| Background&objective:There is strong evidence that breast cancer,as a systemic disease,is affected by complex internal environmental factors,including serum lipid levels.Different molecular subtypes of breast cancer have strong tumor heterogeneity,and present different invasiveness and clinical prognosis.Therefore,it is necessary to better understand the molecular biological differences of each subtype of breast cancer in order to determine new therapeutic targets and biomarkers for monitoring therapeutic response.As a micro invasive detection method,serum lipid detection is expected to be a new way to assist early diagnosis,assess prognosis,and explore molecular differences between different molecular subtypes.Methods:One hundred and thirty-two female patients with invasive ductal carcinoma of breast diagnosed by pathology after operation in Northern Jiangsu People’s Hospital between October 1st,2018 to October 31th,2019 were involved in this study.The following data of each patient were collected:medical history,age at diagnosis,Body Mass Index(BMI),tumor size,the number of axillary metastatic lymph node,status of hormone receptor(HR),status of HER-2,level of Ki-67 and the data of serum lipid including total cholesterol(TC),triglyceride(TG),low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cholesterol(HDL-C),lipoprotein(a)(LP(a)),apolipoprotein A1(Apo A1),apolipoprotein B(Apo B).According to the immunohistochemistry(IHC),patients were divided into 4 groups including Luminal A group(35 cases),Luminal B group(40 cases),HER-2 group(31 cases),triple negative breast cancer(TNBC)group(26 cases),compare and analyze the data differences between each group.A logistic regression model was used to explore the independent risk factors of HR negative breast cancer,then we built a nomogram based on regression coefficients.Results:The Luminal A group had a lower stage of tumor size compared with the Luminal B,HER-2 and TNBC group,and the difference was statistically significant.In the data of serum lipid,the level of serum TC and LDL-C in the Luminal A group were(4.23±0.59)mmol/L and(2.31±0.51)mmol/L respectively,while those in the HER-2group were(4.78±0.86)mmol/L and(2.85±0.77)mmol/L,that in Luminal A group was significantly lower than in the HER-2 group,P<0.05.The level of serum Apo B was(0.88±0.18)g/L in the Luminal A group,the level of TC,LDL-C,Apo B in the Luminal A group were all significantly lower than in the HER-2 group which were(5.00±0.89)mmol/L,(2.86±0.70)mmol/L,(1.07±0.24)g/L respectively.Further,HER-2 and TNBC group were classified as HR negative group and compared with Luminal group(including Luminal A and Luminal B),further comparison results showed that HR negative group had a higher stage of tumor size compared with the Luminal group,and the difference was statistically significant.In the data of serum lipid,the level of serum TC,LDL-C,Apo B in the HR negative group were(4.88±0.88)mmol/L,(2.86±0.73)mmol/L and(1.04±0.25)g/L respectively,while those in the Luminal group were(4.16±0.71)mmol/L,(2.32±0.53)mmol/L and(0.87±0.19)g/L,that in HR negative group was significantly higher than in the Luminal group,P<0.05.After controlling the confounding effect of age,tumor stage and lymph node stage,compared with Luminal type,the increased of TC,LDL-C and Apo B can independently increase the risk of HR negative breast cancer,the odds ratio were 3.483(95%CI:1.914～6.339)、3.954(95%CI:1.961～7.973)、27.112(95%CI:3.950～186.087)respectively.The concordance statistics(C-statistics)value of the nomogram model was 0.776,and the Hosmer-Lemeshow test showed that P=0.14,χ~2=12.25,the calibration curve indicated that the predicted incidence rate of the model was basically consistent with the actual incidence of the disease,which indicated that the model had better discrimination and concordance.Conclusion:(1)Compared with Luminal breast cancer,high level of TC,LDL-C and Apo B are independent risk factors for HR negative breast cancer.(2)We built a nomogram model to predict the HR status of breast cancer patients before IHC examination,which will be helpful for patient consultation and decision-making of surgical methods,and can also provide clues for exploring the molecular biological differences between different molecular types of breast cancer. |
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