Huang Yu-Sen, Chen Jenny Ling-Yu, Huang Chiun-Sheng, Kuo Sung-Hsin, Jaw Fu-Shan, Tseng Yao-Hui, Ko Wei-Chun, Chang Yeun-Chung
Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan.
Breast Cancer Res. 2016 Dec 1;18(1):120. doi: 10.1186/s13058-016-0784-3.
We aimed to evaluate the influence of mammographic breast density at diagnosis on the risk of cancer recurrence and survival outcomes in patients with invasive breast cancer after modified radical mastectomy.
This case-control study included 121 case-control pairs of women diagnosed with invasive breast cancer between 2004 and 2009, and who had undergone modified radical mastectomy and had mammographic breast density measured before or at diagnosis. Women with known locoregional recurrence or distant metastasis were matched by pathological disease stage, age, and year of diagnosis to women without recurrence. Locoregional recurrence was defined as recurrence in the ipsilateral chest wall, or axillary, internal mammary, or supraclavicular nodes. The median follow-up duration was 84.0 months for case patients and 92.9 months for control patients.
Patients with heterogeneously dense (50-75% density) and extremely dense (>75% density) breasts had an increased risk of locoregional recurrence (hazard ratios 3.1 and 5.7, 95% confidence intervals 1.1-9.8 and 1.2-34.9, p = 0.043 and 0.048, respectively) than did women with less dense breasts. Positive margins after surgery also increased the risk of locoregional recurrence (hazard ratio 3.3, 95% confidence interval 1.3-8.3, p = 0.010). Multivariate analysis that included dense breasts (>50% density), positive margin, no adjuvant radiotherapy, and no adjuvant chemotherapy revealed that dense breasts were significant factors for predicting locoregional recurrence risk (hazard ratio 3.6, 95% confidence interval 1.2-11.1, p = 0.025).
Our results demonstrate that dense breast tissue (>50% density) increased the risk of locoregional recurrence after modified radical mastectomy in patients with invasive breast cancer. Additional prospective studies are necessary to validate these findings.
The study is retrospectively registered with ClinicalTrials.gov, number NCT02771665 , on May 11, 2016.
我们旨在评估诊断时乳腺钼靶密度对浸润性乳腺癌患者改良根治术后癌症复发风险和生存结局的影响。
这项病例对照研究纳入了2004年至2009年间诊断为浸润性乳腺癌、接受过改良根治术且在诊断前或诊断时测量过乳腺钼靶密度的121对病例对照女性。已知有局部区域复发或远处转移的女性，根据病理疾病分期、年龄和诊断年份，与无复发的女性进行匹配。局部区域复发定义为同侧胸壁、腋窝、内乳或锁骨上淋巴结复发。病例组患者的中位随访时间为84.0个月，对照组患者为92.9个月。
乳房密度为不均匀致密（50 - 75%密度）和极度致密（>75%密度）的患者，与乳房密度较低的女性相比，局部区域复发风险增加（风险比分别为3.1和5.7，95%置信区间为1.1 - 9.8和1.2 - 34.9，p分别为0.043和0.048）。手术后切缘阳性也增加了局部区域复发风险（风险比3.3，95%置信区间1.3 - 8.3，p = 0.010）。多因素分析包括乳房致密（>50%密度）、切缘阳性、未接受辅助放疗和未接受辅助化疗，结果显示乳房致密是预测局部区域复发风险的重要因素（风险比3.6，95%置信区间1.2 - 11.1，p = 0.025）。
我们的结果表明，致密乳腺组织（>50%密度）增加了浸润性乳腺癌患者改良根治术后局部区域复发的风险。需要进一步的前瞻性研究来验证这些发现。
该研究于2016年5月11日在ClinicalTrials.gov进行回顾性注册，编号为NCT02771665。
