Mason B H, Holdaway I M, Stewart A W, Neave L M, Kay R G
Department of Surgery, Auckland Hospital, New Zealand.
Breast Cancer Res Treat. 1990 Jan;15(1):27-37. doi: 10.1007/BF01811887.
The rate of initial detection of breast tumours varies during the year in a seasonal fashion, more tumours being discovered in late spring/early summer than at other times of the year. This phenomenon is particularly pronounced in young women (less than 50 years) with progesterone receptor positive tumours. The present study investigates whether season of tumour detection influences the predictive capacity of several recognised prognostic and risk factors in patients with breast cancer. Axillary nodal status, tumour progesterone receptor status, and season of tumour detection significantly influenced survival in both older (greater than 50 yrs) and younger (less than 50 yrs) patients. Parity, lactational history, body mass index, tumour oestrogen receptor status, and patient age also influenced survival, but these effects were significant only in age groups less than 50 or greater than 50 yrs. Season of detection of tumour did not effect the prognostic significance of axillary nodal status. However, the effect of oestrogen receptor status on survival was more significant in patients who detected their tumours in the spring/summer compared with winter (odds ratio 0.52 and 0.73 respectively). Negative progesterone receptor status was associated with significant poorer survival only in patients with tumours found in the winter. There was a significant survival disadvantage for nulliparous compared with parous women with breast cancer who were greater than or equal to 50 years at diagnosis, and for women who had never lactated compared with those who had lactated, but this disadvantage was restricted to those who found their tumours in the summer. An increased body mass index (greater than or equal to 28) was associated with decreased survival, but this was significant only for those detecting tumours in winter. The increased incidence of detection of breast cancer in spring/summer may reflect cyclic influences on tumour growth. Such influences may be hormonal in nature and may underlie the effect of season of tumour detection on the prognostic influence of lactation, parity, body mass index, and oestrogen and progesterone receptor status in patients with breast cancer.
乳腺肿瘤的初次检出率在一年中呈季节性变化，晚春/初夏发现的肿瘤比一年中的其他时间更多。这种现象在患有孕激素受体阳性肿瘤的年轻女性（小于50岁）中尤为明显。本研究调查了肿瘤检出季节是否会影响乳腺癌患者几种公认的预后和风险因素的预测能力。腋窝淋巴结状态、肿瘤孕激素受体状态和肿瘤检出季节对老年（大于50岁）和年轻（小于50岁）患者的生存率均有显著影响。产次、哺乳史、体重指数、肿瘤雌激素受体状态和患者年龄也会影响生存率，但这些影响仅在小于50岁或大于50岁的年龄组中显著。肿瘤检出季节并不影响腋窝淋巴结状态的预后意义。然而，与冬季相比，春季/夏季检出肿瘤的患者中，雌激素受体状态对生存率的影响更为显著（优势比分别为0.52和0.73）。仅在冬季发现肿瘤的患者中，孕激素受体阴性状态与显著较差的生存率相关。与诊断时年龄大于或等于50岁的经产妇相比，未生育的乳腺癌患者存在显著的生存劣势；与曾哺乳的女性相比，从未哺乳的女性存在生存劣势，但这种劣势仅限于夏季发现肿瘤的患者。体重指数增加（大于或等于28）与生存率降低相关，但仅对冬季检出肿瘤的患者显著。春季/夏季乳腺癌检出率的增加可能反映了对肿瘤生长的周期性影响。这种影响可能本质上是激素性的，可能是肿瘤检出季节对乳腺癌患者哺乳、产次、体重指数以及雌激素和孕激素受体状态的预后影响的基础。
