眾所周知，成年體重增加是乳腺癌發(fā)病的風(fēng)險(xiǎn)因素之一。不過(guò)，成年體重增加對(duì)乳腺癌發(fā)病年齡的影響尚不明確。

　　2019年5月9日，施普林格·自然《乳腺癌研究與治療》在線發(fā)表美國(guó)阿拉巴馬大學(xué)、新墨西哥大學(xué)、圣迭戈加利福尼亞大學(xué)、科羅拉多大學(xué)安舒茨醫(yī)學(xué)中心、互動(dòng)健康、阿拉巴馬大學(xué)伯明翰分校的ENERGY研究回顧分析報(bào)告，調(diào)查了成年早期至中期的體重增加是否影響乳腺癌發(fā)病時(shí)間。

ENERGY: Exercise and Nutrition to Enhance Recovery and Good Health for You (NCT01112839)

　　該多中心隨機(jī)對(duì)照研究于2010～2012年入組693例超重或肥胖的早期乳腺癌完成主要治療后生存者進(jìn)行隨機(jī)減重干預(yù)，本文對(duì)其中660例發(fā)病前體重指數(shù)低于乳腺癌確診時(shí)和確診后生存者的體重指數(shù)變化與發(fā)病年齡進(jìn)行回顧分析，將體重指數(shù)平均增加量四等分，通過(guò)樣條回歸模型和協(xié)方差，分析體重指數(shù)增加與發(fā)病年齡之間的相關(guān)性。

　　結(jié)果發(fā)現(xiàn)，對(duì)種族、地區(qū)、乳腺癌確診時(shí)絕經(jīng)狀態(tài)等其他影響因素進(jìn)行校正后，體重指數(shù)增加越多，發(fā)病年齡顯著越早（P<0.0001）

• 體重指數(shù)增加最少的四分之一患者：發(fā)病年齡52.2±0.73歲

• 體重指數(shù)增加次少的四分之一患者：發(fā)病年齡51.9±0.70歲

• 體重指數(shù)增加次多的四分之一患者：發(fā)病年齡49.6±0.66歲

• 體重指數(shù)增加最多的四分之一患者：發(fā)病年齡47.3±0.67歲

　　根據(jù)腫瘤亞型和絕經(jīng)狀態(tài)分層分析，無(wú)論雌激素受體陽(yáng)性或陰性、孕激素受體陽(yáng)性或陰性、HER2陽(yáng)性、已絕經(jīng)或未絕經(jīng)，體重指數(shù)增加越多，發(fā)病年齡顯著越早（P<0.001）；除了三陰性乳腺癌女性（P=0.052）、圍絕經(jīng)女性（P=0.08）。

　　因此，該研究結(jié)果表明，成年體重增加女性不僅存在乳腺癌風(fēng)險(xiǎn)，而且可能較早發(fā)生癌癥、縮短無(wú)癌人生。

Breast Cancer Res Treat. 2019 May 9.

Adult weight gain accelerates the onset of breast cancer.

Maria Azrad, Cindy K. Blair, Cheryl L. Rock, Rebecca L. Sedjo, Kathleen Y. Wolin, Wendy Demark-Wahnefried.

University of Alabama, Tuscaloosa, USA; University of New Mexico, Albuquerque, USA; University of California, San Diego, USA; University of Colorado Anschutz Medical Campus, Aurora, USA; Interactive Health Inc., Schaumburg, USA; University of Alabama at Birmingham, Birmingham, USA.

PURPOSE: Weight gain in adulthood is a risk factor for breast cancer; however, the impact on age of onset is unknown. The objective of this study was to investigate whether weight gain from early- to mid-adulthood influenced the timing of breast cancer onset.

METHODS: Increase in body mass index (BMI) from lowest adult BMI to BMI at diagnosis and age at which these events occurred were calculated from breast cancer survivors enrolled in a weight loss trial (n=660). Quartiles (Q) of the average increase in BMI were determined and associations between weight gain and age at disease onset were analyzed using analysis of covariance and spline regression models.

RESULTS: A significant linear trend was observed across the quartiles of BMI change for earlier age at diagnosis [Q1 52.3 (±0.73), Q2 51.9 (±0.70), Q3 49.6 (±0.66), Q4 47.3 (±0.67), p<0.0001] after adjusting for potential confounders. In analyses that stratified by tumor subtype and menopausal status, significant linear trends continued to be observed for earlier age at diagnosis across quartiles of BMI for ER±, PR±, HER2+, as well as pre- and postmenopausal status (p-values<0.001).

CONCLUSIONS: Women who gain excess weight during adulthood are not only at risk for breast cancer, but also may experience earlier onset of disease and reduced cancer-free years.

KEYWORDS: Breast cancer; Obesity; Weight gain; Neoplasms

DOI: 10.1007/s10549-019-05268-y