von Au Alexandra, Klotzbuecher Mona, Uhlmann Lorenz, Boudewijns Mark, Michel Laura, Wallwiener Markus, Heil Joerg, Golatta Michael, Rom Joachim, Sohn Christof, Schneeweiss Andreas, Schuetz Florian, Domschke Christoph
Department of Gynecology and Obstetrics / National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany.
Arch Gynecol Obstet. 2017 Apr;295(4):971-978. doi: 10.1007/s00404-017-4298-8. Epub 2017 Feb 7.
Some reproductive factors are well-known general risk factors for breast cancer (BC). On the other hand, BC subtypes also have a high prognostic value. Correlations, however, that link these risk factors to the development of a particular one of the different BC subtypes are still poorly understood. The primary objective of our study was to assess the influence of different reproductive factors (duration of breastfeeding, parity, and age at first childbirth) on pathological BC subtypes. Secondarily, we correlated body mass index (BMI), age at primary diagnosis, and smoking behavior with tumor subclasses.
We performed a retrospective chart review of 1082 patients with BC who had been treated for postmenopausal BC at the Heidelberg University Hospital during the period 2009-2014. For statistical analysis, different types of correlation analysis as well as a logistic regression model were used.
Relating to the primary objective, we found that patients with luminal-like BC had significantly fewer children than patients with triple-negative or HER2-positive subtype tumors (P = 0.027). Concerning the duration of breastfeeding, patients with a luminal A-like tumor had a significantly lower mean nursing period than patients with other subtypes (P = 0.012). Furthermore, patients who did breastfeed presented with a significantly lower number of hormone receptor-positive tumors (estrogen receptor-positive, P = 0.04; progesterone receptor-positive, P = 0.017) but the highest rate of HER2-overexpressing malignancies (P = 0.011). Moreover, late first childbirth was associated with the occurrence of luminal tumors (OR 0.952; P = 0.041). Regarding our secondary aim, higher BMI (P = 0.031) and higher age at primary diagnosis (P = 0.038) were both found to be significantly associated with luminal-like BC.
The results suggest a correlation of the occurrence of luminal-like BC subtypes with low parity and short or no duration of breastfeeding. Prospective investigations are needed for further confirmation and to evaluate the molecular basis of our findings.
一些生殖因素是乳腺癌（BC）众所周知的一般风险因素。另一方面，BC亚型也具有很高的预后价值。然而，将这些风险因素与不同BC亚型中某一特定亚型的发生联系起来的相关性仍知之甚少。我们研究的主要目的是评估不同生殖因素（母乳喂养持续时间、产次和初产年龄）对病理性BC亚型的影响。其次，我们将体重指数（BMI）、初次诊断时的年龄和吸烟行为与肿瘤亚类进行关联分析。
我们对2009年至2014年期间在海德堡大学医院接受绝经后BC治疗的1082例BC患者进行了回顾性病历审查。为进行统计分析，使用了不同类型的相关性分析以及逻辑回归模型。
关于主要目的，我们发现管腔样BC患者的子女数量明显少于三阴性或HER2阳性亚型肿瘤患者（P = 0.027）。关于母乳喂养持续时间，管腔A型肿瘤患者的平均哺乳期明显低于其他亚型患者（P = 0.012）。此外，进行母乳喂养的患者激素受体阳性肿瘤数量明显较少（雌激素受体阳性，P = 0.04；孕激素受体阳性，P = 0.017），但HER2过表达恶性肿瘤的发生率最高（P = 0.011）。此外，初产年龄较晚与管腔型肿瘤的发生相关（OR 0.952；P = 0.041）。关于我们的次要目标，发现较高的BMI（P = 0.031）和初次诊断时较高的年龄（P = 0.038）均与管腔样BC显著相关。
结果表明管腔样BC亚型的发生与低产次以及短时间或无母乳喂养持续时间相关。需要进行前瞻性研究以进一步证实并评估我们研究结果的分子基础。
