Kim Ju-Yeon, Han Wonshik, Moon Hyeong-Gon, Ahn Soo Kyung, Kim Jisun, Lee Jun Woo, Kim Min Kyoon, Kim Taeryung, Noh Dong-Young
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Seoul 110-744, Korea.
BMC Cancer. 2013 Oct 27;13:503. doi: 10.1186/1471-2407-13-503.
The prognostic role of serum estrogen level in breast cancer patients is unclear. We investigated the prognostic importance of preoperative serum estradiol (E2) level in postmenopausal women according to their estrogen receptor (ER) status.
The medical records of 313 postmenopausal breast cancer patients who underwent surgery between 2006 and 2008 at a single institution were retrospectively evaluated. Patients who received neoadjuvant chemotherapy, synchronous bilateral breast cancer, or those with metastasis at diagnosis were excluded. Serum E2 and follicular stimulating hormone (FSH) levels were measured by radioimmunoassay and immunoradiometric assay, respectively, within 3 months prior to surgery. After a median follow-up of 52.0 months (11-77 months), 21 women were found to have metastatic disease.
The overall, median E2 level was 13.0 pg/ml, and was slightly higher in ER-positive than ER-negative (p=0.69). The mean serum E2 level was significantly higher in patients with metastasis (17.41 ± 8.34 pg/ml) than in those without metastasis (13.54 ± 7.58 pg/ml) (p=0.02). Kaplan-Meier analysis using a cut-off of 13 pg/ml showed that, ER negative (p=0.02) but not ER positive (p>0.05) patients with higher E2 level showed significantly poorer metastasis-free survival. Multivariate analysis showed that, the high E2 level of ER negative tumors was an independent negative prognostic factor for metastasis- free survival (HR, 3.32; 95% CI, 1.05 to 10.51; p=0.04).
Higher preoperative serum E2 level had a negative prognostic effect in postmenopausal women with breast cancer, especially in the ER-negative subgroup.
血清雌激素水平在乳腺癌患者中的预后作用尚不清楚。我们根据雌激素受体（ER）状态，研究了绝经后女性术前血清雌二醇（E2）水平的预后重要性。
回顾性评估了2006年至2008年在一家机构接受手术的313例绝经后乳腺癌患者的病历。排除接受新辅助化疗、同步双侧乳腺癌或诊断时已有转移的患者。术前3个月内分别采用放射免疫分析法和免疫放射分析法测定血清E2和促卵泡生成素（FSH）水平。中位随访52.0个月（11 - 77个月）后，发现21名女性出现转移性疾病。
总体而言，E2水平中位数为13.0 pg/ml，ER阳性患者略高于ER阴性患者（p = 0.69）。发生转移的患者血清E2平均水平（17.41 ± 8.34 pg/ml）显著高于未发生转移的患者（13.54 ± 7.58 pg/ml）（p = 0.02）。采用13 pg/ml的临界值进行Kaplan - Meier分析显示，E2水平较高的ER阴性（p = 0.02）而非ER阳性（p>0.05）患者无转移生存期显著较差。多因素分析显示，ER阴性肿瘤的高E2水平是无转移生存期的独立阴性预后因素（HR，3.32；95% CI，1.05至10.51；p = 0.04）。
术前血清E2水平较高对绝经后乳腺癌女性具有负面预后影响，尤其是在ER阴性亚组中。
