Established breast cancer risk factors by clinically important tumour characteristics.
Established breast cancer risk factors by clinically important tumour characteristics.
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DOI：
10.1038/sj.bjc.6603207
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发表时间：
2006-07-03
影响因子：
8.8
通讯作者：
中科院分区：
文献类型：
--
作者：
乳腺癌是一种形态学和临床异质性疾病;然而，尚不清楚风险因素与肿瘤特征的关系。我们在波兰的2386例乳腺癌和2502例对照人群中，通过肿瘤特征（组织病理学类型、分级、大小和淋巴结状态）评估了风险因素。使用一种新的扩展的多分类逻辑回归允许同时建模的多个肿瘤的特点。第一次足月分娩时年龄较晚与大肿瘤（>2 cm）的风险增加相关（年龄增加5岁的优势比（95%置信区间）为1.19（1.07-1.33）），但与较小肿瘤的风险无关（调整其他肿瘤特征的异质性P =0.007）。另一方面，多产与小肿瘤的风险降低有关（每多生0.76（0.68-0.86）; Phet=0.004）。同时考虑所有肿瘤特征，发现当前或近期使用联合激素替代疗法与小的风险相关。（2.29（1.66-3.15））和1级（3.36（2.22-5.08））肿瘤（大小Phet=0.05，1级与3级Phet = 0.0008），而不是特定的组织病理学类型（导管与小叶Phet=0.63）。最后，在绝经前和绝经后妇女中，体重指数升高与较大的肿瘤大小相关（Phet分别为0.05和0.0001）。这些关系都不能用肿瘤的激素受体状态来解释。总之，这些数据支持肿瘤特征与预后相关性的独特风险因素关系。这些发现可能有助于开展有针对性的预防工作。
Breast cancer is a morphologically and clinically heterogeneous disease; however, it is less clear how risk factors relate to tumour features. We evaluated risk factors by tumour characteristics (histopathologic type, grade, size, and nodal status) in a population-based case–control of 2386 breast cancers and 2502 controls in Poland. Use of a novel extension of the polytomous logistic regression permitted simultaneous modelling of multiple tumour characteristics. Late age at first full-term birth was associated with increased risk of large (>2 cm) tumours (odds ratios (95% confidence intervals) 1.19 (1.07–1.33) for a 5-year increase in age), but not smaller tumours (P for heterogeneity adjusting for other tumour features (Phet)=0.007). On the other hand, multiparity was associated with reduced risk for small tumours (0.76 (0.68–0.86) per additional birth; Phet=0.004). Consideration of all tumour characteristics simultaneously revealed that current or recent use of combined hormone replacement therapy was associated with risk of small (2.29 (1.66–3.15)) and grade 1 (3.36 (2.22–5.08)) tumours (Phet=0.05 for size and 0.0008 for grade 1 vs 3), rather than specific histopathologic types (Phet=0.63 for ductal vs lobular). Finally, elevated body mass index was associated with larger tumour size among both pre- and postmenopausal women (Phet=0.05 and 0.0001, respectively). None of these relationships were explained by hormone receptor status of the tumours. In conclusion, these data support distinctive risk factor relationships by tumour characteristics of prognostic relevance. These findings might be useful in developing targeted prevention efforts.
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