Chen Qi, Duan Cheng-Bin, Huang Ye, Liu Kun
Department of Medical Oncology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital. C. T.), Chengdu, China.
Front Oncol. 2023 Jan 13;12:1050481. doi: 10.3389/fonc.2022.1050481. eCollection 2022.
Breast cancer is one of the major malignancies threatening women's health worldwide. The incidence of breast cancer at high altitudes increased over the years. But few studies focused on the characteristics of clinicopathology and molecular subtypes among breast cancer at high altitudes, which are still unknown. Tibet, with an average altitude over 4000 meters, is a representative city at high altitudes, lying in the Qinghai-Tibetan Plateau in southwestern China. This study aimed to identify the clinicopathological characteristics and features of molecular subtypes among Tibetan women with breast cancer, and provide evidence for cancer prevention and personalized therapeutics in high-altitude regions.
Between May 2013 and March 2022, 104 Tibetan women from high-altitude regions (Tibetan-group) and 34 Han Chinese women from low-altitude regions (Han-group), consecutively diagnosed with breast cancer in the Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, were included in the study. We retrospectively reviewed the clinical character, altitudes of residence, tumor size, lymph nodes metastasis, distant metastasis, pathological type, immunohistochemical index, and molecular subtype.
In the study, we calculated the patient delay, equal to the period from symptoms onset to hospital visits. The patient delay of Tibetan-group was 7.47 ± 11.53 months, which was significantly longer than that of Han-group, 7.22 ± 22.96 months (p<0.05). Body Mass Index (BMI) was significantly different (p<0.05). Tumors in Tibetan-group were significantly larger than those in Han-group, 4.13 ± 2.98cm and 2.51 ± 0.82cm in diameter, respectively (p<0.05). According to ordinal logistic regression analysis, exposure to high altitudes might result in more advanced T stage (OR=2.45 95%CI 1.10-5.44). 41.3% (43/104) of cases in Tibetan-group had lymph node positive disease, whereas the percentage was found in 38.26% (13/34) in Han-group(p<0.05). The distribution of molecular subtypes was quite significantly different between two groups (p<0.05), according to the comparison of constituent ratios.
Our study verified that breast cancer at high altitudes possessed its own unique clinicopathological characteristics and distinct features of molecular subtypes. It broadened the understanding of this heterogenous disease and also provided valuable evidence for cancer prevention and personalized therapeutics of breast cancer at high altitudes.
乳腺癌是全球威胁女性健康的主要恶性肿瘤之一。多年来，高海拔地区乳腺癌的发病率有所上升。但很少有研究关注高海拔地区乳腺癌的临床病理特征和分子亚型，这些仍不清楚。西藏平均海拔超过4000米，是高海拔地区的代表性城市，位于中国西南部的青藏高原。本研究旨在确定藏族乳腺癌女性的临床病理特征和分子亚型特征，并为高海拔地区的癌症预防和个性化治疗提供依据。
2013年5月至2022年3月期间，在西藏自治区人民政府驻成都办事处医院连续诊断为乳腺癌的104名高海拔地区藏族女性（藏族组）和34名低海拔地区汉族女性（汉族组）被纳入研究。我们回顾性分析了临床特征、居住海拔、肿瘤大小、淋巴结转移、远处转移、病理类型、免疫组化指标和分子亚型。
在本研究中，我们计算了患者延迟时间，即从症状出现到就诊的时间。藏族组的患者延迟时间为7.47±11.53个月，明显长于汉族组的7.22±22.96个月（p<0.05）。体重指数（BMI）有显著差异（p<0.05）。藏族组的肿瘤明显大于汉族组，直径分别为4.13±2.98厘米和2.51±0.82厘米（p<0.05）。根据有序逻辑回归分析，暴露于高海拔地区可能导致更晚期的T分期（OR=2.45，95%CI 1.10-5.44）。藏族组41.3%（43/104）的病例有淋巴结阳性疾病，而汉族组这一比例为38.26%（13/34）（p<0.05）。根据构成比的比较，两组分子亚型的分布有非常显著的差异（p<0.05）。
我们的研究证实，高海拔地区的乳腺癌具有其独特的临床病理特征和不同的分子亚型特征。它拓宽了对这种异质性疾病的认识，也为高海拔地区乳腺癌的癌症预防和个性化治疗提供了有价值的证据。
