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Borsati A, Giannarelli D, Belluomini L, Ciurnelli C, Colonna A, D’Amico I, Daniele A, Del Bianco N, Toniolo L, Trestini I, Tregnago D, Insolda J, Sposito M, Lanza M, Milella M, Schena F, Pilotto S, Avancini A. Exploring the Association between Health-Related Physical Fitness and Quality of Life in Patients with Cancer: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1643. [PMID: 39201201 PMCID: PMC11353676 DOI: 10.3390/healthcare12161643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Whereas an exercise intervention effectively improves patients' quality of life, little information is available about the contribution of each physical fitness component. This study aims to explore the association between physical fitness components and the quality-of-life domain in patients with cancer. Between September 2021 and August 2023, 160 patients with mixed cancer types visiting the Oncology Unit were selected on a consecutive basis according to selection criteria. They underwent a comprehensive baseline assessment including the six-minute walking test, the handgrip strength test, the isometric leg press test, the back scratch, sit and reach tests, their waist-hip ratio, and their body mass index. The European Organization for Research and Treatment of Cancer Quality of Life and Core Questionnaire was used to measure the quality of life. The sample size was based on the use of regression models to study associations between clinical characteristics and fitness outcomes. All of the analyses were performed using the SPSS v.25 statistical package. Patients had a mean age of 58 years, 68% were female, 42% were affected by breast cancer, and all were receiving anticancer treatments. Higher functional capacity was associated with better global health status (p < 0.0001) and physical (p < 0.0001), role (p < 0.0001), emotional (p = 0.026), and social function (p = 0.016) and inversely linked with fatigue (p = 0.001). Lower-limb flexibility was significantly associated with all of the domains except for role and social functions. The waist-hip ratio was inversely associated with physical function (p < 0.0001) and positively related to fatigue (p = 0.037). Exercise programs aiming to improve the quality of life in cancer should be addressed to optimize these fitness components.
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Affiliation(s)
- Anita Borsati
- Department of Medicine, University of Verona, 37129 Verona, Italy;
| | - Diana Giannarelli
- A. Gemelli University Hospital Foundation, IRCCS-Epidemiology&Biostatistic, 00168 Rome, Italy;
| | - Lorenzo Belluomini
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Christian Ciurnelli
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Alessio Colonna
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Irene D’Amico
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Arianna Daniele
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Nicole Del Bianco
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Linda Toniolo
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Ilaria Trestini
- Dietetics Service, Medical Direction, University Hospital of Verona, 37126 Verona, Italy;
| | - Daniela Tregnago
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Jessica Insolda
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Marco Sposito
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Massimo Lanza
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Michele Milella
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Federico Schena
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
| | - Sara Pilotto
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
| | - Alice Avancini
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37126 Verona, Italy; (L.B.); (D.T.); (J.I.); (M.S.); (M.M.); (S.P.)
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy (A.C.); (I.D.); (A.D.); (N.D.B.); (L.T.); (M.L.); (F.S.)
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Fong AJ, Llanos AAM, Hudson SV, Schmitz K, Lu SE, Phillips SM, Manne SL. Online-delivered resistance exercise intervention among racially diverse breast cancer survivors: Feasibility, acceptability, and exploratory outcomes of B-REP. Support Care Cancer 2024; 32:565. [PMID: 39090218 DOI: 10.1007/s00520-024-08769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The aims are to determine the feasibility of an online-delivered resistance exercise program among racially diverse breast cancer survivors and to conduct an exploratory analysis of the intervention on muscular strength, physical activity levels, health-related quality of life, and self-efficacy. METHODS A 2-arm randomized controlled trial study design with assessments at pre- and post-intervention was used. Participants (n = 52) were recruited from clinics at the host institution and randomized to either intervention (n = 28) or minimal contact control (MCC) conditions (n = 24). All participants received a 12-week individualized resistance exercise prescription based on their baseline functional strength assessment. Intervention participants exercised one-on-one once per week over Zoom with an exercise trainer. MCC participants received no supervision. Descriptive statistics were used to determine feasibility and acceptability (primary outcomes). Repeated measures ANOVAs were used to examine exploratory outcomes. RESULTS The intervention demonstrated high rates for feasibility outcomes of enrollment (80.0%) and post-intervention assessment completion (92.9%). Acceptability outcomes were high for session attendance (98.0%) and satisfaction (Mscore = 4.87 out of 5, SD = .18). The intervention group increased upper- (p < .01) and lower- (p < .02) body strength compared to MCC condition. CONCLUSIONS The intervention was feasible, acceptable, and demonstrated increases in muscular strength. Limitations include a small sample recruited from one cancer center. Future research is needed to determine longitudinal impacts of resistance exercise on survivorship outcomes. Online-delivered resistance exercise shows promising efficacy among racially diverse breast cancer survivors. CLINICALTRIALS gov registration: NCT04562233 on September 18, 2020.
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Affiliation(s)
- Angela J Fong
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
| | - Adana A M Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Johnson Medical School, Rutgers Robert Wood, New Brunswick, NJ, USA
| | - Kathryn Schmitz
- Division of Hematology/Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
| | - Shou-En Lu
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sharon L Manne
- Section of Behavioral Sciences, Rutgers Cancer Institute, New Brunswick, NJ, USA
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3
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Kim JS, Song J, Choi S, Kim SM, Park YJ, Park SJ, Cho Y, Oh YH, Jeong S, Kim KH, Park SM. Association between body composition and subsequent cardiovascular diseases among 5-year breast cancer survivors. Nutr Metab Cardiovasc Dis 2024; 34:1787-1797. [PMID: 38658227 DOI: 10.1016/j.numecd.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 02/13/2024] [Accepted: 03/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIMS Cardiovascular disease (CVD) remain one of the leading causes of mortality in breast cancer survivors. This study aimed to investigate the association between body composition and subsequent CVD in breast cancer survivors. METHODS AND RESULTS A retrospective cohort study of more than 70 thousand 5-year breast cancer survivors aged 40 years or older was conducted using data from the National Health Insurance Service of South Korea. Based on the percentage of predicted lean body mass (pLBMP), appendicular skeletal muscle mass (pASMP), and body fat mass (pBFMP), which were calculated using prediction equations with anthropometric data and health habits, groups were equally divided into quartiles. The risk of CVD was evaluated using multivariate Cox proportional hazards regression. Compared to those with the lowest pLBMP and pASMP, those with the highest pLBMP and pASMP had a 38% and 42% lower risk of CVD, respectively. In contrast, those with the highest pBFMP had a 57% higher risk of CVD compared to those with the lowest pBFMP. Each 1 % increase in pLBMP and pASMP was associated with a decreased risk of CVD [pLBMP, adjusted hazard ratio (aHR): 0.96, 95% CI 0.94-0.98, p < 0.05; pASMP, aHR: 0.91, 95% CI 0.87-0.95, p < 0.05] while each 1 % increase in pBFMP was associated with the increased risk of CVD (aHR: 1.05, 95% CI 1.03-1.07, p < 0.01). CONCLUSION In this cohort study, a high pLBMP, a high pASMP, and a low pBFMP were associated with a lower risk of CVD.
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Affiliation(s)
- Ji Soo Kim
- International Healthcare Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jihun Song
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Seulggie Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Young Jun Park
- Medical Research Center, Genomic Medicine Institute, Seoul National University, Seoul, South Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Yoosun Cho
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yun Hwan Oh
- Department of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, South Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, Korea University College of Medicine, Seoul, South Korea
| | - Kyae Hyung Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.
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Sánchez-Díaz CT, Babel RA, Iyer HS, Goldman N, Zeinomar N, Rundle AG, Omene CO, Pawlish KS, Ambrosone CB, Demissie K, Hong CC, Lovasi GS, Bandera EV, Qin B. Neighborhood Archetypes and Cardiovascular Health in Black Breast Cancer Survivors. JACC CardioOncol 2024; 6:405-418. [PMID: 38983388 PMCID: PMC11229551 DOI: 10.1016/j.jaccao.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/23/2024] [Indexed: 07/11/2024] Open
Abstract
Background Maintaining cardiovascular health (CVH) is critical for breast cancer (BC) survivors, particularly given the potential cardiotoxic effects of cancer treatments. Poor CVH among Black BC survivors may be influenced by various area-level social determinants of health, yet the impact of neighborhood archetypes in CVH among this population remains understudied. Objectives This study aimed to characterize the neighborhood archetypes where Black BC survivors resided at diagnosis and evaluate their associations with CVH. Methods We assessed CVH 24 months post-diagnosis in 713 participants diagnosed between 2012 and 2017 in the Women's Circle of Health Follow-Up Study, a population-based study of Black BC survivors in New Jersey. Neighborhood archetypes, identified via latent class analysis based on 16 social and built environment features, were categorized into tertiles. Associations between neighborhood archetypes and CVH scores were estimated using polytomous logistic regression. Results CVH scores were assessed categorically (low, moderate, and optimal) and as continuous variables. On average, Black BC survivors achieved only half of the recommended score for optimal CVH. Among the 4 identified archetypes, women in the Mostly Culturally Black and Hispanic/Mixed Land Use archetype showed the lowest CVH scores. Compared to this archetype, Black BC survivors in the Culturally Diverse/Mixed Land Use archetype were nearly 3 times as likely to have optimal CVH (relative risk ratio: 2.92; 95% CI: 1.58-5.40), with a stronger association observed in younger or premenopausal women. No significant CVH differences were noted for the other 2 archetypes with fewer built environment features. Conclusions Neighborhood archetypes, integrating social and built environment factors, may represent crucial targets for promoting CVH among BC survivors.
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Affiliation(s)
- Carola T Sánchez-Díaz
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Riddhi A Babel
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Hari S Iyer
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Noreen Goldman
- Office of Population Research, Princeton School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA
| | - Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Coral O Omene
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Karen S Pawlish
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, New Jersey, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University School of Public Health, Brooklyn, New York, USA
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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5
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Schindler EA, Takita C, Collado-Mesa F, Reis IM, Zhao W, Yang GR, Acosta LG, Hu JJ. The interrelationship between obesity and race in breast cancer prognosis: a prospective cohort study. BMC Womens Health 2024; 24:312. [PMID: 38816709 PMCID: PMC11138080 DOI: 10.1186/s12905-024-03020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/12/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Obesity is associated with an increased breast cancer risk in postmenopausal women and may contribute to worse outcomes. Black women experience higher obesity and breast cancer mortality rates than non-Black women. We examined associations between race, obesity, and clinical tumor stage with breast cancer prognosis. METHODS We conducted a prospective cohort study in 1,110 breast cancer patients, using univariable and multivariable Cox regression analyses to evaluate the effects of obesity, race/ethnicity, and clinical tumor stage on progression-free and overall survival (PFS and OS). RESULTS 22% of participants were Black, 64% were Hispanic White, and 14% were non-Hispanic White or another race. 39% of participants were obese (body mass index [BMI] ≥ 30 kg/m2). In univariable analyses, tumor stage III-IV was associated with worse PFS and OS compared to tumor stage 0-II (hazard ratio [HR] = 4.68, 95% confidence interval [CI] = 3.52-6.22 for PFS and HR = 5.92, 95% CI = 4.00-8.77 for OS). Multivariable analysis revealed an association between Black race and worse PFS in obese (HR = 2.19, 95% CI = 1.06-4.51) and non-obese (HR = 2.11, 95% CI = 1.05-4.21) women with tumors staged 0-II. Obesity alone was not associated with worse PFS or OS. CONCLUSIONS Results suggest a complex interrelationship between obesity and race in breast cancer prognosis. The association between the Black race and worse PFS in tumor stages 0-II underscores the importance of early intervention in this group. Future studies are warranted to evaluate whether alternative measures of body composition and biomarkers are better prognostic indicators than BMI among Black breast cancer survivors.
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Affiliation(s)
- Emma A Schindler
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 1511, Miami, FL, 33136, USA
| | - Cristiane Takita
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Fernando Collado-Mesa
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Isildinha M Reis
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 1511, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - George R Yang
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 1511, Miami, FL, 33136, USA
| | - Laura G Acosta
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 1511, Miami, FL, 33136, USA
| | - Jennifer J Hu
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 1511, Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
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Omilian AR, Cannioto R, Mendicino L, Stein L, Bshara W, Qin B, Bandera EV, Zeinomar N, Abrams SI, Hong CC, Yao S, Khoury T, Ambrosone CB. CD163 + macrophages in the triple-negative breast tumor microenvironment are associated with improved survival in the Women's Circle of Health Study and the Women's Circle of Health Follow-Up Study. Breast Cancer Res 2024; 26:75. [PMID: 38720366 PMCID: PMC11077737 DOI: 10.1186/s13058-024-01831-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Tumor-associated macrophages (TAMs) are a prominent immune subpopulation in the tumor microenvironment that could potentially serve as therapeutic targets for breast cancer. Thus, it is important to characterize this cell population across different tumor subtypes including patterns of association with demographic and prognostic factors, and breast cancer outcomes. METHODS We investigated CD163+ macrophages in relation to clinicopathologic variables and breast cancer outcomes in the Women's Circle of Health Study and Women's Circle of Health Follow-up Study populations of predominantly Black women with breast cancer. We evaluated 611 invasive breast tumor samples (507 from Black women, 104 from White women) with immunohistochemical staining of tissue microarray slides followed by digital image analysis. Multivariable Cox proportional hazards models were used to estimate hazard ratios for overall survival (OS) and breast cancer-specific survival (BCSS) for 546 cases with available survival data (median follow-up time 9.68 years (IQR: 7.43-12.33). RESULTS Women with triple-negative breast cancer showed significantly improved OS in relation to increased levels of tumor-infiltrating CD163+ macrophages in age-adjusted (Q3 vs. Q1: HR = 0.36; 95% CI 0.16-0.83) and fully adjusted models (Q3 vs. Q1: HR = 0.30; 95% CI 0.12-0.73). A similar, but non-statistically significant, association was observed for BCSS. Macrophage infiltration in luminal and HER2+ tumors was not associated with OS or BCSS. In a multivariate regression model that adjusted for age, subtype, grade, and tumor size, there was no significant difference in CD163+ macrophage density between Black and White women (RR = 0.88; 95% CI 0.71-1.10). CONCLUSIONS In contrast to previous studies, we observed that higher densities of CD163+ macrophages are independently associated with improved OS and BCSS in women with invasive triple-negative breast cancer. Trial registration Not applicable.
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Affiliation(s)
- Angela R Omilian
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | - Rikki Cannioto
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lucas Mendicino
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Leighton Stein
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Wiam Bshara
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bo Qin
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Elisa V Bandera
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nur Zeinomar
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Scott I Abrams
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Thaer Khoury
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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7
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Goldberg C, Greenberg MR, Noveihed A, Agrawal L, Omene C, Toppmeyer D, George MA. Ovarian Suppression: Early Menopause, Late Effects. Curr Oncol Rep 2024; 26:427-438. [PMID: 38305992 DOI: 10.1007/s11912-023-01491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE OF REVIEW Pre-menopausal women diagnosed with hormone receptor (HR) breast cancer are candidates for prolonged hypoestrogenism to improve cancer outcomes. However, the disease benefit eclipses the toxicities associated with ovarian function suppression (OFS), which are often under-reported. RECENT FINDINGS Increased risk of mortality from cardiovascular disease, bone disorders, and metabolic disorders is well reported in women with no history of cancer, after surgical oophorectomy or premature ovarian failure. Vasomotor symptoms, urogenital atrophy, weight gain, sexual dysfunction, cognitive decline, and sleep disturbances contribute to the increased non-compliance associated with OFS, especially in younger women. Balancing the toxicities of prolonged OFS with its benefits should be critically analyzed by providers when making recommendations for their patients. Supportive care to manage multi-system toxicities and to counteract the long-term impact on all-cause mortality should be emphasized by every cancer program. Future studies with OFS should incorporate patient outcomes and strategies for symptom management in addition to focusing on improving disease outcomes.
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Affiliation(s)
- Chaya Goldberg
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | | | - Coral Omene
- Rutgers Cancer Institute of New Jersey, Rutgers, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Deborah Toppmeyer
- Rutgers Cancer Institute of New Jersey, Rutgers, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Mridula A George
- Rutgers Cancer Institute of New Jersey, Rutgers, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
- The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
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8
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Edmonds MC, Bickell NA, Gallagher EJ, LeRoith D, Lin JJ. Racial differences in weight perception among Black and White women diagnosed with breast cancer. J Cancer Surviv 2024; 18:531-540. [PMID: 36169797 PMCID: PMC10166002 DOI: 10.1007/s11764-022-01255-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Black women are more likely than White women to have obesity, and obesity is associated with worse breast cancer prognosis. Weight perception, however, has not been studied as a potential mediator of obesity disparities in women with breast cancer. In this study, we sought to describe racial differences and the association of lifestyle factors with weight perception. METHODS In this cross-sectional study design, Black and White women with a new primary breast cancer were surveyed about socio-demographics, weight perception, diet, and exercise habits. Height and weight were measured at enrollment. We classified women with a BMI ≥ 25 kg/m2 or waist circumference ≥ 88 cm who reported that they were "about the right weight" as under-perceivers. Chi-square and t tests were used to assess study variables (e.g., race, physical activity) associated with under-perception of weight. Logistic regression models were fit to evaluate for racial differences in under-perception while controlling for other covariates. RESULTS Of 1,197 women with newly diagnosed breast cancer, the average age was 58 years, and 909 (75.9%) were White. Nine hundred eighteen (77%) had stage I cancer, 1,035 (87%) had estrogen receptor positive cancer, and 795 (66%) were privately insured at time of diagnosis. Seven hundred eighty-nine (66%) women had abdominal obesity (waist circumference ≥ 88 cm), while 366 (31%) women had a BMI ≥ 25 kg/m2. Overall, 24% of women were under-perceivers. Compared to White women, Black women with WC ≥ 88 cm more frequently under-perceived their weight (24% vs. 14% p < 0.0001) were more obese with BMI > 30 kg/m2 (51% vs. 23%, p < 0.0001) and had lower physical activity (22% vs. 77%, p < 0.0001). After controlling for age, education, and stage, Black women remained more likely to under-perceive their weight relative to White women for those with BMI ≥ 25 kg/m2 (OR: 2.64; 95% CI: 1.4-4.6) or waist circumference ≥ 88 cm (OR: 2.89; 95% CI: 1.8-4.5). With respect to lifestyle factors, among women with BMI ≥ 25 kg/m2, those who met physical activity guidelines were less likely to under-perceive their weight compared to those who did not meet physical activity guidelines (OR: 0.37; 95% CI: 0.2-0.6), regardless of race. CONCLUSIONS We found racial differences in weight perception and identified social determinants and lifestyle factors such as lower education and physical inactivity that influenced under-perception of weight among newly diagnosed breast cancer patients. IMPLICATIONS FOR CANCER SURVIVORS Since obesity is associated with worse breast cancer outcomes, identifying optimal modifiable factors to intervene upon to support weight management among breast cancer survivors is clinically important. Breast cancer patients' perceptions about their weight provide insight that may inform lifestyle behavior interventions to reduce obesity during survivorship care.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Nina A Bickell
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily J Gallagher
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Derek LeRoith
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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9
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Liu W, Li B, Liu D, Zhao B, Sun G, Ding J. Obesity correlates with the immunosuppressive ILC2s-MDSCs axis in advanced breast cancer. Immun Inflamm Dis 2024; 12:e1196. [PMID: 38501542 PMCID: PMC10949396 DOI: 10.1002/iid3.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/20/2024] Open
Abstract
AIM We investigated the relationship between the group 2 innate lymphoid cells (ILC2s)-myeloid-derived suppressor cells (MDSCs) axis and obesity-related breast cancer. METHODS Fifty-eight patients with breast cancer who had first relapse and metastasis between January 2019 and August 2021 were enrolled. The proportions of ILC2s and MDSCs in blood and the levels of cytokines in serum were detected with flow cytometry. Correlation analysis among clinical characteristics (such as body mass index [BMI]), cytokines, ILC2s, and MDSCs was conducted. RESULTS There was a significant difference in the proportions of ILC2s and MDSCs between the high BMI group and the normal BMI group (p < .05). In the triple-negative breast cancer (TNBC) patients, the proportions of ILC2s and MDSCs in the obese group were significantly higher than those in the nonobese group (p < .05). In all breast cancer patients, there was a positive correlation between BMI and the ILC2s-MDSCs axis (p < .05). However, there was no correlation observed between the number of metastases, progression-free survival, and the ILC2s-MDSCs axis (p > .05). Additionally, ILC2s showed positive correlations with MDSCs, interleukin-5 (IL-5), IL-10, IL-17A, (PD-L1), programmed cell death 2 ligand 2 (PD-L2), and molecular typing (p < .05). Similarly, MDSCs exhibited positive correlations with IL-5, IL-8, IL-9, IL-17A, PD-L1, and PD-L2 (p < .05). In patients with TNBC, there was a positive correlation between BMI and IL-5 (p < .05). CONCLUSION Conclusively, obesity may enhance the immunosuppressive effect of the ILC2-MDSC axis in advanced breast cancer. IL-5 may play a vital role in the ILC2-MDSC axis and obesity in TNBC.
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Affiliation(s)
- Wei Liu
- School of Public HealthXinjiang Medical UniversityUrumqiPeople's Republic of China
- Department of Mammary MedicineAffiliated Tumor Hospital of Xinjiang Medical UniversityUrumqiPeople's Republic of China
- Department of Internal Medicinethe Third Clinical College of Xinjiang Medical UniversityUrumqiPeople's Republic of China
- Xinjiang Uygur Autonomous Region Cancer Center/Xinjiang Key Laboratory of OncologyUrumqiPeople's Republic of China
- Xinjiang Key Laboratory of Molecular Biology for Endemic DiseasesUrumqiXinjiangPeople's Republic of China
- Key Laboratory of Oncology of Xinjiang Uyghur Autonomous RegionUrumqiXinjiangPeople's Republic of China
| | - Bingyu Li
- Department of Mammary MedicineAffiliated Tumor Hospital of Xinjiang Medical UniversityUrumqiPeople's Republic of China
- Department of Internal Medicinethe Third Clinical College of Xinjiang Medical UniversityUrumqiPeople's Republic of China
- Xinjiang Uygur Autonomous Region Cancer Center/Xinjiang Key Laboratory of OncologyUrumqiPeople's Republic of China
| | - Dan Liu
- Department of Mammary MedicineAffiliated Tumor Hospital of Xinjiang Medical UniversityUrumqiPeople's Republic of China
- Department of Internal Medicinethe Third Clinical College of Xinjiang Medical UniversityUrumqiPeople's Republic of China
- Xinjiang Uygur Autonomous Region Cancer Center/Xinjiang Key Laboratory of OncologyUrumqiPeople's Republic of China
| | - Bing Zhao
- Department of Mammary MedicineAffiliated Tumor Hospital of Xinjiang Medical UniversityUrumqiPeople's Republic of China
- Department of Internal Medicinethe Third Clinical College of Xinjiang Medical UniversityUrumqiPeople's Republic of China
- Xinjiang Uygur Autonomous Region Cancer Center/Xinjiang Key Laboratory of OncologyUrumqiPeople's Republic of China
| | - Gang Sun
- Xinjiang Uygur Autonomous Region Cancer Center/Xinjiang Key Laboratory of OncologyUrumqiPeople's Republic of China
- Department of Breast and Thyroid SurgeryAffiliated Tumor Hospital of Xinjiang Medical UniversityUrumqiXinjiangPeople's Republic of China
| | - Jianbing Ding
- Xinjiang Key Laboratory of Molecular Biology for Endemic DiseasesUrumqiXinjiangPeople's Republic of China
- Department of Immunology, School of Basic Medical SciencesXinjiang Medical UniversityUrumqiXinjiangPeople's Republic of China
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10
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Wang Y, Hua Y, Zhang H, Liang S, Cao Z, Chen L, Su Z, Zhang W. Ratio of waist circumference to body mass index: A novel predictor of clinical outcome in hypertension patients. J Clin Hypertens (Greenwich) 2024; 26:24-35. [PMID: 37864476 PMCID: PMC10795094 DOI: 10.1111/jch.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023]
Abstract
We aim to investigate the influence of waist circumference and body mass index (BMI) on all-cause death and cardiovascular-specific death in patients with hypertension. This prospective cohort study, based on waist circumference and body mass index measurements in patients with hypertension, provided risk estimates of all-cause mortality and cardiovascular events. The waist circumference-to-BMI ratio (WtBR) is an anthropometric measure integrating waist circumference and BMI. We utilized multivariable Cox regression analysis, restricted cubic spline model, Kaplan-Meier plot, random forest analysis, and sensitivity analysis to assess the relationship of WtBR with all-cause mortality. Subsequently, Fine-Gray competing risk regression models were applied to precisely evaluate the probability of cardiovascular-specific death attributed to high WtBR. The results indicate that thea deceased group showed significantly higher WtBR and lower BMI compared with the alive groups (P < .05), while no significant difference was observed in waist circumference (P = .373). When analyzed as continuous, the risk of all-cause death elevated with increasing WtBR in the adjusted model with an HR of 2.42 (95% CI, 2.06-2.85). The restricted cubic spline illustrated an elevated risk of all-cause mortality as WtBR increased (J-shaped curve). Nevertheless, WtBR showed no significant association with cardiovascular-specific death and the prediction model exhibited a reliable performance in the testing set. This study supported that WtBR, an anthropometric measure, is independently associated with all-cause death in hypertensive patients. It's advisable to routinely assess waist circumference in hypertensive patients regardless of BMI, in order to more effectively manage the risk of obesity-related health.
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Affiliation(s)
| | - Yang Hua
- Nanjing Medical UniversityNanjingChina
| | | | | | | | - Lu‐Lu Chen
- Department of Anatomy, Histology, and EmbryologyNanjing Medical UniversityNanjingChina
| | | | - Wei Zhang
- Department of Anatomy, Kangda CollegeNanjing Medical UniversityLianyungangJiangsuChina
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11
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Crispo A, Augustin LSA, Luongo A, Calderaio C, Breda J, Coluccia S, Calabrese A, Marrazzo V, Giannatiempo R, Trasacco P, Palumbo E, Vitale S, Porciello G, Di Gennaro P, Caputo R, Buono G, Vernieri C, Schettini F, Grimaldi M, Nocerino F, Celentano E, Amore A, Giuliano M, De Placido P, De Angelis C, Bianco R, De Laurentiis M, La Vecchia C, Arpino G. Central obesity, body mass index, metabolic syndrome and mortality in Mediterranean breast cancer patients. Sci Rep 2023; 13:21208. [PMID: 38040773 PMCID: PMC10692221 DOI: 10.1038/s41598-023-45439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/19/2023] [Indexed: 12/03/2023] Open
Abstract
Obesity and metabolic disorders have been associated with poor outcomes in non-Mediterranean breast cancer (BC) patients. The purpose of this study was to investigate the prognostic potential of anthropometric variables in patients with early BC living in Southern Mediterranean region of Italy. We enrolled 955 consecutive early BC patients treated in hospitals in Naples between 2009 and 2013 (median follow-up 11.8-year ending 15/09/2022). Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and metabolic syndrome (MetS) were collected. All-cause and BC-specific mortality were calculated. At the last day of contact 208 (22%) patients had died, 131 (14%) from BC. High WC (≥ 88 cm) or WHR (> 0.85) and the MetS were significantly associated with moderately increased risk of all-cause mortality (HR=1.39, 1.62, 1.61, respectively). A significant increased risk of BC-specific mortality was found in obese patients, in those with high WC, high WHR and those with MetS (HR=1.72, 1.71, 1.80, 1.81, respectively). Central obesity significantly increased total and BC-specific mortality particularly in pre-menopausal women and in luminal subtypes, while in post-menopause MetS was a stronger risk factor. Obesity and MetS may impair the effectiveness of BC therapies hence active lifestyle interventions are encouraged.
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Affiliation(s)
- Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Livia S A Augustin
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Claudia Calderaio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy
| | - Joao Breda
- WHO Athens Quality of Care Office, Athens, Greece
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Alessandra Calabrese
- Department of Senology, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, NA, Italy
| | - Vittorio Marrazzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy
| | | | - Paola Trasacco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy
| | - Elvira Palumbo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Sara Vitale
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Roberta Caputo
- Department of Senology, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, NA, Italy
| | - Giuseppe Buono
- Department of Senology, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, NA, Italy
| | - Claudio Vernieri
- IFOM ETS, the AIRC Institute of Molecular Oncology, Milan, Italy
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Flavia Nocerino
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Alfonso Amore
- Division of Surgery of Melanoma and Skin Cancer, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy.
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA.
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy
| | - Michelino De Laurentiis
- Department of Senology, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Naples, NA, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy
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12
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Kim JS, Song J, Choi S, Park SM. Changes in body composition and subsequent cardiovascular disease risk among 5-year breast cancer survivors. Front Cardiovasc Med 2023; 10:1259292. [PMID: 38054098 PMCID: PMC10694451 DOI: 10.3389/fcvm.2023.1259292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
Introduction Cardiovascular disease (CVD) remains a leading cause of death in breast cancer survivors, a growing population. The aim of this study was to determine whether changes in body composition, commonly observed in breast cancer survivors, is associated with subsequent CVD risk. Methods This cohort study used the Korean National Health Insurance Service database. The study population included 73,271 5-year breast cancer survivors aged 40 years or above. To assess changes in body composition and its effect on the risk of CVD, validated prediction equations and multivariate Cox proportional hazards regression were used. Changes in metabolic markers (blood pressure, total cholesterol, and fasting serum glucose) according to changes in body composition were calculated by multiple linear regression. Results Having persistently high predicted lean body and appendicular skeletal muscle mass percentages (LBMP and ASMP, respectively) among breast cancer survivors was associated with 32% and 40% lower CVD risks than a persistently low predicted LBMP or ASMP, respectively. Conversely, persistently high predicted body fat mass percentage (BFMP) was associated with a higher CVD risk than persistently low predicted BFMP. Additionally, those with a low to high change in predicted BFMP had a higher risk of CVD than those with persistently low predicted BFMP. Changes in body composition were accompanied by changes in metabolic markers. Discussion Maintaining high percentages of lean body and appendicular skeletal muscle mass and preventing an increase in fat mass may be beneficial in preventing CVD in breast cancer survivors.
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Affiliation(s)
- Ji Soo Kim
- International Healthcare Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jihun Song
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Seulggie Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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13
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Schindler EA, Takita C, Collado-Mesa F, Reis IM, Zhao W, Yang GR, Acosta LG, Hu JJ. The Interrelationship between Obesity and Race in Breast Cancer Prognosis: A Prospective Cohort Study. RESEARCH SQUARE 2023:rs.3.rs-3338366. [PMID: 37841856 PMCID: PMC10571610 DOI: 10.21203/rs.3.rs-3338366/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Purpose Obesity is associated with an increased breast cancer risk in postmenopausal women and may contribute to worse outcomes. Black women experience higher obesity and breast cancer mortality rates than non-Black women. We examined associations between race, obesity, and clinical tumor stage with breast cancer prognosis. Methods We conducted a prospective cohort study in 1,110 breast cancer patients, using univariable and multivariable Cox regression analyses to evaluate the effects of obesity, race/ethnicity, and clinical tumor stage on progression-free and overall survival (PFS and OS). Results 22% of participants were Black, 64% were Hispanic White, and 14% were non-Hispanic White or another race. 39% of participants were obese (body mass index [BMI] ≥ 30 kg/m2). In univariable analyses, tumor stage III-IV was associated with worse PFS and OS compared to tumor stage 0-II (hazard ratio [HR] = 4.68, 95% confidence interval [CI] = 3.52-6.22 for PFS and HR = 5.92, 95% CI = 4.00-8.77 for OS). Multivariable analysis revealed an association between Black race and worse PFS in obese (HR = 2.19, 95% CI = 1.06-4.51) and non-obese (HR = 2.11, 95% CI = 1.05-4.21) women with tumors staged 0-II. Obesity alone was not associated with worse PFS or OS. Conclusion Results suggest a complex interrelationship between obesity and race in breast cancer prognosis. The association between Black race and worse PFS in tumor stages 0-II underscores the importance of early intervention in this group. Future studies are warranted to evaluate whether alternative measures of body composition and biomarkers are better prognostic indicators than BMI among Black breast cancer survivors.
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Affiliation(s)
| | - Cristiane Takita
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Fernando Collado-Mesa
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Isildinha M Reis
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Wei Zhao
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - George R Yang
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Laura G Acosta
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Jennifer J Hu
- University of Miami Miller School of Medicine: University of Miami School of Medicine
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14
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Dai M, Xia B, Xu J, Zhao W, Chen D, Wang X. Association of waist-calf circumference ratio, waist circumference, calf circumference, and body mass index with all-cause and cause-specific mortality in older adults: a cohort study. BMC Public Health 2023; 23:1777. [PMID: 37700278 PMCID: PMC10498546 DOI: 10.1186/s12889-023-16711-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Waist circumference (WC), calf circumference (CC), and body mass index (BMI) have been independently linked to mortality. However, it's not yet clear how the waist-calf circumference ratio (WCR) relates to mortality. This study aims to investigate the relationship between WCR, WC, CC, and BMI with all-cause and cause-specific mortality in older adults. METHODS In the 2014 Chinese Longitudinal Healthy Longevity Survey, 4627 participants aged 65 years and older were included, and they were subsequently followed up in 2018. Cox proportional hazards models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality, based on WCR, WC, CC, and BMI. RESULTS During a median follow-up of 3.4 years, 1671 deaths (36.1%) occurred. Compared to the second quartile of WCR, the highest quartile had a higher risk of mortality from all causes (HR 1.42, 95%CI 1.24-1.64), cardiovascular disease (CVD) (HR 1.88, 95%CI 1.38-2.56), and other causes (HR 1.37, 95%CI 1.15-1.63). The first and fourth quartiles of WC had HRs of 2.19 (1.00-4.79) and 2.69 (1.23-5.89), respectively, for cancer mortality. The highest quartile of CC was associated with a lower risk of all-cause and other-cause mortality, whereas the lowest quartile was associated with a higher risk of all-cause, CVD, and other-cause mortality compared to the second CC quartile. Additionally, the lowest quartile of BMI was associated with a higher risk of all-cause and respiratory disease mortality. Interaction analyses showed that the effects of CC on all-cause and CVD mortality were more pronounced in adults aged ≥ 80 years (P-interaction < .05). CONCLUSIONS Higher WCR and lower CC increased the risk of all-cause, CVD, and other-cause mortality. Lower BMI was associated with higher all-cause and respiratory disease mortality risk, while WC only predicted cancer mortality.
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Affiliation(s)
- Miao Dai
- Department of Geriatrics, Jiujiang First People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Bin Xia
- Department of Geriatrics, Jiujiang First People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Jiangqi Xu
- Department of Geriatrics, Jiujiang First People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Weiyun Zhao
- Department of Geriatrics, Jiujiang First People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Dongdong Chen
- Department of Geriatrics, Jiujiang First People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Xiang Wang
- Department of Cardiology, Jiujiang First People's Hospital, Jiujiang, 332000, Jiangxi, China.
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Izuegbuna OO, Sodiq T, Olawumi HO, Olatoke SA, Agodirin O. Body composition, energy expenditure and caloric intake among breast cancer patients at a teaching hospital in Nigeria-a cross sectional study. Ecancermedicalscience 2023; 17:1600. [PMID: 37799944 PMCID: PMC10550329 DOI: 10.3332/ecancer.2023.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Indexed: 10/07/2023] Open
Abstract
Objective This cross-sectional study was conducted on the associations between body composition, energy expenditure and caloric intake among 45 Nigerian breast cancer patients. Methods Forty-five Nigerian breast cancer patients were measured and analysed for their body composition, energy expenditure and caloric intake. Statistical analyses included a chi-square test, Student's t-test, paired t-test, Spearman correlation and linear regression using Statistical Package for the Social Sciences 23.0. Results The body fat indices (body mass index (BMI), fat mass index (FMI), and body fats percentage) show that more than 50% of breast cancer patients were either overweight or obese. The Spearman correlation showed that fat-free mass (FFM) was the most strongly correlated with energy expenditure (r = 0.84). BMI and (FMI - fat mass in relation to height) were significantly correlated with the Harris-Benedict equation for energy expenditure (p < 0.001; p = 0.002), but they were not correlated significantly with the Karnofsky performance status. A paired t-test showed that caloric intake was significantly higher than total energy expenditure (p < 0.001). FFM was the best predictor of resting energy expenditure (REE). Conclusion In conclusion, FFM remains the best predictor of REE. High body mass and high caloric intake indicate the need for support from nutritional programmes.
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Affiliation(s)
- Ogochukwu O Izuegbuna
- Department of Haematology and Blood Transfusion, University of Ilorin Teaching Hospital, Ilorin 241102, Nigeria
| | - Toyin Sodiq
- Dietetics Unit, University of Ilorin Teaching Hospital, Ilorin 241102, Nigeria
| | - Hannah O Olawumi
- Department of Haematology and Blood Transfusion, University of Ilorin Teaching Hospital, Ilorin 241102, Nigeria
| | - Samuel A Olatoke
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin 241102, Nigeria
| | - Olayide Agodirin
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin 241102, Nigeria
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16
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Huang LK, Lin YC, Chuang HH, Chuang CK, Pang ST, Wu CT, Chang YH, Yu KJ, Lin PH, Kan HC, Chu YC, Hung WK, Hsieh ML, Shao IH. Body composition as a predictor of oncological outcome in patients with non-muscle-invasive bladder cancer receiving intravesical instillation after transurethral resection of bladder tumor. Front Oncol 2023; 13:1180888. [PMID: 37637042 PMCID: PMC10448957 DOI: 10.3389/fonc.2023.1180888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/07/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Body status, categorized as sarcopenia or obesity and assessed using body mass index and body composition, affects the outcome of bladder cancer patients. However, studies comparing disease progression, recurrence, or overall survival in patients with non-muscle-invasive bladder cancer (NMIBC) with different body compositions are lacking. Therefore, we conducted a retrospective study to identify the impact of body composition, sarcopenia, and obesity on the oncological prognosis of patients with NMIBC who underwent transurethral resection of bladder tumor (TURBT) with Bacillus Calmette-Guerin (BCG) intravesical instillation (IVI). Methods Patients with NMIBC who had undergone TURBT with adjuvant IVI with BCG from March 2005 to April 2021 were included. Body composition parameters were evaluated using computed tomography images of the third lumbar vertebrae and further categorized by sarcopenia and obesity. Oncological outcomes including recurrence-free survival (RFS), progression-free survival, and overall survival (OS) after treatment were analyzed. Results A total of 269 patients were enrolled. Subcutaneous adipose tissue (SAT) density was a significant predictor of RFS, whereas psoas muscle density was a significant predictor of OS in the multivariate analysis. Patients with sarcopenia but without obesity tolerated significantly fewer BCG IVIs than patients without sarcopenia or obesity. Patients with sarcopenia had poorer RFS and OS than those without sarcopenia. In contrast, patients with obesity had better OS than those without obesity. Discussion Body composition parameters, including SAT density and psoas muscle density, emerged as significant predictors of OS and RFS, respectively. Hence, our findings indicate that body composition is a helpful measurement to assess the oncological outcomes of patients with NMIBC.
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Affiliation(s)
- Liang-Kang Huang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung and Chang Gung University, Taoyuan, Taiwan
| | - Hai-Hua Chuang
- Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Te Wu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Department of Urology, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei, Taiwan
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hung-Cheng Kan
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yuan-Cheng Chu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Kang Hung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Li Hsieh
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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17
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Iyer HS, Zeinomar N, Omilian AR, Perlstein M, Davis MB, Omene CO, Pawlish K, Demissie K, Hong CC, Yao S, Ambrosone CB, Bandera EV, Qin B. Neighborhood Disadvantage, African Genetic Ancestry, Cancer Subtype, and Mortality Among Breast Cancer Survivors. JAMA Netw Open 2023; 6:e2331295. [PMID: 37647068 PMCID: PMC10469269 DOI: 10.1001/jamanetworkopen.2023.31295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
Importance Racial disparities in breast cancer (BC) survival arise from multilevel causes, which may exert influence at different stages of BC progression. Clarifying the importance of genetic and social factors could help prioritize interventions. Objective To jointly examine associations between African genetic ancestry, social environment, and mortality from any cause and BC in Black BC survivors. Design, Setting, and Participants This population-based cohort study enrolled self-identified Black women aged 20 to 75 years with histologically confirmed BC from June 2005 to May 2019 and followed them up until death or censoring in September 2021. Participants lived in 10 New Jersey counties. Data were analyzed between December 2022 and April 2023. Exposures A neighborhood socioeconomic status (nSES) index composed of census tract measures (education, income, wealth, employment status, and occupation) was linked to residential addresses at diagnosis. Percentage African ancestry was estimated using the ADMIXTURE program. Main Outcomes and Measures Sequentially adjusted (age adjusted: age and interview year; fully adjusted: age adjusted with individual SES, lifestyle factors, and comorbidities) logistic regression models were fit to estimate associations with tumor subtypes (estrogen receptor-negative [ER-] vs estrogen receptor-positive [ER+]; triple-negative breast cancer [TNBC] vs luminal A), and Cox models were fit for associations with all-cause mortality (ACM) and breast cancer-specific mortality (BCSM). Models for BCSM were fit using Fine-Gray competing risks models, and robust standard errors were used to account for census tract-level clustering. Results Among 1575 participants, median (IQR) African ancestry was 85% (76%-90%), and median (IQR) age was 55 (46-63) years. A 10-percentage point increase in African ancestry was associated with higher odds of ER- vs ER+ (adjusted odds ratio [aOR], 1.08; 95% CI, 0.98-1.18) and TNBC vs luminal (aOR, 1.15; 95% CI, 1.02-1.31) tumors, but not with ACM or BCSM. A 1-IQR increase in nSES was associated with lower ACM (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.63-0.93), and the HR for BCSM was less than 1 but not statistically significant (aHR, 0.81; 95% CI, 0.62-1.04) in age-adjusted models, but associations attenuated following further adjustment for potential mediators (individual SES, lifestyles, comorbidities). Conclusions and Relevance In this cohort study of Black female BC survivors, higher African ancestry was associated with aggressive tumor subtypes. Compared with genetic ancestry, mediating pathways related to social environments may be more important for survival in these patients.
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Affiliation(s)
- Hari S. Iyer
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Angela R. Omilian
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Marley Perlstein
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Melissa B. Davis
- Institute of Genomic Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Coral O. Omene
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Karen Pawlish
- Cancer Epidemiology Services, New Jersey State Cancer Registry, New Jersey Department of Health, Trenton
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University School of Public Health, Brooklyn, New York
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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18
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Harborg S, Feldt M, Cronin-Fenton D, Klintman M, Dalton SO, Rosendahl AH, Borgquist S. Obesity and breast cancer prognosis: pre-diagnostic anthropometric measures in relation to patient, tumor, and treatment characteristics. Cancer Metab 2023; 11:8. [PMID: 37370158 DOI: 10.1186/s40170-023-00308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE Examine the association between obesity and clinical outcomes in early breast cancer and assess if patient, tumor, and treatment characteristics modify such associations in Malmö Diet and Cancer Study patients (MDCS). METHODS The MDCS enrolled 17,035 Swedish women from 1991 to 1996. At enrollment, participants' body mass index (BMI), waist circumference and body fat percentage measures were collected. We identified all female MDCS participants with invasive breast cancer from 1991 to 2014. Follow-up began at breast cancer diagnosis and ended at breast cancer recurrence (BCR), death, emigration, or June 8, 2020. The World Health Organization guidelines were used to classify BMI, waist circumference, and body fat percentage into three categories of healthy weight, overweight, and obesity. We fit Cox regression models to compute adjusted hazard ratios (HRs) with 95% confidence intervals (CI) of BCR according to body composition. To evaluate effect measure modification, we stratified Cox models by patient, tumor, and treatment characteristics. RESULTS In total, 263 BCRs were diagnosed over 12,816 person-years among 1099 breast cancer patients with a median follow-up of 11.1 years. Obesity according to BMI (HR = 1.44 [95%CI 1.00-2.07]), waist circumference (HR = 1.31 [95%CI 0.98-1.77]), and body fat percentage (HR = 1.41 [95%CI 1.02-1.98]) was associated with increased risk of BCR compared with healthy weight. Obesity was stronger associated with BCR in patients with low socioeconomic position (HR = 2.55 [95%CI 1.08-6.02]), larger tumors > 20 mm (HR = 2.68 [95%CI 1.42-5.06]), estrogen-receptor-negative breast cancer (HR = 3.13 [95%CI 1.09-8.97]), and with adjuvant chemotherapy treatment (HR = 2.06 [95%CI 1.08-4.31]). CONCLUSION Higher pre-diagnostic BMI, waist circumference, and body fat percentage was associated with increased risk of BCR. The association between obesity and BCR appears dependent on patient, tumor, and treatment characteristics.
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Affiliation(s)
- Sixten Harborg
- Department of Oncology, Aarhus University/Aarhus University Hospital, Entrance C, Level 1, C106, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
| | - Maria Feldt
- Department of Clinical Sciences Lund, Oncology, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Marie Klintman
- Department of Clinical Sciences Lund, Oncology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Services, Zealand University Hospital, Næstved, Denmark
| | - Ann H Rosendahl
- Department of Clinical Sciences Lund, Oncology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Signe Borgquist
- Department of Oncology, Aarhus University/Aarhus University Hospital, Entrance C, Level 1, C106, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Sciences Lund, Oncology, Lund University, Skåne University Hospital, Lund, Sweden
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19
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Fong AJ, Llanos AAM, Ashrafi A, Zeinomar N, Chokshi S, Bandera EV, Devine KA, Hudson SV, Qin B, O’Malley D, Paddock LE, Stroup AM, Evens AM, Manne SL. Sociodemographic and Health Correlates of Multiple Health Behavior Adherence among Cancer Survivors: A Latent Class Analysis. Nutrients 2023; 15:2354. [PMID: 37242237 PMCID: PMC10223681 DOI: 10.3390/nu15102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
The study aimed to (a) assess current levels of adherence to the National Comprehensive Cancer Network's multiple health behavior guidelines and (b) identify characteristics of cancer survivors associated with different adherence levels. Cancer survivors (N = 661) were identified through the state registry and completed questionnaires. Latent class analysis (LCA) was used to identify patterns of adherence. Associations between predictors with the latent classes were reported as risk ratios. LCA identified three classes: lower- (39.6%), moderate- (52.0%), and high-risk lifestyle (8.3%). Participants in the lower-risk lifestyle class had the highest probability of meeting most of the multiple health behavior guidelines compared to participants in the high-risk lifestyle class. Characteristics associated with membership in the moderate-risk lifestyle class included self-identifying as a race other than Asian/Asian American, being never married, having some college education, and having been diagnosed with later stage colorectal or lung cancer. Those in the high-risk lifestyle class were more likely to be male, never married, have a high school diploma or less, diagnosed with colorectal or lung cancer, and diagnosed with pulmonary comorbidities. Study findings can be used to inform development of future interventions to promote multiple health behavior adherence among higher risk cancer survivors.
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Affiliation(s)
- Angela J. Fong
- Section of Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Adana A. M. Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Adiba Ashrafi
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Nur Zeinomar
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Sagar Chokshi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ 08901, USA
| | - Elisa V. Bandera
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Katie A. Devine
- Department of Pediatrics, Section of Pediatric Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Shawna V. Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Bo Qin
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Denalee O’Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Lisa E. Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Antoinette M. Stroup
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Andrew M. Evens
- Department of Medicine, Division of Blood Disorders, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Sharon L. Manne
- Section of Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
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20
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Chan DS, Vieira R, Abar L, Aune D, Balducci K, Cariolou M, Greenwood DC, Markozannes G, Nanu N, Becerra‐Tomás N, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:572-599. [PMID: 36279884 PMCID: PMC10092239 DOI: 10.1002/ijc.34322] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/29/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.
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Affiliation(s)
- Doris S.M. Chan
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Katia Balducci
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Margarita Cariolou
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Nutrition, Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
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21
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Zeinomar N, Qin B, Amin S, Lin Y, Xu B, Chanumolu D, Omene CO, Pawlish KS, Demissie K, Ambrosone CB, Hong CC, Bandera EV. Association of Cigarette Smoking and Alcohol Consumption With Subsequent Mortality Among Black Breast Cancer Survivors in New Jersey. JAMA Netw Open 2023; 6:e2252371. [PMID: 36692882 PMCID: PMC10148653 DOI: 10.1001/jamanetworkopen.2022.52371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE There are limited data about how lifestyle factors are associated with breast cancer prognosis among Black or African American women because most of the evidence is based on studies of White breast cancer survivors. OBJECTIVE To examine the association of prediagnostic cigarette smoking and alcohol consumption with all-cause mortality and breast cancer-specific mortality in a cohort of Black breast cancer survivors. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included 1926 Black or African American breast cancer survivors who received a diagnosis from June 6, 2005, to May 21, 2019, identified in 10 counties in New Jersey through rapid case ascertainment by the New Jersey State Cancer Registry. Statistical analysis was conducted from January 1, 2021, to August 1, 2022. EXPOSURES Information on prediagnostic cigarette smoking, alcohol consumption, and additional covariates was collected during in-person interviews. The covariates examined included smoking status at the time of breast cancer diagnosis (currently smoking at the time of breast cancer diagnosis, formerly smoking, or never smoking), smoking duration (number of years smoking), smoking intensity (cigarettes smoked per day), number of pack-years of smoking, and regular alcohol consumption the year before diagnosis (categorized as nondrinkers, ≤3 drinks per week, or >3 drinks per week). MAIN OUTCOMES AND MEASURES Primary outcomes included breast cancer-specific mortality and all-cause mortality. RESULTS Among the 1926 women in the study, the mean (SD) age at breast cancer diagnosis was 54.4 (10.8) years. During 13 464 person-years of follow-up (median follow-up, 6.7 years [range, 0.5-16.0 years]), there were 337 deaths, of which 187 (55.5%) were breast cancer related. Compared with never smokers, current smokers at the time of breast cancer diagnosis had a 52% increased risk for all-cause mortality (hazard ratio [HR], 1.52; 95% CI, 1.15-2.02), which was most pronounced for those with 10 or more pack-years of smoking (HR, 1.84; 95% CI, 1.34-2.53). Similar findings were observed for breast cancer-specific mortality (current smokers vs never smokers: HR, 1.27; 95% CI, 0.87-1.85), although they were not statistically significant. There was no statistically significant association between alcohol consumption and all-cause mortality (>3 drinks per week vs nondrinkers: HR, 1.05; 95% CI, 0.73-1.51) or breast cancer-specific mortality (>3 drinks per week vs nondrinkers: HR, 1.06; 95% CI, 0.67-1.67). CONCLUSIONS AND RELEVANCE This population-based cohort study of Black breast cancer survivors suggests that current smoking at the time of diagnosis was associated with an increased risk of all-cause mortality, particularly among women with greater pack-years of smoking.
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Affiliation(s)
- Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Saber Amin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Yong Lin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Baichen Xu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Dhanya Chanumolu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Coral O Omene
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Karen S Pawlish
- Cancer Epidemiology Services, New Jersey State Cancer Registry, New Jersey Department of Health, Trenton
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, New York
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
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22
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Abdollahi A, Alsaikhan F, Nikolenko DA, Al-Gazally ME, Mahmudiono T, Allen KA, Abdullaev B. Self-care behaviors mediates the relationship between resilience and quality of life in breast cancer patients. BMC Psychiatry 2022; 22:825. [PMID: 36572859 PMCID: PMC9791717 DOI: 10.1186/s12888-022-04470-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022] Open
Abstract
Previous studies have shown that resilience could play an important role in enhancing the quality of life in women with breast cancer; however, the mediating role of self-care behaviors have not been studied. This study aims to explore the mediating role of self-care behaviors in the relationship between resilience and quality of life in breast cancer patients. A sample of 195 women with breast cancer (aged from 21 to 60 years; M = 45.32 ± 8.2) from three hospitals in Tehran, Iran completed online questionnaires measuring resilience, self-care and quality of life. The results of structural equation modeling showed that resilience (β = 0.546, p < .01) and self-care behaviors (β = 0.621, p < .01) positively predicted the quality of life in breast cancer patients. The bootstrapping analysis showed that self-care behaviors acted as a partial mediator between resilience and quality of life. The present study brings to light an underlying mechanism of the relationship between resilience and quality of life via the mediating variable of self-care behaviors for patients with breast cancer.
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Affiliation(s)
- Abbas Abdollahi
- Department of Counseling, Faculty of Education and Psychology, Alzahra University, Tehran, Iran.
| | - Fahad Alsaikhan
- grid.449553.a0000 0004 0441 5588Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Kingdom of Saudi Arabia
| | - Denis Andreevich Nikolenko
- grid.448878.f0000 0001 2288 8774Department of Prosthetic Dentistry, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Trias Mahmudiono
- grid.440745.60000 0001 0152 762XDepartment of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Kelly A. Allen
- grid.1002.30000 0004 1936 7857Educational Psychology and Inclusive Education, Faculty of Education, Monash University, Clayton, Australia
| | - Bekhzod Abdullaev
- Department of Pathology and Physiology, Ferghana Medical Institute of Public Health, Ferghana, Uzbekistan
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Liu X, Zhang E, Wang S, Shen Y, Xi K, Fang Q. Association of body composition with clinical outcome in Chinese women diagnosed with breast cancer. Front Oncol 2022; 12:957527. [PMID: 36203426 PMCID: PMC9530819 DOI: 10.3389/fonc.2022.957527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022] Open
Abstract
Objective This study aims to explore the association of body composition with clinical outcomes in Chinese women diagnosed with breast cancer. Method A total of 2,948 Chinese female patients with breast cancer have been included in this retrospective study. Body composition mainly includes the measurements of adiposity and muscle mass. Visceral fat area (VFA) is used to measure visceral obesity, while appendicular skeletal muscle mass index (ASMI) is utilized to evaluate sarcopenia. The endpoints of this study are disease-free survival (DFS) and overall survival (OS). The association of the body composition parameters with DFS and OS was statistically analyzed. Result The median follow-up time for survivors was 42 months (range, 3 to 70 months). In total, 194 patients (6.9%) had breast cancer recurrence, and 32 patients passed away (1.1%). Among the 2,948 patients included, 1,226 (41.6%) patients were viscerally obese, and 511 (17.3%) patients were sarcopenic. We found that visceral obesity had a significant prognostic impact on DFS (HR, 1.46; 95% CI, 1.10-1.95; p = 0.010) but not on OS (P = 0.173). Multivariate analysis revealed sarcopenia as an independent prognostic factor for DFS (HR, 1.44; 95% CI, 1.02-2.03; p = 0.038) and OS (HR, 2.13; 95% CI, 1.00-4.51; p = 0.049). Body mass index was not significantly associated with both DFS (P = 0.224) and OS (P = 0.544). Conclusion Visceral obesity is associated with a higher risk of disease recurrence, and sarcopenia is significantly associated with increased recurrence and overall mortality among Chinese women with breast cancer. Body composition assessment could be a simple and useful approach in breast cancer management. Further studies can focus on decreasing visceral fat and increasing skeletal muscle mass to improve prognosis in breast cancer survivors.
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Affiliation(s)
- Xinyi Liu
- Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Enming Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Suxing Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yixiao Shen
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Kaiwen Xi
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Fang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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24
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Qin B, Kim K, Goldman N, Rundle AG, Chanumolu D, Zeinomar N, Xu B, Pawlish KS, Ambrosone CB, Demissie K, Hong CC, Lovasi GS, Bandera EV. Multilevel Factors for Adiposity Change in a Population-Based Prospective Study of Black Breast Cancer Survivors. J Clin Oncol 2022; 40:2213-2223. [PMID: 35333586 PMCID: PMC9273374 DOI: 10.1200/jco.21.02973] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Unfavorable weight change after breast cancer diagnosis increases the risk of mortality, but individual and neighborhood risk factors affecting postdiagnosis weight and body fat changes are unclear among Black women, who have higher rates of obesity and mortality than any other racial/ethnic group. METHODS Adiposity changes during the period approximately 10 months-24 months after diagnosis were evaluated among 785 women diagnosed between 2012 and 2018 and enrolled in the Women's Circle of Health Follow-Up Study, a population-based prospective cohort of Black breast cancer survivors in New Jersey. Multilevel factors for weight and fat mass change (with gain or loss defined as a relative difference of 3% or more, and considering whether changes were intentional or unintentional) were estimated using multivariable polytomous logistic regressions and multilevel models. RESULTS Adiposity gain was prevalent: 28% and 47% gained weight and body fat, respectively, despite a high baseline prevalence of overweight or obesity (86%). Risk factors for fat mass gain included receiving chemotherapy (relative risk ratio: 1.59, 95% CI, 1.08 to 2.33) and residing in neighborhoods with a greater density of fast-food restaurants (relative risk ratio comparing highest with lowest tertile: 2.18, 95% CI, 1.38 to 3.46); findings were similar for weight gain. Only 9% of women had intentional weight loss, and multilevel risk factors differed vastly from unintentional loss. CONCLUSION Both individual and neighborhood factors were associated with adiposity change among Black breast cancer survivors. Residential environment characteristics may offer clinically meaningful information to identify cancer survivors at higher risk for unfavorable weight change and to address barriers to postdiagnosis weight management.
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Affiliation(s)
- Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kate Kim
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Noreen Goldman
- Office of Population Research, Princeton University, Princeton, NJ
| | - Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Dhanya Chanumolu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Baichen Xu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Karen S. Pawlish
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University School of Public Health, Brooklyn, NY
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Gina S. Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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25
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Xue H, Du H, Xie Y, Zhai Y, Song S, Luo B, Qiu H, Wang K, Cui J, Song C, Xu H, Li W, Shi H, Li Z. Association Between Fat Mass to Lean Body Mass Ratio and All-Cause Mortality Among Middle-Aged and Elderly Cancer Patients Without Obesity: A Multi-Center Observational Study in China. Front Nutr 2022; 9:914020. [PMID: 35789967 PMCID: PMC9249599 DOI: 10.3389/fnut.2022.914020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We aimed to investigate the association between fat mass to lean body mass ratio (RFL), percentage of body fat (PBF), and fat mass (FM) with mortality among middle-aged and elderly cancer patients without obesity. Methods This prospective hospital-based cohort study comprised 3,201 patients with stage I to IV cancer aged 40 years or above (mean age: 58 years for female patients and 61 years for male patients; mean length of follow-up was 1.67 years; the maximal follow-up length was 6.42 years). FM and PBF were measured by bioelectrical impedance analysis (BIA). Cox proportional hazard models were used, and adjusted hazard ratios (HRs) were estimated. Results We revealed a significant association between RFL and all-cause mortality among men aged ≥60 years after adjusting for confounders. Compared with those in the lowest tertile of RFL, elderly men in the medium and highest tertile had a 35 and 34% lower hazard of death from any cause, respectively. After additionally adjusted for C-reaction protein (CRP), HRs of medium and high tertile of RFL became short of statistical significance [medium tertile: adjusted HRs (95% CI) = 0.74 (0.46, 1.20); highest tertile: adjusted HRs (95% CI) = 0.84 (0.53, 1.33)]. Among elderly women, RFL was significantly related to all-cause mortality only when the additional adjustment for CRP [medium tertile: adjusted HRs (95% CI) = 2.08 (1.08, 4.01); highest tertile: adjusted HRs (95% CI) = 0.90 (0.45, 1.81)]. No significant association between RFL and all-cause mortality was observed among female participants or male participants aged less than 60 years. Conclusion Our findings showed a significant non-linear association between RFL and all-cause mortality, which was observed only in elderly men, and might be attenuated by their inflammation state.
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Affiliation(s)
- Hongmei Xue
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Hongzhen Du
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Ying Xie
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Yijing Zhai
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Shiming Song
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Bin Luo
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Hong Qiu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kunhua Wang
- Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiuwei Cui
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Chunhua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hongxia Xu
- Department of Nutrition, Daping Hospital and Research Institute of Surgery, Third Military Medical University, Chongqing, China
| | - Wei Li
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Chinese Society of Nutritional Oncology, Beijing, China
| | - Zengning Li
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
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26
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Ilozumba MN, Yao S, Llanos AAM, Omilian AR, Zhang W, Datta S, Hong CC, Davis W, Khoury T, Bandera EV, Higgins M, Ambrosone CB, Cheng TYD. mTOR pathway gene expression in association with race and clinicopathological characteristics in Black and White breast cancer patients. Discov Oncol 2022; 13:34. [PMID: 35608730 PMCID: PMC9130392 DOI: 10.1007/s12672-022-00497-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Aberrant activation of the mammalian Target of Rapamycin (mTOR) pathway has been linked to obesity and endocrine therapy resistance, factors that may contribute to Black-White disparities in breast cancer outcomes. We evaluated associations of race and clinicopathological characteristics with mRNA expression of key mTOR pathway genes in breast tumors. METHODS Surgical tumor tissue blocks were collected from 367 newly diagnosed breast cancer patients (190 Black and 177 White). Gene expression of AKT1, EIF4EBP1, MTOR, RPS6KB2, and TSC1 were quantified by NanoString nCounter. Differential gene expression was assessed using linear regression on log2-transformed values. Gene expression and DNA methylation data from TCGA were used for validation and investigation of race-related differences. RESULTS Compared to White women, Black women had relative under-expression of AKT1 (log2 fold-change = - 0.31, 95% CI - 0.44, - 0.18) and RPS6KB2 (log2 fold-change = - 0.11, 95% CI - 0.19, - 0.03). Higher vs. lower tumor grade was associated with relative over-expression of EIF4EBP1 and RPS6KB2, but with lower expression of TSC1. Compared to luminal tumors, triple-negative tumors had relative under-expression of TSC1 (log2 fold-change = - 0.42, 95% CI - 0.22, - 0.01). The results were similar in the TCGA breast cancer dataset. Post-hoc analyses identified differential CpG methylation within the AKT1 and RPS6KB2 locus between Black and White women. CONCLUSIONS Over-expression of RPS6KB2 and EIF4EBP1 and under-expression of TSC1 might be indicators of more aggressive breast cancer phenotypes. Differential expression of AKT1 and RPS6KB2 by race warrants further investigation to elucidate their roles in racial disparities of treatment resistance and outcomes between Black and White women with breast cancer.
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Affiliation(s)
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Adana A M Llanos
- Department of Epidemiology, Mailman School of Public Health and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, NY, New York, United States
| | - Angela R Omilian
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Weizhou Zhang
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Susmita Datta
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Warren Davis
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Thaer Khoury
- Department of Pathology & Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Michael Higgins
- Department of Molecular and Cellular Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ting-Yuan David Cheng
- Department of Epidemiology, University of Florida, Gainesville, FL, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Suite 525, 1590 North High Street, Columbus, OH, 43201, USA.
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Yin L, Song C, Cui J, Lin X, Li N, Fan Y, Zhang L, Liu J, Chong F, Wang C, Liang T, Liu X, Deng L, Yang M, Yu J, Wang X, Liu X, Yang S, Zuo Z, Yuan K, Yu M, Cong M, Li Z, Weng M, Yao Q, Jia P, Li S, Guo Z, Li W, Shi H, Xu H. De novo Creation and Assessment of a Prognostic Fat-Age-Inflammation Index “FAIN” in Patients With Cancer: A Multicenter Cohort Study. Front Nutr 2022; 9:860285. [PMID: 35495957 PMCID: PMC9043856 DOI: 10.3389/fnut.2022.860285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aims Malnutrition is highly prevalent and is related to multiple impaired clinical outcomes in cancer patients. This study aimed to de novo create an objective, nutrition-related index specially for prognostic purposes in oncology populations. Methods We performed a multicenter cohort study including 14,134 cancer patients. The prognostic impact for each baseline characteristic was estimated by calculating Harrell's C-index. The optimal parameters reflecting the nutritional and inflammatory impact on patients' overall survival were selected to develop the fat-age-inflammation (FAIN) index. The associations of the FAIN with the nutritional status, physical performance, quality of life, short-term outcomes and mortality of patients were comprehensively evaluated. Independent external validation was performed to further assess the prognostic value of the FAIN. Results The study enrolled 7,468 men and 6,666 women with a median age of 57 years and a median follow-up of 42 months. The FAIN index was defined as: (triceps skinfold thickness + albumin) / [age + 5 × (neutrophil count/lymphocyte count)]. There were significant associations of the FAIN with the nutritional status, physical performance, quality of life and short-term outcomes. The FAIN also showed better discrimination performance than the Nutritional Risk Index, the Prognostic Nutritional Index and the Controlling Nutritional Status index (all P < 0.05). In multivariable-adjusted models, the FAIN was independently associated with a reduced death hazard both as a continuous variable (HR = 0.57, 95%CI = 0.47–0.68) and per one standard deviation (HR = 0.83, 95%CI = 0.78–0.88). External validation in a multicenter lung cancer cohort (n = 227) further confirmed the prognostic value of the FAIN. Conclusions This study created and assessed the prognostic FAIN index, which might act as a feasible option to monitor the nutritional status and help develop intervention strategies to optimize the survival outcomes of cancer patients.
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Affiliation(s)
- Liangyu Yin
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chunhua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jiuwei Cui
- Cancer Center, The First Hospital, Jilin University, Changchun, China
| | - Xin Lin
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Na Li
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yang Fan
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ling Zhang
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Liu
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Feifei Chong
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chang Wang
- Cancer Center, The First Hospital, Jilin University, Changchun, China
| | - Tingting Liang
- Cancer Center, The First Hospital, Jilin University, Changchun, China
| | - Xiangliang Liu
- Cancer Center, The First Hospital, Jilin University, Changchun, China
| | - Li Deng
- Cancer Center, The First Hospital, Jilin University, Changchun, China
| | - Mei Yang
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jiami Yu
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xiaojie Wang
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xing Liu
- Department of Nutrition and Metabolism of Oncology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Cancer Hospital), Hefei, China
| | - Shoumei Yang
- Department of Nutrition and Metabolism of Oncology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Cancer Hospital), Hefei, China
| | - Zheng Zuo
- Department of Nutrition and Metabolism of Oncology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Cancer Hospital), Hefei, China
| | - Kaitao Yuan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Miao Yu
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minghua Cong
- Department of Comprehensive Oncology, National Cancer Center or Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zengning Li
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Min Weng
- Department of Clinical Nutrition, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qinghua Yao
- Department of Integrated Chinese and Western Medicine, Cancer Hospital of the University of Chinese Academy of Science (Zhejiang Cancer Hospital), Hangzhou, China
| | - Pingping Jia
- Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Suyi Li
- Department of Nutrition and Metabolism of Oncology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Cancer Hospital), Hefei, China
| | - Zengqing Guo
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Wei Li
- Cancer Center, The First Hospital, Jilin University, Changchun, China
- *Correspondence: Wei Li
| | - Hanping Shi
- Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Hanping Shi
| | - Hongxia Xu
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Hongxia Xu
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28
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Feng Y, Zhang Y, Xiang Y, Guo K, Jin H, Ruan S, Guan Z. Nomograms for Predicting Specific Distant Metastatic Sites and Overall Survival of Breast Invasive Ductal Carcinoma Patients After Surgery: A Large Population-Based Study. Front Surg 2022; 9:779220. [PMID: 35402478 PMCID: PMC8986992 DOI: 10.3389/fsurg.2022.779220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background Breast cancer (BC) has become the most common malignancy worldwide, accounting for 11.7% of newly diagnosed cancer cases last year. Invasive ductal carcinoma (IDC) is the most common pathological type of BC. However, there were few studies to predict distant metastatic sites and overall survival (OS) of IDC patients. Methods Post-operative IDC patients from 2010 to 2016 in the Surveillance, Epidemiology, and End Results (SEER) database were reviewed. Nomograms were developed to predict the specific distant metastatic sites and OS of IDC patients. The performance of nomograms was evaluated with the calibration curves, area under the curve (AUC), and decision curve analysis (DCA). Kaplan-Meier analysis and log-rank tests were used to estimate the survival times of IDC patients with distant metastases. Results A total of 171,967 post-operative IDC patients were enrolled in our study. Univariate and multivariate analyses were used to establish the nomograms of significant variables. The AUC of the nomograms for the prediction of liver, lung, bone, and brain metastases was 0.903, 0.877, 0.863, and 0.811, respectively. In addition, the AUC of the nomogram for the prediction of 1-, 3-, and 5-year OS was 0.809, 0.813, 0.787, respectively. Calibration curves and DCA showed good consistency and clinical benefits, respectively. Conclusions We constructed new predictive models for liver, lung, brain, bone metastases and 1-, 3-, and 5-year OS in IDC patients. These can help clinicians to individualize the treatment of IDC patients, so that patients can get the more appropriate treatment options.
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Affiliation(s)
- Yuqian Feng
- The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yiting Zhang
- The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuying Xiang
- The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kaibo Guo
- The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Huimin Jin
- Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shanming Ruan
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Shanming Ruan
| | - Zhuoya Guan
- Department of Mammary Gland, Medical Community of Taizhou Luqiao Traditional Chinese Medicine Hospital, Taizhou, China
- *Correspondence: Zhuoya Guan
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29
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Llanos AA, Aremu JB, Cheng TYD, Chen W, Chekmareva MA, Cespedes Feliciano EM, Qin B, Lin Y, Omene C, Khoury T, Hong CC, Yao S, Ambrosone CB, Bandera EV, Demissie K. Greater Body Fatness Is Associated With Higher Protein Expression of LEPR in Breast Tumor Tissues: A Cross-Sectional Analysis in the Women's Circle of Health Study. Front Endocrinol (Lausanne) 2022; 13:879164. [PMID: 35846306 PMCID: PMC9277012 DOI: 10.3389/fendo.2022.879164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/27/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The mechanisms underlying the association of overall and central body fatness with poorer breast cancer outcomes remain unclear; altered gene and/or protein expression of the adipokines and their receptors in breast tumors might play a role. METHODS In a sample of Black and White women with primary invasive breast cancer, we investigated associations of body mass index (BMI), waist circumference, hip circumference, waist-to-hip ratio (WHR), fat mass index (FMI), and percent body fat with protein expression (log-transformed, n = 722) and gene expression (log2-transformed, n = 148) of leptin (LEP), leptin receptor (LEPR), adiponectin (ADIPOQ), and adiponectin receptors 1 and 2 (ADIPOR1, ADIPOR2). Multivariable linear models, adjusting for race, menopausal status, and estrogen receptor status, were used to assess these associations, with Bonferroni correction for multiple comparisons. RESULTS In multivariable models, we found that increasing BMI (β = 0.0529, 95% CI: 0.0151, 0.0906) and FMI (β = 0.0832, 95% CI: 0.0268, 0.1397) were associated with higher LEP gene expression, corresponding to 34.5% and 38.3% increases in LEP gene expression for a standard deviation (SD) increase in BMI and FMI, respectively. Increasing BMI (β = 0.0028, 95% CI: 0.0011, 0.0045), waist circumference (β = 0.0013, 95% CI: 0.0005, 0.0022), hip circumference (β = 0.0015, 95% CI: 0.0007, 0.0024), and FMI (β = 0.0041, 95% CI: 0.0015, 0.0067) were associated with higher LEPR protein expression. These associations equate to 16.8%, 17.6%, 17.7%, 17.2% increases in LEPR protein expression for a 1-SD increase in BMI, waist circumference, hip circumference, and FMI, respectively. Further, these associations were stronger among White and postmenopausal women and ER+ cases; formal tests of interaction yielded evidence of effect modification by race. No associations of body fatness with LEP protein expression, LEPR gene expression, or protein or gene expression of ADIPOQ, ADIPOR1, and ADIPOR2 were found. CONCLUSIONS These findings support an association of increased body fatness - beyond overall body size measured using BMI - with higher LEP gene expression and higher LEPR protein expression in breast tumor tissues. Clarifying the impact of adiposity-related adipokine and adipokine receptor expression in breast tumors on long-term breast cancer outcomes is a critical next step.
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Affiliation(s)
- Adana A.M. Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Adana A.M. Llanos,
| | - John B. Aremu
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Ting-Yuan David Cheng
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Wenjin Chen
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Marina A. Chekmareva
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | | | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Yong Lin
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Coral Omene
- Department of Medicine, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Thaer Khoury
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University School of Public Health, Brooklyn, NY, United States
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30
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Zheng YZ, Qin HB, Li ZZ, Jiang HS, Zhang G, Yang SW, Wang XM, Xu YC, Deng ZH, Liu GW. Prognostic Factors and a Nomogram Predicting Survival in Patients with Breast Ductal Carcinoma in situ with Microinvasion: A Population-Based Study. Clin Epidemiol 2021; 13:1095-1108. [PMID: 34876856 PMCID: PMC8643132 DOI: 10.2147/clep.s341422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/12/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose Ductal carcinoma in situ with microinvasion (DCISM) can be challenging to balance the risks of overtreatment versus undertreatment. We aim to identify prognostic factors in patients with DCISM and construct a nomogram to predict breast cancer-specific survival (BCSS). Materials and Methods A retrospective cohort study of women diagnosed with DCISM from 1988 to 2015 who were identified in the Surveillance, Epidemiology and End Results database. Clinical variables and tumor characteristics were evaluated, and Cox proportional-hazards regression was performed. A nomogram was constructed from the multivariate logistic regression to combine all the prognostic factors to predict the prognosis of DCISM patients at 5 years, 10 years, and 15 years. Results We identified 5438 total eligible breast cancer patients with a median and max survival time of 78 and 227 months, respectively. Here, patients with poorer survival outcomes were those diagnosed between 1988 and 2001, African-American race, under 40 years of age, higher tumor N stage, progesterone receptor-negative tumor, and received no surgery. The nomogram was constructed by the seven variables and passed the calibration and validation steps. The area under the receiver operating characteristic (ROC) curve (AUC) of both the training set and the validating set (5-year AUC: 0.77 and 0.88, 10-year AUC: 0.75 and 0.73, 15-year AUC: 0.72 and 0.65). Receiving chemotherapy was associated with a better BCSS (hazard ratio, HR=0.45, 95% confidence interval, 95% CI = 0.23–0.89), especially in patients with estrogen receptor (ER) negative, progesterone receptor (PR) negative (HR = 0.35, 95% CI = 0.13–0.97) and ER+PR-/ER-PR+ DCISM (HR = 0.07, 95% CI = 0.01–0.59). Conclusion Our current study is the first to construct nomograms of patients with DCISM which could help physicians identify breast cancer patients that more likely to benefit from more intensive treatment and follow-up. Chemotherapy might benefit patients with ER-PR- and ER+PR-/ER-PR+ DCISM.
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Affiliation(s)
- Yi-Zi Zheng
- Department of Thyroid and Breast Surgery, The People's Hospital of Hechi, Hechi, Guangxi, People's Republic of China.,Department of Thyroid and Breast Surgery, Shenzhen Breast Tumor Research Center for Diagnosis and Treatment, National Standardization Center for Breast Cancer Diagnosis and Treatment, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Hong-Bin Qin
- Department of Thyroid and Breast Surgery, The People's Hospital of Hechi, Hechi, Guangxi, People's Republic of China
| | - Zi-Zheng Li
- Department of Thyroid and Breast Surgery, The People's Hospital of Hechi, Hechi, Guangxi, People's Republic of China
| | - He-Sheng Jiang
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Greg Zhang
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shi-Wei Yang
- Teaching Office, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xian-Ming Wang
- Department of Thyroid and Breast Surgery, Shenzhen Breast Tumor Research Center for Diagnosis and Treatment, National Standardization Center for Breast Cancer Diagnosis and Treatment, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yang-Chun Xu
- Department of Thyroid and Breast Surgery, The People's Hospital of Hechi, Hechi, Guangxi, People's Republic of China
| | - Zhen-Han Deng
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Guo-Wen Liu
- Department of Thyroid and Breast Surgery, Shenzhen Breast Tumor Research Center for Diagnosis and Treatment, National Standardization Center for Breast Cancer Diagnosis and Treatment, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, People's Republic of China
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31
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Guo Z, Liu J, Zhang C. Association of Adiposity With Mortality Among Black Patients With Breast Cancer. JAMA Oncol 2021; 8:169-170. [PMID: 34762094 DOI: 10.1001/jamaoncol.2021.5759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Zhiyong Guo
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jiannan Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chenping Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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32
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Bandera EV, Qin B, Hong CC. Association of Adiposity With Mortality Among Black Patients With Breast Cancer-Reply. JAMA Oncol 2021; 8:170-171. [PMID: 34762095 DOI: 10.1001/jamaoncol.2021.5762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Bo Qin
- Rutgers Cancer Institute of New Jersey, New Brunswick
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33
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Bandera EV, Alfano CM, Qin B, Kang DW, Friel CP, Dieli-Conwright CM. Harnessing Nutrition and Physical Activity for Breast Cancer Prevention and Control to Reduce Racial/Ethnic Cancer Health Disparities. Am Soc Clin Oncol Educ Book 2021; 41:1-17. [PMID: 33989021 DOI: 10.1200/edbk_321315] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are well-known racial/ethnic disparities in the prevalence of obesity and physical inactivity, as well as breast cancer risk and survival. However, most of the current scientific evidence that serves as a foundation for nutrition and physical activity guidelines is based on studies conducted in predominantly non-Hispanic White populations. Similarly, exercise, diet, or lifestyle intervention trials for breast cancer prevention and survivorship are scarce in racial/ethnic minority populations. We review the current evidence for racial/ethnic disparities in obesity and breast cancer risk and survival (we are focusing on obesity, because this is considered an ASCO priority, and studies conducted in the United States), discuss the evolution of nutrition/physical activity guidelines for cancer prevention and control, and provide an overview of lifestyle interventions, including barriers and facilitators in implementation and dissemination science among minority populations underrepresented in research. There is a critical need to include racially/ethnically diverse populations in cancer prevention and control research or to specifically target minority populations in which disparities are known to exist to achieve much needed health equity.
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Affiliation(s)
- Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Catherine M Alfano
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY.,Northwell Health Cancer Institute, New York, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Dong-Woo Kang
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ciarán P Friel
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY
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