JCO：适量饮酒有利于乳腺癌女性患者生存

酒精摄入与乳腺癌风险增加有关。与此形成对照的是，饮酒与乳腺癌患者生存率间的关系则较为模糊。为此，美国Fred Hutchinson癌症研究中心的Polly A. Newcomb博士等人进行了一项研究，该研究发表于2013年4月8日在线出版的《临床肿瘤学杂志》(Journal of Clinical Oncology)上。
在这项研究中，研究对象为一个由22,890例侵袭性乳腺癌女性患者组成的队列，这些患者为威斯康辛、马萨诸塞或新罕布什尔居民，他们于1985年至2006年期间得到确诊，患者年龄为20岁至79岁，研究人员对她们在确诊前后的酒精摄入情况进行了评价。所有女性患者均报告称在确诊前有过酒精摄入情况；而4,881例患者组成的子样本则报告在确诊后有过酒精摄入。
经过中位时间为11.3年的确诊后随访，共有7,780例患者死亡，其中3,484例患者死于乳腺癌。研究人员对相关的风险比(HR)及95%CI进行了估测。基于二次分析发现，确诊前的适度饮酒与疾病特异性生存率间存在轻度关联(与非饮酒者相比, 每周饮酒为2次及以上、3至6次、7至9次及≥ 10次HR 分别为 0.93 [95% CI, 0.85 至1.02]、0.85 [95% CI, 0.75至0.95]、0.88 [95% CI, 0.75至1.02]，以及 0.89 [95% CI, 0.77至1.04])。该结果并未随酒品种类而发生变化。对于在确诊前后适量饮酒的女性患者，其心血管生存率及总生存率均好于非饮酒患者。
研究人员认为，整体而言，确诊前饮酒与疾病特异性死亡率无关，该研究还发现一种迹象，即适度饮酒对患者有利。之前尚无证据表明乳腺癌确诊后饮酒行为与患者生存率之间的关系。然而该研究确实证实，对于乳腺癌女性患者，有限饮酒在患者心血管生存率及总生存率方面存在益处。 
与乳腺癌相关的拓展阅读：

• Reuters：辉瑞乳腺癌新药palbociclib获FDA重大突破药物认定
• 饮酒不影响乳腺癌患者的生存
• Lancet Oncol：手术范围、超重或肥胖影响术后乳腺癌患者上臂淋巴水肿的发病率
• JNCI：雌激素联合黄体酮会增高乳腺癌发病率
• JNCI：高脂饮食增加乳腺癌患者死亡率
• NCCN 2013：乳腺癌临床实践指南（2013.V1）
更多信息请点击：有关乳腺癌更多资讯

Alcohol Consumption Before and After Breast Cancer Diagnosis: Associations With Survival From Breast Cancer, Cardiovascular Disease, and Other Causes.
Purpose
Alcohol intake is associated with increased risk of breast cancer. In contrast, the relation between alcohol consumption and breast cancer survival is less clear.
Patients And methods
We assessed pre- and postdiagnostic alcohol intake in a cohort of 22,890 women with incident invasive breast cancer who were residents of Wisconsin, Massachusetts, or New Hampshire and diagnosed from 1985 to 2006 at ages 20 to 79 years. All women reported on prediagnostic intake; a subsample of 4,881 reported on postdiagnostic intake.
Results
During a median follow-up of 11.3 years from diagnosis, 7,780 deaths occurred, including 3,484 resulting from breast cancer. Hazard ratios (HR) and 95% CIs were estimated. Based on a quadratic analysis, moderate alcohol consumption before diagnosis was modestly associated with disease-specific survival (compared with nondrinkers, HR = 0.93 [95% CI, 0.85 to 1.02], 0.85 [95% CI, 0.75 to 0.95], 0.88 [95% CI, 0.75 to 1.02], and 0.89 [95% CI, 0.77 to 1.04] for two or more, three to six, seven to nine, and ≥ 10 drinks/wk, respectively). Alcohol consumption after diagnosis was not associated with disease-specific survival (compared with nondrinkers, HR = 0.88 [95% CI, 0.61 to 1.27], 0.80 [95% CI, 0.49 to 1.32], 1.01 [95% CI, 0.55 to 1.87], and 0.83 [95% CI, 0.45 to 1.54] for two or more, three to six, seven to nine, and ≥ 10 drinks/wk, respectively). Results did not vary by beverage type. Women consuming moderate levels of alcohol, either before or after diagnosis, experienced better cardiovascular and overall survival than nondrinkers.
Conclusion
Overall alcohol consumption before diagnosis was not associated with disease-specific survival, but we found a suggestion favoring moderate consumption. There was no evidence for an association with postdiagnosis alcohol intake and breast cancer survival. This study, however, does provide support for a benefit of limited alcohol intake for cardiovascular and overall survival in women with breast cancer.