尿镉水平与乳腺癌临床病理特征的关联性

Association between urinary cadmium and clinicopathological characteristics of breast cancer

目的 探讨人群中尿镉水平与乳腺癌临床病理特征之间的关系。方法2009年10月至2010年7月间，对240例乳腺癌患者进行临床资料和尿液标本的收集，采用电感耦合等离子体质谱仪检测尿镉水平。采用，检验和Wilcoxon秩和检验分析尿镉水平与乳腺癌病理特征之间的关系。结果240例乳腺癌患者尿镉浓度的中位数、第25百分位数（气）和第75百分位数（％）分别为1．99μg／g、1．32μg／g和2．88μg／g。尿镉高水平组和中低水平组患者的人表皮生长因子受体2（HER-2）阳性率分别为28．2％和16．5％，差异有统计学意义（P=0．042）。尿镉高水平组和中低水平组患者的淋巴结和（或）远处转移率分别为47．2％和32．0％，差异有统计学意义（P=0．028）。与尿镉中低水平组比较，尿镉高水平组患者的TNM分期较晚（P=0．017）。采用非条件Logistic回归模型校正年龄后，结果依然显示尿镉水平与HER．2状态、淋巴结和（或）远处转移情况及TNM分期有关（均P〈0．05）。结论尿镉水平与乳腺癌患者的HER-2状态、淋巴结和（或）远处转移情况及TNM分期有关；镉可能导致侵袭力强和恶性程度高的人类乳腺癌。

Objective The aim of this study was to investigate the association between urinary cadmium and clinicopathological characteristics of breast cancer. Methods The clinicopathological characteristics of 240 patients with breast cancer were obtained and urine specimens were collected from October 2009 to July 2010. The concentration of urinary cadmium was determined by inductively coupled plasma mass spectrometry （ICP-MS）. X2 test and Wilcoxon rank sum test were used to analyze whether urinary cadmium is associated with clinicopathological characteristics of breast cancer. Results The median concentration of urine cadmium of 240 patients was 1.99 μg/g （25th percentile, 1.32 μg/g; 75th percentile, 2.88 μg/g）. HER-2 positive rate, regional/distant metastasis rate, and advanced stage rate in patients with the highest tertile of cadmium concentration were significantly higher than those in the patients with second and lowest Cd tertiles （P = 0.042, P =0. 028 and P = 0.017, respectively）, and 28.2% vs. 16.5% for HER-2 and 47.2% vs. 32.0% for regional/distant metastasis, respectively. There were still significant associations between urinary cadmium levels and these clinicopathological parameters after being adjusted in age by unconditional logistic regression model, respectively （P 〈 0.05 ）. Conclusions The results of this study suggest that urinary cadmium levels are associated with the HER-2 status, regional/ distant metastasis status and stages of breast cancer, respectively. Cadmium may induce highly aggressive breast cancer in humans.