تعیین عوامل خطر بروز متاستاز در زنان مبتلا به سرطان پستان

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشیار، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشجوی پزشکی، کمیته‌ی‌ تحقیقات دانشجویی، دانشکده‌ی پزشکی،‌ دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 متخصص پزشکی اجتماعی، معاونت درمان،‌ دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 دانشجوی پزشکی،‌ دانشکده‌ی پزشکی، دانشگاه علوم پزشکی شهرکرد، شهرکرد، ایران

چکیده

مقدمه: سرطان پستان یکی از شایع‌‌ترین سرطان‌ها‌ی زنان است و متاستاز آن عامل مهمی در شکست درمان،‌ عوارض و مرگ و میر حاصل از بیماری می‌باشد. این مطالعه به ‌بررسی ارتباط عوامل خطر سرطان پستان ‌با بروز متاستاز پرداخت.روش‌ها: این مطالعه به صورت هم‌گروهی (Cohort) گذشته‌نگر انجام شد. جمعیت مورد مطالعه بیماران مبتلا به سرطان پستان در اصفهان، که در طول ده سال پی‌گیری شدند، بودند. اطلاعات شامل وجود متاستاز به عنوان متغیر وابسته و سن، وضعیت گیرنده‌ها‌ی هورمونی، اندازه‌ی تومور، نوع پاتولوژی، تعداد حاملگی، سن اولین بارداری، وضعیت قاعدگی، سن اولین قاعدگی، سابقه‌ی خانوادگی، روش جراحی، تعداد غدد درگیر و خارج شده حین عمل به عنوان متغیر مستقل از پرونده‌ها‌ی بیماران جمع‌آوری و ‌با آزمون Logestic regression تجزیه و تحلیل گردید.یافته‌ها: ٦٨٥ بیمار مورد مطالعه قرار گرفتند. ٤/٩١ درصد‌ از بیماران بدون متاستاز و ٦/٨ درصد‌ متاستاز داشتند. متاستاز به ریه شایع‌ترین مکان (۷/٤ درصد‌) و پس از آن به ترتیب استخوان (٦/٢ درصد‌)، دیگر مکان‌ها ‌(١/١ درصد‌) و کبد (٣/٠ درصد‌) بودند. از بین متغیرهای مستقل، تعداد غدد لنفاوی درگیر (043/0 > P) و تعداد حاملگی (022/0 > P) با بروز متاستاز اولیه در سرطان پستان ارتباط داشتند.نتیجه‌گیری: این مطالعه نشان داد در بیماران با تعداد بارداری کمتر و غدد لنفاوی درگیر بیشتر، احتمال متاستاز بیشتر است. لذا با شناسایی زودرس این عوامل خطر و انجام تست‌ها‌ی تشخیصی برای یافتن زودتر سرطان متاستاتیک و درمان‌ها‌ی پیش‌گیری کننده ممکن است ‌بتوان مدت بقا را در بیماران افزایش داد.

کلیدواژه‌ها

عنوان مقاله [English]

Risk Factors of Metastasis in Women with Breast Cancer in Isfahan, Iran

نویسندگان [English]

  • Fariborz Mokarian 1
  • Neda Abdeyazdan 2
  • Neda Motamedi 3
  • Parnian Tabesh 2
  • Shirin Mokarian 2
  • Fariba Hashemi 2
  • Maedeh Abbasi 4
1 Associate Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Community Medicine Specialist, Isfahan University of Medical Sciences, Isfahan, Iran
4 Student of Medicine, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
چکیده [English]

Background: Breast cancer is one of the most common malignancies in women and its metastasis plays an important role in mortality, treatment failures and complications. The objective of this study was to evaluate the risk factors of metastatic breast cancer.Methods: In a retrospective cohort study, breast cancer patients in Isfahan, Iran were followed up for ten years. The existence of metastasis was considered as the dependent variable while independent variables included age at diagnosis, hormone receptor status, family history, number of lymph nodes dissected in surgery and involved ones, number of pregnancies, age at first pregnancy and menarche, menstrual status, histopathology and tumor size. All data was collected from patients' profiles and analyzed using logistic regression in SPSS16.Findings: A total of 685 patients with breast cancer were studied during 1999-2009. While 91.4% of cases had no metastasis, distant metastasis was found in 8.6% of subjects. Sites of metastasis according to prevalence were lung (4.7%), bone (2.6%), other organs (1.1%), and liver (0.3%). Number of involved lymph nodes (P = 0.043) and number of pregnancies (P = 0.022) had significant relationships with metastasis.Conclusion: We concluded that less pregnancies and more involved lymph nodes indicate a high probability of metastasis occurrence. Therefore, survival improvement might be possible with early diagnosis of breast cancer, using prophylactic treatments, and identifying metastatic cases by diagnostic tests.

کلیدواژه‌ها [English]

  • Breast Neoplasms
  • Neoplasm metastasis
  • Risk Factors

مراجع

  1. Chantler ML, Jahanzeb. Breast cancer. In: Govindan R, editor. The Washington Manual of Oncology. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 139.
  2. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55(2): 74-108.
  3. Hortobagyi GN, de la Garza SJ, Pritchard K, Amadori D, Haidinger R, Hudis CA, et al. The global breast cancer burden: variations in epidemiology and survival. Clin Breast Cancer 2005; 6(5): 391-401.
  4. Sirati M, Karami tehrani F. Survey of the status of estrogen and prolactin receptors in breast cancer. Journal of Rafsanjan University of Medical Sciences 2006; 5(3): 137-42.
  5. Sirati F, Yadegari K. Determination of the correlation between Her-2 tumor factor and invasion of breast cancer to axillary lymph nodes in patients undergoing mastectomy in cancer institute (2001-2003). RJMS 2004; 11(43): 781-7.
  6. Fanale MA, Buzdar AU. Breast cancer. In: Kantarjian HM, Wolff RA, Koller CA, editors. The MD Anderson Manual of Medical Oncology. 1st ed. New York: McGraw-Hill; 2006. p. 464.
  7. Ensani F, Hajsadeghi N, Amoozegar-Hashemi F, Haddad P. Evaluation of the effects of biological prognostic and predictive factors on survival of breast cancer patients. Acta Medica Iranica 2007; 45(2): 95-100.
  8. Hunter KW, Alsarraj J. Gene expression profiles and breast cancer metastasis: a genetic perspective. Clin Exp Metastasis 2009; 26(6): 497-503.
  9. Bernard F, Kent OC, Richard M, Wiliam B. Neoplasms of the breast. In: Holland JF, editor. Cancer Medicine. London: Lea & Febiger; 1993. p. 1719-21.
  10. Stemmler HJ, Heinemann V. Central nervous system metastases in HER-2-overexpressing metastatic breast cancer: a treatment challenge. Oncologist 2008; 13(7): 739-50.
  11. Tsukada Y, Fouad A, Pickren JW, Lane WW. Central nervous system metastasis from breast carcinoma. Autopsy study. Cancer 1983; 52(12): 2349-54.
  12. Hedley BD, Vaidya KS, Phadke P, MacKenzie L, Dales DW, Postenka CO, et al. BRMS1 suppresses breast cancer metastasis in multiple experimental models of metastasis by reducing solitary cell survival and inhibiting growth initiation. Clin Exp Metastasis 2008; 25(7): 727-40.
  13. Hlupic L, Jakic-Razumovic J, Bozikov J, Coric M, Belev B, Vrbanec D. Prognostic value of different factors in breast carcinoma. Tumori 2004; 90(1): 112-9.
  14. Gao D, Du J, Cong L, Liu Q. Risk factors for initial lung metastasis from breast invasive ductal carcinoma in stages I-III of operable patients. Jpn J Clin Oncol 2009; 39(2): 97-104.
  15. Hayes DF, Gralow JR, Dizon DS. Systemic treatment for metastatic breast cancer: General principles. UpToDate [Online] 2009 Feb 17. [cited 2011 Jun 7]; Available from: URL: http://www.uptodate.com/contents/systemic-treatment-for-metastatic-breast-cancer-general-principles.
  16. Irawan C, Hukom R, Prayogo N. Factors associated with bone metastasis in breast cancer: a preliminary study in an Indonesian population. Acta Med Indones 2008; 40(4): 178-80.
  17. Alexandria TP, Vicente V, Bryan TH. Metastatic breast cancer. In: Kantarjian HM, Wolff RA, Koller CA, editors. The MD Anderson Manual of Medical Oncology. 1st ed. New York: McGraw-Hill; 2006. p. 464.
  18. Burstein HJ, Harris JR, Monica M. Malignant tumors of the breast. In: DeVita VT, Lawrence TS, Rosenberg SA, DePinho RA, Weinberg RA, editors. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 8th ed. Philadelphia: Lippincott; 2008. p. 1645.
  19. Theriault RL, Hortobagyi GN. Bone metastasis in breast cancer. Anticancer Drugs 1992; 3(5): 455-62.
  20. Arriagada R, Rutqvist LE, Johansson H, Kramar A, Rotstein S. Predicting distant dissemination in patients with early breast cancer. Acta Oncol 2008; 47(6): 1113-21.
  21. Gnant M. Anticancer activity of bisphosphonates in breast cancer. Anticancer Agents Med Chem 2012; 12(2): 114-22.
  22. Najafi B, Fakhri T, Fadakare soghe Gh. Relationship of HER2 with other clinical-pathological diagnostic criteria in breast cancer patients. Journal of Guilan University of Medical Sciences 2006; 15(57): 21-7.
  23. Bijker N, Peterse JL, Duchateau L, Julien JP, Fentiman IS, Duval C, et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853. J Clin Oncol 2001; 19(8): 2263-71.
  24. Schootman M, Jeffe DB, Gillanders WE, Aft R. Racial disparities in the development of breast cancer metastases among older women: a multilevel study. Cancer 2009; 115(4): 731-40.
  25. Fondrinier E, Guerin O, Lorimier G. A comparative study of metastatic patterns of ductal and lobular carcinoma of the breast from two matched series (376 patients). Bull Cancer 1997; 84(12): 1101-7.
  26. Lin NU, Claus E, Sohl J, Razzak AR, Arnaout A, Winer EP. Sites of distant recurrence and clinical outcomes in patients with metastatic triple-negative breast cancer: high incidence of central nervous system metastases. Cancer 2008; 113(10): 2638-45.
  27. Meijnen P, Oldenburg HS, Loo CE, Nieweg OE, Peterse JL, Rutgers EJ. Risk of invasion and axillary lymph node metastasis in ductal carcinoma in situ diagnosed by core-needle biopsy. Br J Surg 2007; 94(8): 952-6.
  28. Kauppila A, Kyyronen P, Lehtinen M, Pukkala E. Dual effect of short interval between first and second birth on ductal breast cancer risk in Finland. Cancer Causes Control 2012; 23(1): 187-93.
  29. Siddiqui T, Khan S, Kayani N, Pervez S, Salam A. Clinical, pathological and molecular factors predicting axillary node involvement in primary breast cancer in Pakistani women. J Pak Med Assoc 2002; 52(5): 192-5.
  30. Litton JK, Theriault RL, Gonzalez-Angulo AM. Breast cancer diagnosis during pregnancy. Womens Health (Lond Engl ) 2009; 5(3): 243-9.
  31. Vinatier E, Merlot B, Poncelet E, Collinet P, Vinatier D. Breast cancer and pregnancy. Gynecol Obstet Fertil 2009; 37(6): 495-503.
  32. Motlagh ME, Rabbani A, Kelishadi R, Mirmoghtadaee P, Shahryari S, Ardalan G, et al. Timing of puberty in Iranian girls according to their living area: a national study. J Res Med Sci 2011; 16(3): 276-81.
  33. Tehrani FR, Mirmiran P, Zahedi-Asl S, Nakhoda K, Azizi F. Menarcheal age of mothers and daughters: Tehran lipid and glucose study. East Mediterr Health J 2010; 16(4): 391-5.
  34. Kashani HH, Kavosh MS, Keshteli AH, Montazer M, Rostampour N, Kelishadi R, et al. Age of puberty in a representative sample of Iranian girls. World J Pediatr 2009; 5(2): 132-5.
  35. Delavar MA, Hajian-Tilaki KO. Age at menarche in girls born from 1985 to 1989 in Mazandaran, Islamic Republic of Iran. East Mediterr Health J 2008; 14(1): 90-4.
  36. Razzaghy-Azar M, Moghimi A, Sadigh N, Montazer M, Golnari P, Zahedi-Shoolami L, et al. Age of puberty in Iranian girls living in Tehran. Ann Hum Biol 2006; 33(5-6): 628-33.
  37. Morris DH, Jones ME, Schoemaker MJ, Ashworth A, Swerdlow AJ. Secular trends in age at menarche in women in the UK born 1908-93: results from the Breakthrough Generations Study. Paediatr Perinat Epidemiol 2011; 25(4): 394-400.
  38. Cordoba O, Bellet M, Vidal X, Cortes J, Llurba E, Rubio IT, et al. Pregnancy after treatment of breast cancer in young women does not adversely affect the prognosis. Breast 2011. [Epub ahead of print].
  39. Moore HC, Foster RS, Jr. Breast cancer and pregnancy. Semin Oncol 2000; 27(6): 646-53.
  40. Petrek JA. Breast cancer and pregnancy. J Natl Cancer Inst Monogr 1994; (16): 113-21.
  41. Barrat J, Marpeau L, Demuynck B. [Breast cancer and pregnancy]. Rev Fr Gynecol Obstet 1993; 88(11): 544-9.
  42. Kroman N, Jensen MB, Wohlfahrt J, Ejlertsen B. Pregnancy after treatment of breast cancer--a population-based study on behalf of Danish Breast Cancer Cooperative Group. Acta Oncol 2008; 47(4): 545-9.
  43. Halaska MJ, Pentheroudakis G, Strnad P, Stankusova H, Chod J, Robova H, et al. Presentation, management and outcome of 32 patients with pregnancy-associated breast cancer: a matched controlled study. Breast J 2009; 15(5): 461-7.
  44. Azim Jr HA, Botteri E, Renne G, Dell'orto P, Rotmensz N, Gentilini O, et al. The biological features and prognosis of breast cancer diagnosed during pregnancy: A case-control study. Acta Oncol 2011. [Epub ahead of print].
  45. Fernandes AF, Santos MC, de Castro e Silva TB, Galvao CM. Prognosis of breast cancer during pregnancy: evidence for nursing care. Rev Lat Am Enfermagem 2011; 19(6): 1453-61.
  46. Kim KJ, Huh SJ, Yang JH, Park W, Nam SJ, Kim JH, et al. Treatment results and prognostic factors of early breast cancer treated with a breast conserving operation and radiotherapy. Jpn J Clin Oncol 2005; 35(3): 126-33.
  47. Rezaianzadeh A, Peacock J, Reidpath D, Talei A, Hosseini SV, Mehrabani D. Survival analysis of 1148 women diagnosed with breast cancer in Southern Iran. BMC Cancer 2009; 9: 168.
  48. Foulkes WD, Reis-Filho JS, Narod SA. Tumor size and survival in breast cancer--a reappraisal. Nat Rev Clin Oncol 2010; 7(6): 348-53.
  49. Whittemore AS, Stearman B, Venne V, Halpern J, Felberg A, McGuire V, et al. No evidence of familial correlation in breast cancer metastasis. Breast Cancer Res Treat 2009; 118(3): 575-81.
  50. Hillen HF, Hupperets PS. Breast cancer in patients, 70 years or older. Ned Tijdschr Geneeskd 2000; 144(23): 1099-104.
  51. Ghiasvand R, Maram ES, Tahmasebi S, Tabatabaee SH. Risk factors for breast cancer among young women in southern Iran. Int J Cancer 2011; 129(6): 1443-9.
  52. Yavari P, Mosavizadeh M, Sadrol-Hefazi B, Mehrabi Y. Reproductive characteristics and the risk of breast cancer--a case-control study in Iran. Asian Pac J Cancer Prev 2005; 6(3): 370-5.
  53. Tham YL, Sexton K, Kramer R, Hilsenbeck S, Elledge R. Primary breast cancer phenotypes associated with propensity for central nervous system metastases. Cancer 2006; 107(4): 696-704.
  54. Bollet MA, Savignoni A, Pierga JY, Lae M, Fourchotte V, Kirova YM, et al. High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies. Br J Cancer 2008; 98(4): 734-41.
  55. Mechera R, Viehl CT, Oertli D. Factors predicting in-breast tumor recurrence after breast-conserving surgery. Breast Cancer Res Treat 2009; 116(1): 171-7.
  56. Tabei S, Ashraf M. Estrogen and progestin receptors in human breast carcinoma 140 cases. IJEM 2000; 2(1): 5-9.
  57. Harrell JC, Dye WW, Allred DC, Jedlicka P, Spoelstra NS, Sartorius CA, et al. Estrogen receptor positive breast cancer metastasis: altered hormonal sensitivity and tumor aggressiveness in lymphatic vessels and lymph nodes. Cancer Res 2006; 66(18): 9308-15.
  58. Giretti MS, Fu XD, De RG, Sarotto I, Baldacci C, Garibaldi S, et al. Extra-nuclear signalling of estrogen receptor to breast cancer cytoskeletal remodelling, migration and invasion. PLoS One 2008; 3(5): e2238.
  59. Fuqua SA. The role of estrogen receptors in breast cancer metastasis. J Mammary Gland Biol Neoplasia 2001; 6(4): 407-17.
  60. Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ. Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol 2003; 21(17): 3357-65.
  61. Bardou VJ, Arpino G, Elledge RM, Osborne CK, Clark GM. Progesterone receptor status significantly improves outcome prediction over estrogen receptor status alone for adjuvant endocrine therapy in two large breast cancer databases. J Clin Oncol 2003; 21(10): 1973-9.
  62. Takei H, Horiguchi J, Maemura M, Koibuchi Y, Oyama T, Yokoe T, et al. Predictive value of estrogen receptor status as assessed by ligand-binding assay in patients with early-stage breast cancer treated with breast conserving surgery and radiation therapy. Oncol Rep 2002; 9(2): 375-8.
  63. Moradi Marjaneh M, Homaei Shandiz F, Shamsian SAA, Eftekharzadeh Mashhadi I, Hedayati Moghadam MR, Bidkhori HR, et al. Associated genes, HER2 and P53 and estrogen and progesterone receptors with survival in women with breast cancer. Iranian Journal of Breast Disease- 2008; 1(2): 7-17.
  64. Guerra I, Algorta J, Diaz de OR, Pelayo A, Farina J. Immunohistochemical prognostic index for breast cancer in young women. Mol Pathol 2003; 56(6): 323-7.
  65. Al-Moundhri M, Nirmala V, Al-Mawaly K, Ganguly S, Burney I, Rizvi A, et al. Significance of p53, Bcl-2, and HER-2/neu protein expression in Omani Arab females with breast cancer. Pathol Oncol Res 2003; 9(4): 226-31.
  66. Slamon DJ, Clark GM, Wong SG, Levin WJ, Ullrich A, McGuire WL. Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene. Science 1987; 235(4785): 177-82.
  67. Yamauchi H, Stearns V, Hayes DF. When is a tumor marker ready for prime time? A case study of c-erbB-2 as a predictive factor in breast cancer. J Clin Oncol 2001; 19(8): 2334-56.
  68. Freudenberg JA, Wang Q, Katsumata M, Drebin J, Nagatomo I, Greene MI. The role of HER2 in early breast cancer metastasis and the origins of resistance to HER2-targeted therapies. Exp Mol Pathol 2009; 87(1): 1-11.
  69. Molina MA, Saez R, Ramsey EE, Garcia-Barchino MJ, Rojo F, Evans AJ, et al. NH(2)-terminal truncated HER-2 protein but not full-length receptor is associated with nodal metastasis in human breast cancer. Clin Cancer Res 2002; 8(2): 347-53.
  70. Bohn OL, Nasir I, Brufsky A, Tseng GC, Bhargava R, MacManus K, et al. Biomarker profile in breast carcinomas presenting with bone metastasis. Int J Clin Exp Pathol 2009; 3(2): 139-46.
  71. Huang CS, Chen YC, Wang M, Lin JK, Chang KJ. HER-2/neu overexpression in Chinese breast cancers: correlation with other prognostic factors. J Formos Med Assoc 1995; 94(11): 660-5.
  72. Rashed MM, Ragab NM, Galal MK. The association of Her-2/neu over expression in relation with p53 nuclear accumulation, hormonal receptor status and common clinicopathological prognostic parameters in a series of Egyptian women with invasive ductal carcinoma. European Journal of General Medicine 2007; 4(2): 73-9.
  73. Choi DH, Shin DB, Lee MH, Lee DW, Dhandapani D, Carter D, et al. A comparison of five immunohistochemical biomarkers and HER-2/neu gene amplification by fluorescence in situ hybridization in white and Korean patients with early-onset breast carcinoma. Cancer 2003; 98(8): 1587-95.
  74. Al-Sahaf O, Wang JH, Browne TJ, Cotter TG, Redmond HP. Surgical injury enhances the expression of genes that mediate breast cancer metastasis to the lung. Ann Surg 2010; 252(6): 1037-43.
  75. Yu KD, Di GH, Wu J, Lu JS, Shen KW, Shen ZZ, et al. Development and trends of surgical modalities for breast cancer in China: a review of 16-year data. Ann Surg Oncol 2007; 14(9): 2502-9.
  76. Rayter Z, Gazet JC, Ford HT, Easton DF, Coombes RC. Comparison of conservative surgery and radiotherapy with mastectomy in the treatment of early breast cancer. Eur J Surg Oncol 1990; 16(6): 486-92.
  77. Yang MT, Rong TH, Huang ZF, Zeng CG, Long H, Fu JH, et al. Clinical analysis of resectable breast cancer: a report of 6 263 cases. Ai Zheng 2005; 24(3): 327-31.
  78. Najafi M, Ebrahimi M, Hashemi E, Kaviani A. Review the performance of general surgeons in various surgical procedures for breast cancer: conservative surgery or mastectomy. Journal of Guilan University of Medical Sciences 2004; 15(58): 15-20.
  79. Thompson B, Baade P, Coory M, Carriere P, Fritschi L. Patterns of surgical treatment for women diagnosed with early breast cancer in Queensland. Ann Surg Oncol 2008; 15(2): 443-51.
  80. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347(16): 1227-32.
مجله دانشکده پزشکی اصفهان
دوره 29، شماره 171 - شماره پیاپی 171
بهمن و اسفند 1390
صفحه 2785-2796

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  • تاریخ دریافت: 11 بهمن 1390
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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