Impact of baseline BMI and weight change in CCTG adjuvant breast cancer trials.
Yerushalmi R, Dong B, Chapman JW, Goss PE, Pollak MN, Burnell MJ, Levine MN, Bramwell VH, Pritchard KI, Whelan TJ, Ingle JN, Shepherd LE, Parulekar WR, Han L, Ding K, Gelmon KA.
British Columbia Cancer Agency, Vancouver, Canada; Canadian Cancer Trials Group (CCTG; formerly, NCIC Clinical Trials Group), Queen's University, Kingston, Canada; Massachusetts General Hospital, Harvard University, Boston, United States; Jewish General Hospital, McGill University, Montreal, Canada; Saint John Regional Hospital, Saint John, Canada; Juravinski Cancer Clinic, Hamilton Health Sciences, McMaster University, Hamilton, Canada; Tom Baker Cancer Centre, Alberta Health Services and University of Calgary, Calgary, Canada; Sunnybrook Odette Cancer Centre and the University of Toronto, Toronto, Canada; Department of Oncology, Mayo Clinic, Rochester, United States.
BACKGROUND: We hypothesized that increased baseline BMI and BMI change would negatively impact clinical outcomes with adjuvant breast cancer systemic therapy.
METHODS: Data from chemotherapy trials MA.5 and MA.21; endocrine therapy MA.12, MA.14 and MA.27; and trastuzumab HERA/MA.24 were analyzed. The primary objective was to examine the effect of BMI change on breast cancer-free interval (BCFI) landmarked at 5-years; secondary objectives included BMI changes at 1- and 3-years; BMI changes on disease-specific survival (DSS) and overall survival (OS); and effects of baseline BMI. Stratified analyses included trial therapy and composite trial stratification factors.
RESULTS: In pre-/peri-/early post-menopausal chemotherapy trials (N=2793), baseline BMI did not impact any endpoint and increased BMI from baseline did not significantly affect BCFI (P=0.85) after 5 years although it was associated with worse BCFI (P=0.03) and DSS (P=0.07) after 1 year. BMI increase by 3- and 5-years was associated with better DSS (P=0.01;0.01) and OS (P=0.003;0.05). In pre-menopausal endocrine therapy trial MA.12 (N=672), patients with higher baseline BMI had worse BCFI (P=0.02) after 1 year, worse DSS (P=0.05;0.004) after 1- and 5-years and worse OS (P=0.01) after 5-years. Increased BMI did not impact BCFI (P=0.90) after 5-years, although it was associated with worse BCFI (P=0.01) after 1-year. In post-menopausal endocrine therapy trials MA.14 and MA.27 (N=8236), baseline BMI did not significantly impact outcome for any endpoint. BMI change did not impact BCFI or DSS after 1- or 3-years, although a mean increased BMI of 0.3 was associated with better OS (P=0.02) after 1-year. With the administration of trastuzumab (N=1395) baseline BMI and BMI change did not significantly impact outcomes.
CONCLUSIONS: Higher baseline BMI and BMI increases negatively affected outcomes only in pre-/peri-/early post-menopausal trial patients. Otherwise, BMI increases similar to those expected in healthy women either did not impact outcome or were associated with better outcomes.
CLINICAL TRIALS NUMBERS: CAN-NCIC-MA5;National Cancer Institute (NCI)-V90-0027; MA.12-NCT00002542; MA.14-NCT00002864; MA.21-NCT00014222; HERA,NCT00045032;CAN-NCIC-MA24; MA-27-NCT00066573.
KEYWORDS: BMI; Disease Specific Survival; Overall survival; Triple Negative; Weight change
PMID: 28379421
DOI: 10.1093/annonc/mdx152