PO.PR01.04 · 预防研究
绝经后女性的中心性和外周性肥胖与乳腺癌风险：11项队列研究的汇总分析
Central and peripheral adiposity and breast cancer risk in postmenopausal women: A pooled analysis of 11 cohort studies
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：以腰围（WC）、臀围（HC）和腰臀比（WHR）衡量的中心性和外周性肥胖，与绝经后乳腺癌（BC）风险呈正相关，但在校正体重指数（BMI）后结果并不一致。我们利用来自11项前瞻性队列的汇总个体水平数据，评估了WC、HC、WHR和身体形态指数（ABSI；基于腰围、身高和体重）与总体绝经后BC风险及按受体状态定义的BC亚型之间的关联。
方法：这些初步分析在402,682名绝经后女性中，采用联盟范围内的五分位数评估了WC、HC、WHR和ABSI与总体BC及三阴性乳腺癌（TNBC）之间的关联。采用Cox比例风险回归模型计算风险比（HR）和95%置信区间（95% CI），校正年龄、问卷年份、研究、BC家族史以及生殖和生活方式因素。分析分别在校正和不校正BMI的情况下进行。
结果：在各研究中位随访2.9-27.5年期间，共记录了20,752例新发浸润性BC（其中TNBC N=998）。绝经后BC比较第5五分位数与第2五分位数的汇总多变量BMI校正HR（95% CI）为：WC 1.14（1.08-1.21）；HC 1.06（0.99-1.14）；WHR 1.10（1.05-1.15）；ABSI 1.03（0.98-1.08）。在从未使用过绝经期激素治疗者中也观察到相似的关联。绝经后TNBC比较第5五分位数与第2五分位数的汇总多变量BMI校正HR（95% CI）为：WC 1.13（0.87-1.46）；HC 0.74（0.45-1.21）；WHR 1.45（1.15-1.84）；ABSI 1.18（0.95-1.47）。
结论：较高相较于较低的WC和WHR与绝经后BC风险增加相关，且独立于BMI。我们的研究结果提示，个体和人群层面预防中心性肥胖的策略可能有助于降低绝经后BC的风险。
汇总多变量（MV）风险比（HR）和95%置信区间（CI） 联盟范围内五分位数 总体 TNBC WC（cm）
<74 0.97（0.92-1.02） 0.92（0.74-1.15） 74-<80 参照 参照 80-<86 1.0（0.95-1.04） 0.89（0.73-1.1） 86-<95 1.06（1.02-1.12） 0.94（0.76-1.17） ≥95 1.14（1.08-1.21） 1.13（0.87-1.46） HC（cm） <95 0.91（0.87-0.96） 0.91（0.60-1.36） 95-<100 参照 参照 100-<105 1.03（0.98-1.08） 1.15（0.82-1.65） 105-<112 1.03（0.98-1.09） 0.92（0.60-1.4） ≥112 1.06（0.99-1.14） 0.74（0.45-1.21） WHR <75 1.02（0.97-1.07） 1.37（1.1-1.69） 75-<79 参照 参照 79-<83 1.04（1.0-1.09） 1.27（1.01-1.59） 83-<87 1.03（0.98-1.08） 1.29（1.02-1.62） ≥87 1.1（1.05-1.15） 1.45（1.15-1.84） ABSI <71 0.97（0.93-1.01） 1.09（0.91-1.32） 71-74 参照 参照 74-77 1.01（0.97-1.05） 1.09（0.89-1.33） 77-81 1.02（0.98-1.07） 1.17（0.95-1.43） ≥81 1.03（0.98-1.08） 1.18（0.95-1.47）
查看英文原文 English abstract
Background: Central and peripheral adiposity, measured by waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR), has been positively associated with postmenopausal breast cancer (BC) risk, but results are inconsistent after adjustment for body mass index (BMI). Using pooled individual-level data from 11 prospective cohorts, we evaluated associations between WC, HC, WHR, and a body shape index (ABSI; based on waist, height, and weight) and risk of postmenopausal BC overall and BC subtypes defined by receptor status.
Methods: These preliminary analyses evaluated associations between WC, HC, WHR, and ABSI using consortium-wide quintiles and overall BC and tumor negative breast cancer (TNBC) in 402,682 postmenopausal women. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CI), adjusting for age, year of questionnaire, study, family history of BC, and reproductive and lifestyle factors. Analyses were performed with and without adjustment for BMI.
Results: During a median follow-up of 2.9-27.5 years across studies, 20,752 incident invasive BC were documented (N=998 TNBC). The pooled multivariable BMI-adjusted HRs (95% CIs) for postmenopausal BC comparing quintile 5 to 2 were 1.14 (1.08-1.21) for WC; 1.06 (0.99-1.14) for HC; 1.10 (1.05-1.15) for WHR, and 1.03 (0.98-1.08) for ABSI. Similar associations were observed among never-users of menopausal hormone therapy. The pooled multivariable BMI-adjusted HRs (95% CIs) for postmenopausal TNBC comparing quintile 5 to 2 were 1.13 (0.87-1.46) for WC; 0.74 (0.45-1.21) for HC; 1.45 (1.15-1.84) for WHR, and 1.18 (0.95-1.47) for ABSI.
Conclusion: Higher compared to lower WC and WHR were associated with increased risk of postmenopausal BC, independent of BMI. Our findings suggest that individual and population-level strategies to prevent central adiposity could help reduce the risk of postmenopausal BC.
Pooled Multivariable (MV) Hazard Ratios (HR) and 95% Confidence Intervals (CI) Consortium-wide quintiles Overall TNBC WC (cm)
<74 0.97 (0.92-1.02) 0.92 (0.74-1.15) 74-<80 REF REF 80-<86 1.0 (0.95-1.04) 0.89 (0.73-1.1) 86-<95 1.06 (1.02-1.12) 0.94 (0.76-1.17) ≥95 1.14 (1.08-1.21) 1.13 (0.87-1.46) HC (cm) <95 0.91 (0.87-0.96) 0.91 (0.60-1.36) 95-<100 REF REF 100-<105 1.03 (0.98-1.08) 1.15 (0.82-1.65) 105-<112 1.03 (0.98-1.09) 0.92 (0.60-1.4) ≥112 1.06 (0.99-1.14) 0.74 (0.45-1.21) WHR <75 1.02 (0.97-1.07) 1.37 (1.1-1.69) 75-<79 REF REF 79-<83 1.04 (1.0-1.09) 1.27 (1.01-1.59) 83-<87 1.03 (0.98-1.08) 1.29 (1.02-1.62) ≥87 1.1 (1.05-1.15) 1.45 (1.15-1.84) ABSI <71 0.97 (0.93-1.01) 1.09 (0.91-1.32) 71-74 REF REF 74-77 1.01 (0.97-1.05) 1.09 (0.89-1.33) 77-81 1.02 (0.98-1.07) 1.17 (0.95-1.43) ≥81 1.03 (0.98-1.08) 1.18 (0.95-1.47)
利益披露 Disclosure
I. Leon-Cepeda, None..
C. Pickett, None..
S. A. Smith-Warner, None..
R. J. MacInnis, None..
J. M. Genkinger, None.