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乳腺钼靶密度与肿瘤标志物定义的乳腺癌亚型之间的关联:一项病例对照研究。

Association between mammographic density and tumor marker-defined breast cancer subtypes: a case-control study.

作者信息

Shin Jinyoung, Lee Jeong Eon, Ko Hyeon Young, Nguyen Tuong Linh, Nam Seok Jin, Hopper John Llewelyn, Song Yun-Mi

机构信息

Departments of Family Medicine.

Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine.

出版信息

Eur J Cancer Prev. 2018 May;27(3):239-247. doi: 10.1097/CEJ.0000000000000353.

Abstract

High mammographic density (MD) is the most important risk factor for breast cancer. This study aimed to clarify the relationship between MD and breast cancer subtypes defined by tumor markers. We enrolled 642 women with breast cancer (69% premenopausal) and 1241 controls matched for age and menopausal status. Absolute mammographic dense area (ADA), percent mammographic dense area (PDA), and nondense area were assessed using a computer-assisted thresholding technique. We classified breast cancer cases into four subtypes using information on tumor marker expression such as estrogen receptor (ER), progesterone receptor (PR), and Cerb2 receptor (HER2); luminal A (ER+ and/or PR+, HER2-), luminal B (ER+ and/or PR+, HER2+), HER2-overexpressing (ER-, PR-, and HER2+), and triple-negative (ER-, PR-, and HER2-). Analysis was carried out using a conditional logistic regression model with adjustment for covariates. ADA and PDA were associated positively with the risk of breast cancer overall. Both ADA and PDA tended to have a positive association with breast cancer with any ER, any PR, or HER2-, but not for HER2+. The risk of luminal A breast cancer increased significantly 1.11 times (95% confidence interval: 1.01-1.23) for ADA and 1.12 times (95% confidence interval: 1.01-1.24) for PDA, estimated per 1 SD of the age and BMI-adjusted MD. However, the risk of breast cancer with luminal B, HER2-overexpressing, and triple-negative subtypes did not differ (P>0.10). Differential associations between MD measures and breast cancer by tumor marker status or tumor marker-defined subtypes were not detected. These findings suggested that the association between MD and breast cancer subtype may be because of other causal pathways.

摘要

乳腺钼靶高密度(MD)是乳腺癌最重要的危险因素。本研究旨在阐明MD与由肿瘤标志物定义的乳腺癌亚型之间的关系。我们纳入了642例乳腺癌女性患者(69%为绝经前患者)以及1241名年龄和绝经状态相匹配的对照。使用计算机辅助阈值技术评估乳腺钼靶绝对致密面积(ADA)、乳腺钼靶致密面积百分比(PDA)和非致密面积。我们利用雌激素受体(ER)、孕激素受体(PR)和Cerb2受体(HER2)等肿瘤标志物表达信息将乳腺癌病例分为四种亚型;腔面A型(ER+和/或PR+,HER2-)、腔面B型(ER+和/或PR+,HER2+)、HER2过表达型(ER-,PR-,HER2+)和三阴性(ER-,PR-,HER2-)。采用条件逻辑回归模型并对协变量进行调整后进行分析。ADA和PDA与总体乳腺癌风险呈正相关。ADA和PDA与任何ER、任何PR或HER2-的乳腺癌均呈正相关趋势,但与HER2+的乳腺癌无关。根据年龄和体重指数调整后的MD每增加1个标准差估计,腔面A型乳腺癌风险显著增加1.11倍(95%置信区间:1.01-1.23),PDA增加1.12倍(95%置信区间:1.01-1.24)。然而,腔面B型、HER2过表达型和三阴性亚型乳腺癌的风险无差异(P>0.10)。未检测到MD测量值与肿瘤标志物状态或肿瘤标志物定义的亚型之间的乳腺癌存在差异关联。这些发现表明,MD与乳腺癌亚型之间的关联可能是由于其他因果途径。

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