雌激素受体阳性乳腺癌患者孕激素受体状态对体质量指数与预后关系的影响

Effect of progesterone receptor on association between body mass index and prognosis in women with estrogen receptor positive breast cancer

目的探讨雌激素受体阳性乳腺癌患者孕激素受体(PR)对体质量指数与预后关系的影响。方法收集2012年3月至2018年1月山西白求恩医院住院的病理证实为浸润性导管癌患者1 036例。以体质量指数(BMI)24 kg/m^(2)为分界值,将患者分为BMI≥24 kg/m^(2)组(608例)和BMI<24 kg/m^(2)组(428例)。采用免疫组织化学法检测肿瘤PR状态。比较BMI不同水平组间临床病理特征的差异;采用Kaplan-Meier法绘制全组和PR分层患者中BMI不同水平两组的总生存(OS)曲线,并行log-rank检验。采用单因素和多因素Cox比例风险模型分析影响OS的因素。结果中位随访4.0年(2.3~5.7年)。BMI <24 kg/m^(2)组和BMI≥24 kg/m^(2)组间年龄、组织学分级、分期、月经状态、肿瘤家族史不同,差异有统计学意义(均P<0.05)。全组中,BMI <24 kg/m^(2)组OS优于BMI≥24 kg/m^(2)组(P=0.033);在PR阴性的ER阳性乳腺癌患者中,BMI <24 kg/m^(2)组OS优于BMI≥24组(P=0.007);PR阳性的ER阳性乳腺癌患者中,BMI <24 kg/m^(2)组和BMI≥24 kg/m^(2)组间OS差异无统计学意义(P=0.466)。单因素Cox回归分析显示,BMI、PR、分期、月经状态与ER阳性乳腺癌患者OS相关(均P<0.05);多因素Cox回归分析显示,BMI≥24 kg/m^(2)(HR=1.916,95%CI:1.167~3.144,P=0.010)、PR阴性(HR=0.348,95%CI:0.208~0.583,P<0.001)为ER阳性乳腺癌患者OS的独立危险因素。结论与PR阳性、ER阳性肥胖乳腺癌患者相比,PR阴性、ER阳性患者生存率更低,因此,PR状态与ER阳性肥胖乳腺癌患者预后相关,为乳腺癌预防和诊治提供理论依据。

Objective This study aims to explore whether the association between body mass index(BMI and prognosis of estrogen receptor positive(ER+)breast cancer(BC)varies according to the tumor PR status.Methods We collected a total of 1 036 cases with invasive ductal breast cancer from March 2012 to January 2018 in department of breast surgery of Shanxi Bethune Hospital. Women were stratified according to their BMI(< 24,≥ 24 kg/m^(2)). Tumor PR status(PR-,PR+)was evaluated by immunohistochemistry. The differences of clinicopathological features between the groups with different BMI levels were compared;Kaplan-Meier method was used to draw the overall survival(OS)curve of the whole group and the patients stratified by PR with different BMI levels,and log-rank test was performed. Univariate and multivariate Cox proportional hazards models were used to analyze the factors affecting OS. Results The median follow-up period was 4.0 years(2.3 ~ 5.7 years). There were significant differences in age,histological grade,stage,menstrual status and family history of tumor between BMI < 24 kg/m^(2) group and BMI ≥ 24 kg/m^(2) group(P < 0.05). In the whole group,OS in BMI <24 kg/m^(2) group was better than that in BMI ≥ 24 kg/m^(2) group(P = 0.033). In breast cancer patients with PR-and ER+,OS in BMI < 24 kg/m^(2) group was better than that in BMI ≥ 24 kg/m^(2)(P = 0.007);In breast cancer patients with PR+and ER+,there was no significant difference in OS between BMI < 24 kg/m^(2) group and BMI ≥ 24 kg/m^(2) group(P =0.466). Univariate Cox regression analysis showed that BMI,PR,stage and menstrual status were associated with OS in ER positive breast cancer patients(P < 0.05). Multivariate Cox regression analysis showed that BMI ≥ 24 kg/m^(2)(HR = 1.916,95% CI:1.167 ~ 3.144,P = 0.010)and PR negative(HR = 0.348,95% CI:0.208 ~ 0.583,P < 0.001)were independent risk factors for OS in ER positive breast cancer patients. Conclusion Compared with PR+,ER+obese breast cancer patients,PR-,ER+women had poorer survival. It suggests that poorer survival is associated with high BMI among women diagnosed with ER+BC,which provides reference for the prevention and treatment of breast cancer.