Relationship between body mass indexes and survival prognosis of breast cancer patients with different menopausal status and molecular subtypes

doi:10.3760/cma.j.cn371439-20241125-00128

Abstract

Abstract:

Objective To investigate the relationship between body mass index （BMI） and survival prognosis of invasive breast cancer patients with different menopausal status and molecular subtypes. Methods A total of 2 823 patients with invasive breast cancer who received treatment at the Affiliated Cancer Hospital of Xinjiang Medical University from January 1， 2015 to December 31， 2019 were selected as the study subjects. Patients were divided into four grades according to the clinical classification standard of BMI： underweight （BMI<18.5 kg/m²， n=57）， normal weight （18.5 kg/m²≤BMI<24.0 kg/m²， n=1 289）， overweight （24.0 kg/m²≤BMI<28.0 kg/m²， n=1 061）， and obesity （BMI≥28.0 kg/m²， n=461）. Kaplan-Meier survival curve was drawn to compare the difference of the 5-year overall survival （OS） rates of breast cancer patients with different BMI， and the effect of BMI on the prognosis of breast cancer patients with different menopausal statuses and molecular subtypes was investigated by Cox proportional risk regression model. The dose-response relationship between BMI levels and the risk of all-cause death was further investigated using a RCS function. Results The 5-year OS rates of the invasive breast cancer patients with underweight， normal weight， overweight， obesity were 92.98%， 96.59%， 94.88%， 90.67%， respectively， with a statistically significant difference （χ²=22.11， P<0.001）； the 5-year OS rate of patients with normal weight was better than that of obese patients， with a statistically significant difference （χ²=15.15， P<0.001）. Univariate analysis showed that， obesity was a factor influencing OS of all patients （HR=2.63， 95%CI： 1.73-4.00， P<0.001）， postmenopausal patients （HR=2.47， 95%CI： 1.52-4.02， P<0.001）， Luminal B subtype patients （HR=3.02， 95%CI： 1.64-5.59， P<0.001）， and Luminal B subtype postmenopausal invasive breast cancer patients （HR=2.65， 95%CI： 1.27-5.50， P=0.009）. Multivariate analysis showed that， obesity was an independent factor influencing OS of all patients （HR=1.79， 95%CI： 1.17-2.76， P=0.008）， postmenopausal patients （HR=1.98， 95%CI： 1.20-3.26， P=0.008）， Luminal B subtype patients （HR=2.36， 95%CI： 1.27-4.42， P=0.007）， and Luminal B subtype postmenopausal invasive breast cancer patients （HR=2.39， 95%CI： 1.12-5.11， P=0.024）. When BMI was used as a continuous variable， it showed a U-shaped dose-response relationship with OS of all patients and postmenopausal patients， and the lowest risk points were 24.04， 24.43 kg/m²， respectively. Conclusions Compared with BMI normal weight， obesity significantly reduces the OS rates of all invasive breast cancer patients. Obesity is an independent influencing factor for the OS of all patients， postmenopausal patients， Luminal B subtype and Luminal B subtype postmenopausal invasive breast cancer patients. There is a U-shaped dose-response relationship between BMI and the OS of all patients and postmenopausal patients. When the BMI level of patients exceeds the lowest risk value， the risk of patient death increases with the rise of BMI levels.

Key words: Breast neoplasms, Body mass index, Prognosis, Root cause analysis

Yipala·Yilihamu , Ma Tao, Wang Yan, Gao Chunjie, Liu Jing, Zhao Ting, Wang Lei. Relationship between body mass indexes and survival prognosis of breast cancer patients with different menopausal status and molecular subtypes[J]. Journal of International Oncology, 2025, 52(12): 745-757.

Figures/Tables 12

References 22

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一般临床资料	过轻（n=57）	正常（n=1 289）	超重（n=1 016）	肥胖（n=461）	H/χ²值	P值
年龄（岁）	48.87（39.09，56.25）	50.39（45.71，56.85）	53.70（48.37，59.59）	56.45（49.93，65.28）	156.64	<0.001
绝经状态
未绝经	30	623	330	119	103.45	<0.001
已绝经	27	666	686	342	103.45	<0.001
TNM分期
Ⅰ	24	523	341	113
Ⅱ（ⅡA~ⅡB）	27	552	491	230	49.50	<0.001
Ⅲ（ⅢA~ⅢC）	6	214	184	118
T分期
T₁	33	705	480	172	53.42	<0.001
T₂	22	501	470	247
T₃	1	60	41	35
T₄	1	23	25	7
N分期
N₀	35	764	558	206	30.16	<0.001
≥N₁	22	525	458	255	30.16	<0.001
分子分型
Luminal A型	5	198	174	66	7.91	0.544
Luminal B型	39	749	577	279
HER2阳性型	3	140	110	51
TNBC	10	202	155	65
ER状态
阴性	44	923	738	333	1.03	0.794
阳性	13	366	278	128	1.03	0.794
PR状态
阴性	40	826	667	307	1.82	0.611
阳性	17	463	349	154	1.82	0.611
HER2状态
阴性	14	274	220	89	1.50	0.682
阳性	43	1 015	796	372	1.50	0.682
化疗
否	29	611	501	260	11.09	0.011
是	28	678	515	201	11.09	0.011
放疗
否	50	1 070	854	389	1.38	0.711
是	7	219	162	72	1.38	0.711
内分泌治疗
否	38	856	695	347	12.51	0.006
是	19	433	321	114	12.51	0.006

因素	单因素			多因素
因素	HR值	95%CI	P值	HR值	95%CI	P值
BMI
18.5 kg/m²≤BMI<24.0 kg/m²		Ref			Ref
BMI<18.5 kg/m²	2.22	0.80~6.18	0.127	3.68	1.30~10.37	0.014
24.0 kg/m²≤BMI<28.0 kg/m²	1.50	1.01~2.24	0.048	1.41	0.94~2.12	0.099
BMI≥28.0 kg/m²	2.63	1.73~4.00	<0.001	1.79	1.17~2.76	0.008
绝经状态
未绝经		Ref			Ref
已绝经	1.46	1.02~2.10	0.040	1.35	0.93~1.97	0.114
TNM分期
Ⅰ		Ref			Ref
Ⅱ（ⅡA~ⅡB）	3.90	1.98~7.69	<0.001	1.50	0.61~3.73	0.378
Ⅲ（ⅢA~ⅢC）	16.26	8.43~31.36	<0.001	4.82	1.77~13.13	0.002
T分期
T₁		Ref			Ref
T₂	4.06	2.56~6.45	<0.001	1.97	1.09~3.54	0.024
T₃	10.18	5.71~18.16	<0.001	2.28	1.11~4.68	0.025
T₄	16.80	8.76~32.20	<0.001	3.44	1.56~7.58	0.002
N分期
N₀		Ref			Ref
≥N₁	3.97	2.71~5.81	<0.001	1.47	0.88~2.45	0.144
分子分型
Luminal A型		Ref			Ref
Luminal B型	2.49	1.14~5.42	0.021	1.44	0.65~3.17	0.366
HER2阳性型	4.20	1.78~9.94	0.001	0.47	0.11~1.91	0.288
TNBC	6.47	2.92~14.32	<0.001	0.99	0.25~3.91	0.992
ER状态
阴性		Ref			Ref
阳性	2.67	1.92~3.71	<0.001	2.63	1.04~6.63	0.041
PR状态
阴性		Ref			Ref
阳性	2.50	1.80~3.48	<0.001	1.61	0.89~2.92	0.114
HER2状态
阴性		Ref
阳性	0.74	0.51~1.08	0.117
化疗
否		Ref			Ref
是	0.42	0.29~0.61	<0.001	0.56	0.38~0.82	0.003
放疗
否		Ref
是	0.99	0.53~1.85	0.970
内分泌治疗
否		Ref			Ref
是	0.22	0.11~0.42	<0.001	0.41	0.21~0.81	0.010

因素	单因素			多因素
因素	HR值	95%CI	P值	HR值	95%CI	P值
BMI
18.5 kg/m²≤BMI<24.0 kg/m²		Ref
BMI<18.5 kg/m²	2.62	0.60~11.45	0.202	4.43	0.95~20.65	0.058
24.0 kg/m²≤BMI<28.0 kg/m²	2.27	1.14~4.50	0.019	2.03	0.99~4.13	0.050
BMI≥28.0 kg/m²	2.02	0.79~5.22	0.144	1.11	0.43~2.89	0.825
TNM分期
Ⅰ		Ref			Ref
Ⅱ（ⅡA~ⅡB）	4.49	1.01~19.89	0.048	0.20	0.02~1.98	0.170
Ⅲ（ⅢA~ⅢC）	23.66	5.62~99.69	<0.001	0.75	0.08~7.52	0.809
T分期
T₁		Ref			Ref
T₂	13.23	3.13~55.86	<0.001	16.91	1.83~155.88	0.013
T₃	26.72	5.55~128.67	<0.001	15.57	1.49~163.10	0.022
T₄	53.55	11.12~257.89	<0.001	23.71	2.21~253.84	0.009
N分期
N₀		Ref			Ref
≥N₁	5.92	2.62~13.35	<0.001	2.22	0.82~6.05	0.119
分子分型
Luminal A型		Ref			Ref
Luminal B型	4.38	0.59~32.42	0.149	2.16	0.29~16.32	0.457
HER2阳性型	9.74	1.17~80.96	0.035	2.86×10⁷	0.00~Inf	0.996
TNBC	8.18	1.05~63.42	0.044	4.12×10⁷	0.00~Inf	0.996
ER状态
阴性		Ref			Ref
阳性	2.12	1.14~3.94	0.018	0.00	0.00~Inf	0.996
PR状态
阴性		Ref			Ref
阳性	2.00	1.08~3.70	0.027	0.75	0.17~3.28	0.705
HER2状态
阴性		Ref
阳性	0.58	0.29~1.13	0.107
化疗
否		Ref			Ref
是	0.26	0.13~0.55	<0.001	0.44	0.20~0.95	0.037
放疗
否		Ref
是	0.91	0.27~3.03	0.873
内分泌治疗
否		Ref			Ref
是	0.18	0.05~0.58	0.004	0.37	0.11~1.27	0.109

因素	单因素			多因素
因素	HR值	95%CI	P值	HR值	95%CI	P值
BMI
18.5 kg/m²≤BMI<24.0 kg/m²		Ref			Ref
BMI<18.5 kg/m²	2.11	0.50~8.87	0.306	2.73	0.64~1.67	0.175
24.0 kg/m²≤BMI<28.0 kg/m²	1.19	0.72~1.95	0.498	1.24	0.75~2.06	0.410
BMI≥28.0 kg/m²	2.47	1.52~4.02	<0.001	1.98	1.20~3.26	0.008
TNM分期
Ⅰ		Ref			Ref
Ⅱ（ⅡA~ⅡB）	3.89	1.81~8.34	<0.001	2.29	0.85~6.19	0.103
Ⅲ（ⅢA~ⅢC）	14.47	6.89~30.36	<0.001	6.85	2.23~21.06	<0.001
T分期
T₁		Ref			Ref
T₂	3.23	1.96~5.32	<0.001	1.34	0.72~2.49	0.353
T₃	9.45	4.93~18.12	<0.001	1.77	0.80~3.91	0.160
T₄	14.71	6.51~33.25	<0.001	2.95	1.13~7.67	0.027
N分期
N₀		Ref			Ref
≥N₁	3.51	2.27~5.43	<0.001	1.20	0.66~2.19	0.556
分子分型
Luminal A型		Ref			Ref
Luminal B型	2.25	0.96~5.28	0.061	1.26	0.53~3.02	0.597
HER2阳性型	3.30	1.27~8.58	0.015	0.22	0.05~1.01	0.051
TNBC	6.63	2.79~15.75	<0.001	0.53	0.12~2.34	0.401
ER状态
阴性		Ref			Ref
阳性	2.88	1.95~4.24	<0.001	3.98	1.52~10.41	0.005
PR状态
阴性		Ref			Ref
阳性	2.66	1.79~3.96	<0.001	2.05	1.05~4.02	0.036
HER2状态
阴性		Ref
阳性	0.83	0.52~1.31	0.422
化疗
否		Ref			Ref
是	0.52	0.34~0.80	0.003	0.61	0.39~0.95	0.030
放疗
否		Ref
是	1.06	0.51~2.21	0.878
内分泌治疗
否		Ref			Ref
是	0.26	0.12~0.55	<0.001	0.47	0.21~1.05	0.066

因素	HR值	95%CI	P值	因素	HR值	95%CI	P值
BMI				N分期
18.5 kg/m²≤BMI<24.0 kg/m²		Ref		N₀		Ref
BMI<18.5 kg/m²	0.00	0.00~Inf	0.999	≥N₁	2.68	0.60~11.97	0.197
24.0 kg/m²≤BMI<28.0 kg/m²	3.49	0.36~33.52	0.280	ER状态
BMI≥28.0 kg/m²	9.40	0.98~90.37	0.052	阴性		Ref
绝经状态				阳性	0.00	0.00~Inf	0.998
未绝经		Ref		PR 状态
已绝经	2.82	0.34~23.55	0.337	阴性		Ref
TNM分期				阳性	2.12	0.25~17.59	0.487
Ⅰ		Ref		化疗
Ⅱ（ⅡA~ⅡB）	3.58×10⁸	0.00~Inf	0.998	否		Ref
Ⅲ（ⅢA~ⅢC）	1.65×10⁹	0.00~Inf	0.998	是	0.28	0.03~2.32	0.237
T分期				放疗
T₁		Ref		否		Ref
T₂	6.89	0.72~66.23	0.095	是	0.00	0.00~Inf	0.998
T₃	49.27	4.44~547.06	0.002	内分泌治疗
T₄	56.66	3.53~909.31	0.004	否		Ref
				是	0.00	0.00~Inf	0.998