肥胖及血管内皮生长因子与乳腺癌临床病理及预后关系研究

Effect of obesity and VEGF on clinical pathology and prognosis of breast cancer

目的探讨肥胖及血管内皮生长因子(vascular endothelial growth factor,VEGF)与乳腺癌临床病理及预后关系。方法收集江苏大学附属人民医院2013年1月至2015年12月的147例乳腺癌患者的体质指数(body mass index,BMI)、临床病理资料及生存预后信息,采用χ2对各因素与肥胖的相关性进行分析,采用Log-rank检验和Cox回归分析对影响因素进行单因素和多因素分析;生物公共信息数据库Oncomine、Kaplan Meier plotter中分析VEGF在乳腺癌中的表达及与其生存预后关系。结果147例中位随访时间40个月,范围为12~58个月,肥胖与肿瘤体积增大相关性(χ^2=11.009,P=0.001);单因素分析结果提示肥胖及腋窝淋巴结状态显著减少乳腺癌患者总生存期(overall survival,OS)(P=0.035,P=0.038)及无复发生存期(recurrence free survival,RFS)(P=0.035,P=0.036),Cox多因素回归分析结果提示肥胖可考虑为乳腺癌预后不良的独立因素(P=0.051,HR=3.849,95% CI: 0.995~14.895);Oncomine数据库分析发现VEGF相对于癌旁组织在乳腺癌组织高表达,Kaplan Meier plotter分析结果乳腺癌组织低表达VEGF的患者OS及RFS较好。结论肥胖是乳腺癌患者预后的不良因素,可能与肥胖引起的VEGF升高相关,减轻体重可能改善乳腺癌患者的预后。

Objective To investigate the relationship of obesity and vascular endothelial growth factor (VEGF) and the clinicopathological characteristics and prognosis of breast cancer. Methods From Jan. 2013 to Dec.2015, 147 breast cancer patients were treated at the Department of Breast Surgery in Jiangsu University Affiliated People’s Hospital. The clinical factors such as BMI, clinicopathological data and survival prognosis were collected. The chi-square test was used to analyze the association between factors and obesity. Log-rank test and COX regression analysis were performed to make univariate and multivariate analysis. The Oncomine and Kaplan Meier plotter were employed to assess the expression of VEGF in breast cancer and its association with survival prognosis of breast cancer patients. Results The median follow-up time was 40 (ranging from 12 to 58) months. Obesity was associated with tumor size (χ^2=11.009, P=0.001), and there was no significant correlation between axillary lymph node status, hormone receptor and Her-2 expression. The results of single factor analysis suggested that obesity and axillary lymph node status significantly affected the breast cancer patients OS (P=0.035, P=0.038) and RFS (P=0.035, P=0.036)). Cox multivariate regression analysis results suggested that obesity could be considered as an independent prognostic factor of breast cancer: P=0.051, HR=3.849 (95% CI: 0.995-14.895);Oncomine database analysis found that VEGF was relatively high in breast cancer tissue compared to that in adjacent tissues. Kaplan Meier plotter analysis results showed better overall survival (OS) and recurrence free survival (RFS) in patients with low expression of VEGF in breast cancer tissues. Conclusions Obesity is an adverse prognostic factor in breast cancer patients, and may be associated with elevated VEGF. Weight control may improve the prognosis of breast cancer patients.