雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER2）乳腺癌亚型之间危险因素的多样分布：一项在中国进行的为期10年的回顾性多中心研究
The diverse distribution of risk factors between breast cancer subtypes of ER, PR and HER2: a 10-year retrospective multi-center study in China.
作者信息
Song Qingkun, Huang Rong, Li Jing, Fan Jinhu, Zheng Shan, Zhang Bin, Yang Hongjian, Tang Zhonghua, He Jianjun, Xie Xiaoming, Li Hui, Li Jiayuan, Qiao Youlin
机构信息
Departments of Epidemiology, Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
出版信息
PLoS One. 2013 Aug 20;8(8):e72175. doi: 10.1371/journal.pone.0072175. eCollection 2013.
INTRODUCTION
Hormone receptors, human epidermal growth factor receptor 2 and some risk factors determine therapies and prognosis of breast cancer. The risk factors distributed differently between patients with receptors. This study aimed to investigate the distribution of risk factors between subtypes of breast cancer by the 3 receptors in Chinese native women with a large sample size.
METHODS
The multi-center study analyzed 4211 patient medical records from 1999 to 2008 in 7 regions of China. Data on patients' demographic information, risk factors (menopausal status, parity, body mass index) and receptor statuses were extracted. Breast cancer subtypes included ER (+/-), PR (+/-), HER2 (+/-), 4 ER/PR and 4 molecular subtypes. Wilcoxon and Chi-square tests were used to estimate the difference. The unconditional logistic regression model was used for analysis, and presented p-value after Bonferroni correction in the results.
RESULTS
Compared to patients with negative progesterone receptor, the positive patients were younger at diagnosis, and reported less likely in postmenopausal status and lower parity (p<0.05). Comparing with the subtype of ER+/PR+, ER+/PR- subtype were 4-year older at diagnosis (OR = 1.02), more likely to be postmenopausal (OR = 1.91) and more likely to have >1 parity (OR = 1.36) (p<0.05); ER-/PR- subtype were more likely to be postmenopausal (OR = 1.33) and have >1 parity (OR = 1.19) (p<0.05). In contrast to the luminal A subtype, triple negative subtype had a lower BMI (OR = 0.96) and ORs of overweight and obesity reduced by >20% (p<0.05).
CONCLUSION
In this study, it was found that Chinese female patients did have statistically significant differences of age, menopausal status, parity and body mass index between breast cancer subtypes. Studies are warranted to further investigate the risk factors between subtypes, which was meaningful for prevention and treatment among Chinese females.
引言
激素受体、人表皮生长因子受体2以及一些风险因素决定了乳腺癌的治疗方案和预后。这些风险因素在不同受体状态的患者中分布各异。本研究旨在通过对大量中国本土女性患者样本，调查乳腺癌各亚型之间风险因素的分布情况，其中乳腺癌各亚型依据三种受体状态进行划分。
方法
这项多中心研究分析了1999年至2008年期间中国7个地区的4211例患者的病历。提取了患者的人口统计学信息、风险因素（绝经状态、生育次数、体重指数）以及受体状态数据。乳腺癌亚型包括雌激素受体（ER）（阳性/阴性）、孕激素受体（PR）（阳性/阴性）、人表皮生长因子受体2（HER2）（阳性/阴性）、4种雌激素受体/孕激素受体状态组合以及4种分子亚型。采用Wilcoxon检验和卡方检验来评估差异。使用无条件逻辑回归模型进行分析，并在结果中呈现经Bonferroni校正后的p值。
结果
与孕激素受体阴性的患者相比，阳性患者诊断时年龄更小，绝经状态的比例更低，生育次数更少（p<0.05）。与雌激素受体阳性/孕激素受体阳性亚型相比，雌激素受体阳性/孕激素受体阴性亚型诊断时年龄大4岁（OR = 1.02），更可能处于绝经后状态（OR = 1.91），生育次数>1次的可能性更大（OR = 1.36）（p<0.05）；雌激素受体阴性/孕激素受体阴性亚型更可能处于绝经后状态（OR = 1.33）且生育次数>1次（OR = 1.19）（p<0.05）。与管腔A型亚型相比，三阴性亚型的体重指数较低（OR = 0.96），超重和肥胖的比值比降低超过20%（p<0.05）。
结论
在本研究中，发现中国女性患者在乳腺癌各亚型之间，年龄、绝经状态、生育次数和体重指数存在统计学显著差异。有必要进一步研究各亚型之间的风险因素，这对中国女性乳腺癌的预防和治疗具有重要意义。
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