Department of Thyroid and Breast Surgery, The First Affiliated Hospital of ChongQing Medical University, Friendship Road, Yu-Zhong District, ChongQing, 400016, China.
Department of Oncology, The First Affiliated Hospital of ChongQing Medical University, Friendship Road, Yu-Zhong District, ChongQing, 400016, China.
Cancer Med. 2018 Jun;7(6):2753-2763. doi: 10.1002/cam4.1503. Epub 2018 Apr 19.
Premenopausal and postmenopausal breast cancers are considered different types. Thus, this study aimed to explore differences in risk factors, epidemiological features, clinicopathological features, and treatment modes of premenopausal breast cancer compared to postmenopausal patients in western China. This was a hospital-based, retrospective, multicenter epidemiological study of patients with breast cancer. Using the Western China Clinical Cooperation Group database, we obtained the records of 15,389 female breast cancers between January 2010 and April 2017. These patients were divided into premenopausal and postmenopausal groups, and their risk factors, epidemiological feature, clinicopathological features, and treatment modes were compared. Chi-square tests, t-test, and the multivariate logistic regression analysis were applied for statistical analysis. A total of 8395 patients were categorized as premenopausal, and 6994 patients were categorized as postmenopausal. Their risk factors, epidemiological features, clinicopathological features, and treatment modes were compared. Premenopausal patients with breast cancer had a greater tumor diameter at diagnosis (P = 0.008); higher rates of estrogen receptor (ER) expression (P < 0.0001), progesterone receptor (PR) expression (P < 0.0001), negative human epidermal growth factor receptor 2 (HER2) expression (P = 0.015), and negative P53 expression (P < 0.0001); and higher proportions of receiving breast-conserving surgery and breast reconstruction (P < 0.0001), chemotherapy (P < 0.0001), radiotherapy (P < 0.0001), and endocrine therapy (P < 0.0001). The ethnicity, age at menarche, marital status, number of pregnancies, and number of births were the risk factors for age at diagnosis of breast cancer before or after menopause in western China. We found that the fall in the fertility rate, early menarche age, married, and less breastfeeding might have increased the possibility of premenopausal breast cancer. Significant differences exist in the tumor size, hormone receptor state, HER2 expression, epidemiological features, and treatment modes between premenopausal and postmenopausal female breast cancer patients in western China. Its further implementation requires prospective clinical testing.
绝经前和绝经后乳腺癌被认为是两种不同的类型。因此，本研究旨在探索中国西部绝经前和绝经后乳腺癌患者在危险因素、流行病学特征、临床病理特征和治疗方式方面的差异。这是一项基于医院的、回顾性的、多中心的乳腺癌患者流行病学研究。我们使用中国西部临床协作组数据库，获得了 2010 年 1 月至 2017 年 4 月期间的 15389 例女性乳腺癌患者的记录。这些患者被分为绝经前和绝经后组，并比较了她们的危险因素、流行病学特征、临床病理特征和治疗方式。应用卡方检验、t 检验和多因素 logistic 回归分析进行统计学分析。共有 8395 例患者被归类为绝经前，6994 例患者被归类为绝经后。比较了她们的危险因素、流行病学特征、临床病理特征和治疗方式。绝经前乳腺癌患者的肿瘤直径在诊断时更大（P=0.008）；雌激素受体（ER）表达率更高（P<0.0001）、孕激素受体（PR）表达率更高（P<0.0001）、人表皮生长因子受体 2（HER2）阴性表达率更高（P=0.015）、P53 阴性表达率更高（P<0.0001）；并且接受保乳手术和乳房重建（P<0.0001）、化疗（P<0.0001）、放疗（P<0.0001）和内分泌治疗（P<0.0001）的比例更高。在中国西部，种族、初潮年龄、婚姻状况、妊娠次数和分娩次数是绝经前和绝经后乳腺癌发病年龄的危险因素。我们发现，生育率下降、初潮年龄提前、已婚和母乳喂养较少可能增加了绝经前乳腺癌的可能性。中国西部绝经前和绝经后女性乳腺癌患者在肿瘤大小、激素受体状态、HER2 表达、流行病学特征和治疗方式方面存在显著差异。其进一步实施需要前瞻性临床测试。
