1
|
Liu YS, Wu PE, Chou WC, Vikram R, Chen WT, Yang SL, Bolla MK, Wang Q, Dennis J, Chan TL, Choi JY, Hou MF, Ito H, Kang D, Kim SW, Kwong A, Matsuo K, Park SK, Shu XO, Zheng W, Dunning AM, Easton DF, Shen CY. Body mass index and type 2 diabetes and breast cancer survival: a Mendelian randomization study. Am J Cancer Res 2021; 11:3921-3934. [PMID: 34522458 PMCID: PMC8414374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/10/2021] [Indexed: 06/13/2023] Open
Abstract
The causal relationship between body mass index (BMI) and type 2 diabetes (T2D) and breast cancer prognosis is still ambiguous. The aim of this study was to investigate the prognostic effect of BMI and T2D on breast cancer disease-free survival (DFS) among Asian individuals. In this two-sample Mendelian randomization (MR) study, the instrumental variables (IVs) were identified using a genome-wide association study (GWAS) among 24,000 participants in the Taiwan Biobank. Importantly, the validity of these IVs was confirmed with a previous large-scale GWAS (Biobank Japan Project, BBJ). In this study, we found that a genetic predisposition toward higher BMI (as indicated by BMI IVs, F = 86.88) was associated with poor breast cancer DFS (hazard ratio [HR] = 6.11; P < 0.001). Furthermore, higher level of genetically predicted T2D (as indicated by T2D IVs) was associated with an increased risk of recurrence of and mortality from breast cancer (HR = 1.43; P < 0.001). Sensitivity analyses, including the weighted-median approach, MR-Egger regression, Radial regression and Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) supported the consistency of our findings. Finally, the causal relationship between BMI and poor breast cancer prognosis was confirmed in a prospective cohort study. Our MR analyses demonstrated the causal relationship between the genetic prediction of elevated BMI and a greater risk of T2D with poor breast cancer prognosis. BMI and T2D have important clinical implications and may be used as prognostic indicators of breast cancer.
Collapse
Affiliation(s)
- Yi-Shian Liu
- Institute of Biomedical Sciences, Academia SinicaTaipei, Taiwan
| | - Pei-Ei Wu
- Institute of Biomedical Sciences, Academia SinicaTaipei, Taiwan
| | - Wen-Cheng Chou
- Institute of Biomedical Sciences, Academia SinicaTaipei, Taiwan
| | - Rajeev Vikram
- Institute of Biomedical Sciences, Academia SinicaTaipei, Taiwan
| | - Wei-Ting Chen
- Institute of Biomedical Sciences, Academia SinicaTaipei, Taiwan
| | - Show-Ling Yang
- Institute of Biomedical Sciences, Academia SinicaTaipei, Taiwan
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of CambridgeCambridge, United Kingdom
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of CambridgeCambridge, United Kingdom
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of CambridgeCambridge, United Kingdom
| | - Tsun L Chan
- Hong Kong Hereditary Breast Cancer Family Registry, Cancer Genetics CentreHappy Valley, Hong Kong, China
- Department of Pathology, Hong Kong Sanatorium and HospitalHappy Valley, Hong Kong, China
| | - Ji-Yeob Choi
- Department of Biomedical Sciences, Seoul National University Graduate SchoolSeoul, Korea
- Cancer Research Institute, Seoul National UniversitySeoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research CenterSeoul, Korea
| | - Ming-Feng Hou
- Department of Surgery, Kaohsiung Municipal Hsiao-Kang HospitalKaohsiung, Taiwan
| | - Hidemi Ito
- Division of Cancer Information and Control, Aichi Cancer Center Research InstituteNagoya, Japan
- Division of Cancer Epidemiology, Nagoya University Graduate School of MedicineNagoya, Japan
| | - Daehee Kang
- Cancer Research Institute, Seoul National UniversitySeoul, Korea
- Department of Preventive Medicine, Seoul National University College of MedicineSeoul, Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim Saint Mary’s HospitalSeoul, Korea
| | - Ava Kwong
- Hong Kong Hereditary Breast Cancer Family Registry, Cancer Genetics CentreHappy Valley, Hong Kong, China
- Department of Surgery, The University of Hong KongPok Fu Lam, Hong Kong, China
- Department of Surgery, Hong Kong Sanatorium and HospitalHappy Valley, Hong Kong, China
| | - Keitaro Matsuo
- Division of Cancer Epidemiology, Nagoya University Graduate School of MedicineNagoya, Japan
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research InstituteNagoya, Japan
| | - Sue K Park
- Department of Biomedical Sciences, Seoul National University Graduate SchoolSeoul, Korea
- Cancer Research Institute, Seoul National UniversitySeoul, Korea
- Department of Preventive Medicine, Seoul National University College of MedicineSeoul, Korea
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of MedicineNashville, TN, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of MedicineNashville, TN, USA
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of CambridgeCambridge, United Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of CambridgeCambridge, United Kingdom
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of CambridgeCambridge, United Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of CambridgeCambridge, United Kingdom
| | - Chen-Yang Shen
- Institute of Biomedical Sciences, Academia SinicaTaipei, Taiwan
- College of Public Health, China Medical UniversityTaichung, Taiwan
| |
Collapse
|