基线血脂水平对非三阴性乳腺癌患者预后的影响研究  

Study on the Effect of Baseline Blood Lipid Level on the Prognosis of Patients with Non-triple-negative Breast Cancer

作　　者：吴文霞[1] 张萌[1] WU Wenxia;ZHANG Meng(Department of General Practice,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510289,China)

机构地区：[1]中山大学孙逸仙纪念医院全科医学科,广东省广州市510289

出　　处：《中国全科医学》2021年第26期3316-3322,共7页Chinese General Practice

摘　　要：背景血脂异常是乳腺癌发病的高危因素之一,目前研究发现血脂代谢水平还可能与乳腺癌分期、病理特点、无病生存期(DFS)及总生存期(OS)紧密相关,但多项研究结果存在争议。目的探讨基线血脂代谢水平对非三阴性乳腺癌患者预后的影响。方法2019年1月-2021年3月检索中山大学孙逸仙纪念医院2016年1月-2017年3月电子病历系统中非三阴性乳腺癌患者202例,均无冠心病、脑血管疾病、糖尿病及血脂异常病史。收集其一般资料〔包括年龄、绝经状态、高血压史、体质指数(BMI)〕;空腹血标本检验血糖、血脂〔包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(APOA1)、载脂蛋白B(APOB)、载脂蛋白E(APOE)〕、超敏C反应蛋白(hsCRP)、尿酸;病理结果包括肿瘤大小(T分期)、淋巴结转移(N分期)及雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体2(HER-2)、Ki-67、组织分级。将患者按照肿瘤分期进行分组,即乳腺癌分期Ⅰ~Ⅱ期为组1,Ⅲ期为组2。记录患者DFS和OS。采用Kaplan-Meier法绘制DFS和OS的生存曲线,比较采用Log-rank检验。血脂对乳腺癌OS及DFS的影响采用多因素Cox回归模型。结果组2 TG水平高于组1,而HDL-C水平低于组1(P<0.05)。TG和HDL-C预测肿瘤分期Ⅲ期的最佳截断值分别为1.39 mmo/L〔受试者工作特征曲线(ROC曲线)下面积(AUC)为0.626,95%CI(0.562,0.690)〕和1.14 mmol/L〔AUC为0.599,95%CI(0.531,0.668)〕。TG≥1.39 mmol/L和HDL-C<1.14 mmol/L患者Ⅲ期比例高于TG<1.39 mmol/L和HDL-C≥1.14 mmol/L者(P<0.05)。TG≥1.39 mmol/L患者淋巴结转移比例高于TG<1.39 mmol/L者(P<0.05)。HDL-C<1.14 mmol/L患者肿瘤T分期高于HDL-C≥1.14 mmol/L者(P<0.05)。HDL-C≥1.14 mmol/L患者总生存率(98.1%)高于HDL-C<1.14 mmol/L患者(90.9%)(χ2=4.669,P=0.031);HDL-C<1.14 mmol/L患者无病生存率(77.4%)低于HDL-C≥1.14 mmol/L患者(89.8%)(χ2=3.85Background Dyslipidemia is one of high risk factors of breast cancer.Current studies have found that the level of blood lipid metabolism may also be closely related to the stage,pathology,overall survival(OS)and disease free survival(DFS)of breast cancer,but the results were stil controversial.Objective To explore the effect of baseline blood lipid metabolism on the prognosis of non-Triple Negative Breast Cancer(TNBC).Methods Retrieved from January 2019 to March 2021 in Sun Yat-sen memorial Hospital from January 2016 to March 2017 in the electronic medical record system,202 cases of non-triple-negative breast cancer patients were included.All the patients had no history of diabetes,dyslipidemia,cardiovascular or cerebrovascular disease.The clinical general information including age,menopausal status,history of hypertension,body mass index(BMI),fasting blood glucose,blood lipids〔including total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),apolipoprotein A1(APOA1),apolipoprotein B(APOB),apolipoprotein E(APOE)〕,high-sensitivity C-reactive protein(hsCRP),uric acid,pathological results〔including tumor size(T stage),lymph node metastasis(N stage),ER,PR,HER-2,Ki-67,tissue grade〕were collected.The OS and DFS time until three years of diagnosis were recorded.The patients were divided into two groups according to the breast cancer stage.Group 1was stageⅠ-Ⅱand group 2 was stageⅢ.Kaplan-Meier curves were used to determine OS and DFS rates.Log rank-tests were performed to compare differences in survival curves.Multivariable Cox proportional hazards regression models were used to study the associations between pre-diagnostic lipids and DFS,OS of non-TNBC.Results The TG level of group 2 was higher than that of group 1,while the level of HDL-C was lower than that of group 1(P<0.05).The optimal cutoff values of the TG level and HDL-C were determined to be 1.39 mmol/L〔AUC=0.626,95%CI(0.562,0.690)〕and 1.14 mmol/L〔AUC=0.599,95%CI(0.531,

关 键 词：乳腺肿瘤 非三阴性乳腺癌 三阴性乳腺癌 无病生存 总生存期 血脂水平 预后 

分 类 号：R737.9[医药卫生—肿瘤]