Enterolactone concentrations and prognosis after postmenopausal breast cancer: assessment of effect modification and meta-analysis
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Enterolactone concentrations and prognosis after postmenopausal breast cancer: assessment of effect modification and meta-analysis. / Seibold, Petra; Vrieling, Alina; Johnson, Theron S; Buck, Katharina; Behrens, Sabine; Kaaks, Rudolf; Linseisen, Jakob; Obi-Osius, Nadia; Heinz, Judith; Flesch-Janys, Dieter; Chang-Claude, Jenny.
In: INT J CANCER, Vol. 135, No. 4, 15.08.2014, p. 923-33.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Enterolactone concentrations and prognosis after postmenopausal breast cancer: assessment of effect modification and meta-analysis
AU - Seibold, Petra
AU - Vrieling, Alina
AU - Johnson, Theron S
AU - Buck, Katharina
AU - Behrens, Sabine
AU - Kaaks, Rudolf
AU - Linseisen, Jakob
AU - Obi-Osius, Nadia
AU - Heinz, Judith
AU - Flesch-Janys, Dieter
AU - Chang-Claude, Jenny
N1 - © 2014 UICC.
PY - 2014/8/15
Y1 - 2014/8/15
N2 - We previously reported that high concentrations of enterolactone, a lignan metabolite, are associated with lower mortality in 1,140 breast cancer patients from Germany. Using an extended set of 2,182 patients aged 50-74 years at diagnosis (2001-2005) and prospectively followed up until 2009, we investigated whether the association with mortality differs by lifestyle factors and tumor characteristics. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable Cox regression. Potential differential effects by tumor characteristics and lifestyle factors were assessed and a meta-analysis of five studies addressing lignan exposure and breast cancer prognosis was performed to summarize evidence. Median enterolactone concentrations were 17.4 (± 30.5 standard deviation) and 22.9 nmol L(-1) (± 44.8), respectively, for 269 deceased and 1,913 patients still alive. High enterolactone concentrations were significantly associated with lower all-cause mortality (per 10 nmol L(-1) : HR 0.94, 95% CI 0.90-0.98), breast cancer-specific mortality (HR 0.94, 0.89-0.99), and distant disease-free survival (HR 0.94, 0.90-0.98). Associations were found for stage 0-IIIA but not for stage IIIB-IV disease (p(het) = 0.01) and were stronger in patients with BMI <25 kg m(-2) than those with BMI ≥ 25 (p(het) = 0.04). In patients with healthy lifestyle (BMI <25, nonsmoker, physically active), the inverse association with all-cause mortality was still apparent (HR 0.92, 0.85-0.99). The meta-analysis yielded significant associations both for all-cause (HR 0.57, 0.42-0.78) and breast cancer-specific mortality (HR 0.54, 0.39-0.75). Our findings show that high lignan exposure is associated with reduced mortality in breast cancer patients. The inverse association observed in this study cannot be entirely explained by a healthy lifestyle.
AB - We previously reported that high concentrations of enterolactone, a lignan metabolite, are associated with lower mortality in 1,140 breast cancer patients from Germany. Using an extended set of 2,182 patients aged 50-74 years at diagnosis (2001-2005) and prospectively followed up until 2009, we investigated whether the association with mortality differs by lifestyle factors and tumor characteristics. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable Cox regression. Potential differential effects by tumor characteristics and lifestyle factors were assessed and a meta-analysis of five studies addressing lignan exposure and breast cancer prognosis was performed to summarize evidence. Median enterolactone concentrations were 17.4 (± 30.5 standard deviation) and 22.9 nmol L(-1) (± 44.8), respectively, for 269 deceased and 1,913 patients still alive. High enterolactone concentrations were significantly associated with lower all-cause mortality (per 10 nmol L(-1) : HR 0.94, 95% CI 0.90-0.98), breast cancer-specific mortality (HR 0.94, 0.89-0.99), and distant disease-free survival (HR 0.94, 0.90-0.98). Associations were found for stage 0-IIIA but not for stage IIIB-IV disease (p(het) = 0.01) and were stronger in patients with BMI <25 kg m(-2) than those with BMI ≥ 25 (p(het) = 0.04). In patients with healthy lifestyle (BMI <25, nonsmoker, physically active), the inverse association with all-cause mortality was still apparent (HR 0.92, 0.85-0.99). The meta-analysis yielded significant associations both for all-cause (HR 0.57, 0.42-0.78) and breast cancer-specific mortality (HR 0.54, 0.39-0.75). Our findings show that high lignan exposure is associated with reduced mortality in breast cancer patients. The inverse association observed in this study cannot be entirely explained by a healthy lifestyle.
KW - 4-Butyrolactone
KW - Aged
KW - Body Mass Index
KW - Breast Neoplasms
KW - Diet
KW - Disease Progression
KW - Disease-Free Survival
KW - Female
KW - Germany
KW - Humans
KW - Life Style
KW - Lignans
KW - Middle Aged
KW - Postmenopause
KW - Prognosis
KW - Proportional Hazards Models
KW - Prospective Studies
KW - Risk Factors
KW - Tumor Markers, Biological
U2 - 10.1002/ijc.28729
DO - 10.1002/ijc.28729
M3 - SCORING: Journal article
C2 - 24436155
VL - 135
SP - 923
EP - 933
JO - INT J CANCER
JF - INT J CANCER
SN - 0020-7136
IS - 4
ER -