Breast cancer heterogeneity: Comparing pre- and postmenopausal breast cancer in an African population

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL
F. Ntirenganya, J. Twagirumukiza, Georges Bucyibaruta, B. Rugwizangoga, S. Rulisa
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引用次数: 0

Abstract

Background: Breast cancer (BC) is the most prevalent cancer in women and the leading cause of women's cancer-related deaths and morbidity worldwide. Conventionally considered as a single disease, recent advances suggest that BC is rather a heterogeneous disease with different molecular subtypes exhibiting distinct clinical presentation, anatomo-pathological features, response to treatment and survival outcomes. The purpose of this study was to compare tumor characteristics and epidemiologic risk factors associated with premenopausal versus postmenopausal BC and to assess heterogeneity by menopausal status. Methods: This was a comparative cross-sectional study. A total of 340 patients were included in the study (170 premenopausal vs. 170 postmenopausal BC). Patients' and tumor characteristics were compared in both populations. Percentages and means have been used for descriptive statistics. For categorical variables with comparison groups not exceeding 2, Fischer's exact test was used, otherwise, Chi-square test was used. For continuous variables, Mann–Whitney U-test has been used to compare the numerical ranked variables. A value of P = 0.05 or less was considered statistically significant. Odds ratio (OR) and 95% confidence interval (CI) was estimated using logistic regression analysis. Results: The median age of patients was 49 years (range: 18–89 years), with premenopausal median age of 41 years (range 18–50 years) and postmenopausal median age of 58 years (range 48–89 years). Factors associated more with the occurrence of premenopausal BC than postmenopausal BC were obesity/overweight in adolescence/early adulthood (OR = 0.29 95% CI 0.18–0.49, P < 0.001) and history of benign breast disease (OR 0.34 95% CI 0.14–0.83, P = 0.014), while factors associated more with postmenopausal than premenopausal BC included alcohol intake (OR = 2.47 95% CI 1.54–3.98, P < 0.001), history of breastfeeding (OR = 2.75 1.12–6.78, P = 0.036). However, sports activities (OR = 0.33 95% CI 0.16–0.65, P = 0.0015) and contraceptive use (OR = 0.19 95% CI 0.12–0.32, P < 0.001) seem to be protective for postmenopausal BC. In premenopausal period, patients presented more at advanced stages (Stage III and IV) (51.2% of premenopausal vs. 44.7% for postmenopausal, P = 0.0246), reported more intermediate-to-rapid disease progression (92% in premenopausal vs. 81.1% in postmenopausal (P < 0.001), had more invasive ductal carcinoma (98% in premenopausal vs. 93.5% in postmenopausal (P = 0.053) and had more poorly differentiated tumors (72% compared to 19.4% of postmenopausal BC patients (P < 0.0001). There was no statistically difference in molecular subtypes distribution between premenopausal and postmenopausal women (P = 0.062). However, progesterone receptor (PR) positivity was more associated with postmenopausal BC (P = 0.0165). Conclusion: BC is a heterogeneous disease. Premenopausal BC seems to be more aggressive than postmenopausal BC, with a relatively high prevalence of poorly differentiated and high-grade tumors with rapid progression. However, pre- and postmenopausal BC have similar molecular subtypes with different PR expression but similar ER and human epidermal growth factor receptor 2/Neu oncogene expression.
乳腺癌异质性:比较非洲人口绝经前和绝经后乳腺癌
背景:乳腺癌(BC)是女性中最常见的癌症,也是世界范围内女性癌症相关死亡和发病的主要原因。传统上被认为是一种单一疾病,最近的进展表明,BC是一种异质性疾病,具有不同的分子亚型,表现出不同的临床表现、解剖病理特征、对治疗的反应和生存结果。本研究的目的是比较与绝经前和绝经后BC相关的肿瘤特征和流行病学危险因素,并评估绝经状态的异质性。方法:采用比较横断面研究。研究共纳入340例患者(170例绝经前和170例绝经后BC)。比较两组患者和肿瘤特征。描述性统计使用了百分比和平均数。对于比较分组不超过2的分类变量,采用Fischer精确检验,否则采用卡方检验。对于连续变量,采用Mann-Whitney u检验对数值排序变量进行比较。P = 0.05或更小的值被认为具有统计学意义。使用logistic回归分析估计优势比(OR)和95%置信区间(CI)。结果:患者中位年龄49岁(范围18-89岁),绝经前患者中位年龄41岁(范围18-50岁),绝经后患者中位年龄58岁(范围48-89岁)。绝经前乳腺癌比绝经后乳腺癌发生的相关因素有青春期/成年早期肥胖/超重(OR = 0.29 95% CI 0.18-0.49, P < 0.001)和乳腺良性疾病史(OR = 0.34 95% CI 0.14-0.83, P = 0.014),绝经后乳腺癌比绝经前乳腺癌发生的相关因素有饮酒(OR = 2.47 95% CI 1.54-3.98, P < 0.001)、母乳喂养史(OR = 2.75 1.12-6.78, P = 0.036)。然而,体育活动(OR = 0.33 95% CI 0.16-0.65, P = 0.0015)和避孕措施的使用(OR = 0.19 95% CI 0.12-0.32, P < 0.001)似乎对绝经后BC有保护作用。在绝经前,患者更多出现在晚期(III期和IV期)(绝经前的51.2% vs绝经后的44.7%,P = 0.0246),报告更多的中快速疾病进展(绝经前的92% vs绝经后的81.1% (P < 0.001)),有更多的浸润性导管癌(绝经前的98% vs绝经后的93.5% (P = 0.053)),有更多的低分化肿瘤(72% vs 19.4%)绝经后BC患者(P < 0.0001)。绝经前和绝经后妇女的分子亚型分布无统计学差异(P = 0.062)。然而,孕激素受体(PR)阳性与绝经后BC的相关性更大(P = 0.0165)。结论:BC是一种异质性疾病。绝经前BC似乎比绝经后BC更具侵袭性,低分化和高级别肿瘤的患病率相对较高,进展迅速。然而,绝经前和绝经后的BC具有相似的分子亚型,PR表达不同,但ER和人表皮生长因子受体2/Neu癌基因表达相似。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Clinical Sciences
Journal of Clinical Sciences MEDICINE, GENERAL & INTERNAL-
自引率
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发文量
15
审稿时长
45 weeks
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