Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
PLoS One. 2013 May 29;8(5):e58867. doi: 10.1371/journal.pone.0058867. Print 2013.
The clinical tumor-node-metastasis (T, N and M) classes of breast cancers provide important prognostic information. However, the possible association of TNM classes with reproductive factors has remained largely unexplored. Because every woman has a reproductive history, implications to outcome prediction are potentially significant.
During the study period from 2002 through 2008, 5,614 pre- and 27,310 postmenopausal patients were identified in the Swedish Family-Cancer Database. Ordinal logistic regression analysis was used to estimate odds ratios (ORs) for TNM classes of breast cancers by histology. The reproductive variables were parity, age at first and last childbirth and time interval between first and last childbirth.
Among postmenopausal patients, the ORs for high-T class (T2-T4) (tumor size ≥2 cm) and metastasis were decreased by parity. A late age at first and last childbirth associated with high-T class and the effects were higher for lobular (OR for late age at first childbirth = 2.85) than ductal carcinoma. Overall, long time interval between first and last childbirth was related to high-T class and metastasis. However, a short time interval between first and last childbirth in patients with late age at first or last childbirth increased the risk of metastasis. Late age at last childbirth was associated with increased occurrence of lobular carcinoma in situ. Among premenopausal ductal carcinoma patients, nulliparity and early age at first childbirth were associated with high-T class.
Increasing parity was protective against high-T class and metastasis; late ages at first and last childbirth were risk factors for high-T class in postmenopausal breast cancers. The current decline in parity and delayed age at first childbirth in many countries may negatively influence prognosis of breast cancer.
乳腺癌的临床肿瘤-淋巴结-转移（T、N 和 M）分期为提供了重要的预后信息。然而，TNM 分期与生殖因素的可能关联在很大程度上仍未得到探索。因为每个女性都有生育史，所以这对预后预测具有潜在的重要意义。
在 2002 年至 2008 年期间，在瑞典家族癌症数据库中确定了 5614 名绝经前和 27310 名绝经后患者。使用有序逻辑回归分析按组织学估计乳腺癌的 TNM 分期的优势比（OR）。生殖变量为产次、首次和末次分娩年龄以及首次和末次分娩之间的时间间隔。
在绝经后患者中，产次与高 T 类（T2-T4）（肿瘤大小≥2cm）和转移的 OR 降低。首次和末次分娩年龄较晚与高 T 类相关，且对于小叶癌（首次分娩年龄较晚的 OR 为 2.85）的影响更高。总体而言，首次和末次分娩之间的长时间间隔与高 T 类和转移有关。然而，对于首次和末次分娩年龄较晚的患者，短时间间隔会增加转移的风险。末次分娩年龄较晚与小叶原位癌的发生增加有关。在绝经前的导管癌患者中，未婚和首次分娩年龄较早与高 T 类有关。
产次增加可预防高 T 类和转移；首次和末次分娩年龄较晚是绝经后乳腺癌高 T 类的危险因素。目前许多国家的生育率下降和首次分娩年龄推迟可能会对乳腺癌的预后产生负面影响。
