已知的预后因素，如临床诊断指标和治疗方法，尚不能解释乳腺癌患者个体间的预后差异。以往研究证据提示诊断后生活方式对乳腺癌预后起着重要作用。同时，乳腺癌是一种异质性肿瘤，不同亚型乳腺癌生物学特征不同，复发和死亡风险亦有显著差异，尤其三阴性乳腺癌预后较差。至今以人群为基础的乳腺癌长期生存队列研究在国内外都较少。本研究拟以乳腺癌诊断10年后的生存队列为基础开展调查，结合已知预后因素，探讨诊断后可干预的生活方式（肥胖、锻炼、饮茶、饮食摄入等）对不同亚型乳腺癌预后的影响，并分别运用传统和多结局Cox模型，建立和验证预后评估模型，提高预后评价敏感性和特异性，最终构建不同亚型乳腺癌死亡和复发/转移风险评估模型。模型构建和性能验证经交叉验证方法和ROC曲线下AUC计算实现。研究结果将形成对不同亚型乳腺癌做出更为准确的预后判断的各模型，以应用于临床康复指导，并为社区开展针对性强、更高效的个性化干预提供依据。

Breast cancer is the most common type of cancer in women and the leading cause of cancer death among women. Established prognostic factors include age, tumor state at diagnosis, tumor grade,histology, lymph node status and methods of therapy. However, even after controlling for treatment and known clinical predictors, there is considerable inter-individual variability in prognosis. Lifestyle factors, particularly those occurring after cancer treatment, such as obesity, weight change, exercise and dietary intakes, have been suggested to play an important role in cancer prognosis. On the other hand, breast cancer has been recognized as a more heterogeneous group of diseases. Breast cancer can be classified into four intrinsic tumor subtypes based on ER、PR and HER2 status: luminal A [ER(+) and/or PR(+), HER2 (-)], luminal B [(ER(+) and/or PR(+), HER2(+)], Her-2 enriched (ER(-), PR(-), HER2(+)), and triple negative [ER(-)、PR(-)、HER2(-), TNBC). The survival rate and clinicopathologic features varies among different subtypes and TNBC tumors have a higher risk of mortality and recurrence. . There have been no population-based breast cancer survival study to investigate the prognostic factors according to the breast cancer subtypes and no prognostic models to predict the prognosis of breast cancer among Chinese women,especially the effect for modifiable lifestyle factors on mortality and late recurrence of breast cancer. Studies in this area will provide much needed information for reducing recurrence and mortality of breast cancer survivors through close surveillance, targeted chemoprevention, and lifestyle modification.. The Cox proportional model is the most popular model for the analysis of survival data. Stratified 5-fold cross-validation method will be used to develop the final prognostic model and to evaluate the performance of the model. The correct and incorrect predictions in the test set across all 5 repetitions will be summarized into a ROC curve and the area under the ROC curve (AUC) will be calculated.. In summary, further face-to-face survey will conducted at over 10 year past cancer diagnosis in this study. The effect of modifiable lifestyle factors on prognosis of breast cancer subtypes will be comprehensively analyized. Furthermore,prognostic models for specific mortality and recurrence for breast cancer subtypes were will be developed and validated separately to evaluate the attributable risk on mortality and recurrence.

研究提示治疗后生活方式，如肥胖、体育锻炼等对其预后起着重要作用，同时乳腺癌是一种异质性肿瘤，不同分子分型乳腺癌生物学特征不同，相关因素对其预后的影响也可能存在差异。本研究在以人群为基础的乳腺癌前瞻性生存队列研究基础上，进一步开展肿瘤诊断10年后流行病学调查，通过问卷调查和体格检查等，收集研究对象相关信息，探讨随时间改变的生活方式（如锻炼、饮茶）对乳腺癌长期预后的影响，并探讨这些因素对不同分子分型乳腺癌预后的影响，构建不同亚型乳腺癌死亡和复发/转移风险评估模型。研究结果显示乳腺癌总体预后较好，10年观察生存率和无病生存率分别为80.5%和78.8%，不同分子分型乳腺癌的预后存在显著差异。诊断年龄、教育文化程度、临床诊断特征、治疗方式和诊断后生活方式等影响乳腺癌预后。诊断后生活方式对不同分型预后影响存在差别，表现在诊断后18、36和60个月体育锻炼（时间相依变量）显著改善乳腺癌患者长期预后，且锻炼时间和锻炼强度与总生存率和无病生存率改善呈正相关，锻炼强度超过7.6 MET-小时者/周和每周锻炼时间超过2.5小时者总死亡风险和乳腺癌死亡/复发/转移风险明显降低，体育锻炼能显著改善Luminal B型、HER-2过表达型和三阴型乳腺癌预后；诊断后18、36和60个月饮茶（时间相依变量）显著降低三阴型乳腺癌总死亡风险及乳腺癌死亡/复发/转移风险。研究建立了预测乳腺癌患者生存概率的列线图，不同分子分型乳腺癌预后预测模型的列线图所纳入的预后因子不同，预测能力较高，Bootstrap法校正C-index值在 0.67-0.74范围，该列线图能对患者进行较为直观、方便和准确的个体化预测。但构建的预测模型列线图还需进行外部验证。这些结果为个体化生存率预测、临床医生的治疗决策以及为社区乳腺癌患者指导康复和针对性的生活方式干预等提供参考依据，有着一定的指导意义。该项目进展顺利，部分结果已在国内外期刊《Epidemiology》、《Cancer Causes Control》和《中华外科杂志》等杂志发表，研究结果为“中国乳腺癌患者生活方式指南”提供了循证依据。