术前总胆固醇和高密度脂蛋白胆固醇水平对乳腺癌患者预后的影响

李成伟; 乔梦祥; 刘铁成; 金功圣

doi:10.16766/j.cnki.issn.1674-4152.002457

术前总胆固醇和高密度脂蛋白胆固醇水平对乳腺癌患者预后的影响

doi: 10.16766/j.cnki.issn.1674-4152.002457

蚌埠医学院第一附属医院肿瘤外科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学基金项目 KJ2019A0352

详细信息

通讯作者:
金功圣，E-mail：jgs2007@qq.com

中图分类号: R737.9 R446.112
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出版历程
- 收稿日期: 2021-09-15
- 网络出版日期: 2022-09-05

Effect of preoperative total cholesterol and high-density lipoprotein-cholesterol levels on the prognosis of breast cancer

Department of Oncology Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的通过测定乳腺癌患者术前血清总胆固醇及高密度脂蛋白胆固醇水平，探讨术前总胆固醇及高密度脂蛋白胆固醇水平对乳腺癌患者预后的影响。方法回顾性收集2012年1月—2014年12月蚌埠医学院第一附属医院341例经病理确诊的乳腺癌患者清晨空腹多项血脂数据及临床病理资料，采用Kaplan-Meier分析法和Cox比例风险回归模型分析乳腺癌患者的总体生存期(OS)及无病生存期(DFS)。结果患者TC水平 < 6.2 mmol/L的平均OS为96.2个月，患者TC水平≥6.2 mmol/L的平均OS为95.4个月(P=0.556)，患者TC水平 < 6.2 mmol/L的平均DFS为95.9个月，患者TC水平≥6.2 mmol/L的平均DFS为94.0个月(P=0.122)。在不同水平的TC组中，总体生存率及无病生存率差异均无统计学意义。患者HDL-C水平 < 1.04 mmol/L的平均OS为94.7个月，患者HDL-C水平≥1.04 mmol/L的平均OS为97.6个月(P=0.019)，患者HDL-C水平 < 1.04 mmol/L的平均DFS为93.2个月，而患者HDL-C水平≥1.04 mmol/L的平均DFS为97.6个月(P=0.003)。在不同水平的HDL-C组中，总体生存期及无病生存期差异均有统计学意义。COX多因素分析发现，高水平HDL-C患者DFS更长(HR=3.916，95%CI：1.355~11.313, P=0.012)。结论术前HDL-C水平可能是预测乳腺癌患者DFS的独立因素。
- 乳腺癌 /
- 血脂水平 /
- 预后
Abstract: Objective To determine serum total cholesterol (TC) and high-density lipoprotein-cholesterol (HDL-C) of patients with breast cancer, explore the effect of preoperative blood lipid levels on the prognosis of patients with breast cancer. Methods Fasting plasma lipid in the morning and clinical pathological data of 341 patients with breast cancer confirmed by pathology from January 2012 to December 2014 in the First Affiliated Hospital of Bengbu Medical College were collected retrospectively. Kaplan-Meier analysis and Cox proportional hazard regression model were used to analyse overall survival (OS) and disease-free survival (DFS). Results The average OS of patients with TC < 6.2 mmol/L was 96.2 months, whereas that of patients with TC≥6.2 mmol/L was 95.4 months (P=0.556). The average DFS of patients with TC < 6.2 mmol/L was 95.9 months, and that of patients with TC≥6.2 mmol/L was 94.0 months (P=0.122). In different levels of TC groups, the OS rate and DFS rate were not statistically significant. The average OS of patients with HDL-C < 1.04 mmol/L was 94.7 months, whereas that of patients with HDL-C≥1.04 mmol/L was 97.6 months (P=0.019). The average DFS of patients with HDL-C < 1.04 mmol/L was 93.2 months, whereas the average DFS of patients with HDL-C level≥1.04 mmol/L was 94.7 months (P=0.003). In different levels of HDL-C groups, the OS time and DFS time were statistically significant. COX multivariate analysis showed that high HDL-C was beneficial to DFS (HR=3.916, 95% CI: 1.355-11.313, P=0.012). Conclusion The preoperative HDL-C level may be an independent factor predicting DFS in patients with breast cancer.
- Breast cancer /
- Blood lipid level /
- Prognosis

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图 1 不同TC水平的总体生存期的K-M曲线

Figure 1. Overall survival curves of K-M at different levels of TC

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图 2 不同TC水平的无疾病生存期的K-M曲线

Figure 2. Curves of disease-free survival with K-M at different levels of TC

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图 3 不同HDL-C水平的总体生存期的K-M曲线

Figure 3. Overall survival curves of K-M with different levels of HDL-C

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图 4 不同HDL-C水平的无疾病生存期的K-M曲线

Figure 4. Curves of disease-free survival with different levels of HDL-C and K-M

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表 1 341例乳腺癌患者临床病理特征

Table 1. Clinicopathological features of 341 patients with breast cancer

项目	类别	例数	百分比(%)
年龄(岁)	≥45	202	59.2
	< 45	139	40.8
月经状态	未绝经	138	40.5
	绝经	203	59.5
肿瘤分期	T1	167	49.0
	T2	153	44.9
	T3	18	5.3
	T4	3	0.9
淋巴结分期	N0	163	47.8
	N1	88	25.8
	N2	78	22.9
	N3	12	3.5
分子分型	Luminal A型	61	17.9
	Luminal B型	112	32.8
	HER-2阳性型	86	25.2
	TNBC型	82	24.0
TC(mmol/L)	≥6.2	110	32.3
	< 6.2	231	67.7
TG(mmol/L)	≥2.3	90	26.4
	< 2.3	251	73.6
HDL-C(mmol/L)	≥1.04	108	32.3
	< 1.04	233	68.3
LDL-C(mmol/L)	≥3.4	113	33.1
	< 3.4	228	66.9

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表 2 341例乳腺癌患者不同TC水平与临床特征的关系(例)

Table 2. Relationship between different TC levels and clinical features in 341 breast cancer patients (cases)

项目	TC		统计量	P值
项目	≥6.2 mmol/L(n=110)	< 6.2 mmol/L(n=231)	统计量	P值
年龄			10.643^a	0.001
≥45岁	31	108
< 45岁	79	123
月经状态			13.355^a	0.001
未绝经	60	78
绝经	50	153
肿瘤分期			7.935^b	0.005
T1	45	122
T2	50	103
T3	13	5
T4	2	1
淋巴结分期			8.190^b	0.004
N0	43	120
N1	28	60
N2	30	48
N3	9	3
分子分型			2.470^a	0.481
Luminal A型	17	44
Luminal B型	34	78
HER-2阳性型	27	59
TNBC型	32	50
注：^a为χ²值，^b为H值。

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表 3 341例乳腺癌患者不同HDL-C水平与临床特征的关系(例)

Table 3. Relationship between levels of different HDL-C and clinical features in 341 Patients with breast cancer (cases)

项目	HDL-C		统计量	P值
项目	≥1.04 mmol/L(n=108)	< 1.04 mmol/L(n=233)	统计量	P值
年龄			0.219^a	0.640
≥45岁	46	93
< 45岁	62	140
月经状态			2.530^a	0.112
未绝经	37	101
绝经	71	132
肿瘤分期			14.800^b	< 0.001
T1	69	98
T2	36	117
T3	3	15
T4	0	3
淋巴结分期			0.550^b	0.457
N0	52	111
N1	33	55
N2	21	57
N3	2	10
分子分型			3.385^a	0.336
Luminal A型	24	37
Luminal B型	38	74
HER-2阳性型	23	63
TNBC型	23	59
注：^a为χ²值，^b为H值。

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表 4 341例乳腺癌患者总体生存期、无疾病生存期的单因素Cox回归分析

Table 4. Univariate Cox regression analysis of overall survival and disease-free survival in 341 breast cancer patients

项目	OS单因素分析			DFS单因素分析
项目	HR值	95% CI	P值	HR值	95% CI	P值
年龄	0.830	0.376~1.832	0.645	0.853	0.386~1.882	0.693
月经状态	0.649	0.293~1.436	0.286	0.635	0.287~1.402	0.261
分子分型	1.339	0.906~1.980	0.143	1.335	0.909~1.961	0.141
TC水平	0.780	0.340~2.387	0.557	0.525	0.229~1.204	0.128
TG水平	0.513	0.227~1.160	0.109	0.315	0.140~0.709	0.005
HDL-C水平	3.086	1.148~8.295	0.025	4.294	1.541~11.964	0.005
LDL-C水平	0.419	0.191~0.921	0.030	0.306	0.139~0.678	0.030

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表 5 341例乳腺癌患者总体生存期、无疾病生存期多因素Cox比例分析

Table 5. Multivariate Cox ratio analysis of overall survival and disease-free survival in 341 breast cancer patients

项目	OS多因素分析			DFS多因素分析
项目	HR值	95% CI	P值	HR值	95% CI	P值
TG水平				0.408	0.175~0.951	0.038
HDL-C水平	2.673	0.977~7.309	0.055	3.916	1.355~11.313	0.012
LDL-C水平	0.503	0.226~1.121	0.093	0.412	0.180~0.946	0.037

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