| Objective:The purpose of this study was to investigate the effects of serum cholesterol levels before operation,including total cholesterol(TC),low density lipoprotein,cholesterol,(LDL-C),and high density lipoprotein,cholesterol,(HDL-C),on the development of endocrine therapy resistance in patients with Luminal type breast cancer.The correlation between hypercholesterolemia and drug resistance in endocrine therapy was further analyzed,and the independent risk factors of drug resistance in endocrine therapy for breast cancer were discussed.Methods:A total of 186 patients with newly diagnosed breast cancer who were admitted to Zhongda hospital of southeast university from January 2014 to December 2017 were selected according to strict inclusion and exclusion criteria,all clinical data were measured before surgery.1.According to the examination results of patients during the reexamination,the recurrence and metastasis are determined.According to the definition of endocrine therapy resistance,the recurrence and metastasis are considered as the occurrence of endocrine therapy resistance.According to the occurrence of endocrine therapy resistance,44 patients were divided into drug resistance group and 142 patients were divided into non-drug resistance group.The clinical data and pathological characteristics of the two groups were compared to determine whether there was a correlation between cholesterol level and endocrine therapy resistance.2.According to the blood biochemical diagnostic criteria of Zhongda hospital of southeast university,any one of TC or LDL-C beyond the normal range limit is hypercholesterolemia.According to the combination of hypercholesterolemia or not,the patients were divided into the hypercholesterolemia group(45 cases)and the control group(141 cases).The difference in the incidence of endocrine drug resistance between the two groups was compared,and judge whether hypercholesterolemia is associated with drug resistance.3.Single factor and multiple factor analysis were carried out on the factors that may affect the drug resistance of endocrine therapy,and the most risky factors and independent risk factors were found.Meanwhile,ROC curve was used to predict the critical value of the drug resistance of endocrine therapy.4.The observation deadline for all patients was recurrence and metastasis or the last review before December 31,2019,and the time of disease-free survival is form surgery to deadline.Survival analysis was used to compare the difference between the hypercholesterolemia group and the control group in the progress-free survival5.Statistical analysis was performed using SPSS version 25.0 software.Results:1.Among the 186 breast cancer patients enrolled,there were 44 patients in the drug resistance group,accounting for 23.66%,and 142 patients in the non-drug resistance group,accounting for 76.36%.There were no statistically significant differences between the two groups in baseline data,including age,menstrual status,BMI,tumor stage and molecular typing(P>0.05).There were no statistically significant differences in ER and PR scores and hdl-c levels between the two groups,while there were statistically significant differences in lymph node metastasis status,TC and ldl-c levels between the two groups(P<0.05),suggesting that they may be clinical factors affecting drug resistance to endocrine therapy.2.In the hypercholesterolemia group,there were 45 cases,accounting for 24.19%,among which,there were 23 cases with endocrine resistance,accounting for 51.11%.A total of 141 patients(75.81%)were in the control group,among which 21 patients(14.89%)were resistant to endocrine drugs.There was a significant difference between the two groups(χ~2=24.777,P<0.001).3.In the single factor analysis,there were statistically significant differences in total cholesterol level,low density lipoprotein cholesterol level and lymph node metastasis status.In the multivariate Logistic regression analysis,the above three data also showed statistical differences,suggesting that they were all independent risk factors for drug resistance to endocrine therapy.Among them,postoperative cholesterol level was an independent factor with the highest risk of occurrence of drug resistance in endocrine therapy(odds ratio[OR][95%ci]3.208[1.213～8.484]).4.In the ROC curve analysis,the TC,LDL-C levels and the diagnostic value of the combined prediction of the two had statistical significance(P<0.05).On the TC curve,the area under the curve was 0.716,the optimal critical value was 5.91mmol/L,the corresponding sensitivity was 56.80%,the specificity was 84.50%,and the yodeng index was 0.417.[95%CI][0.628 0.804].5.The median progression-free period was 33 months in the hypercholesterolemia group and 36 months in the control group,suggesting that patients without hypercholesterolemia could benefit more.Conclusion:1.Serum cholesterol level is correlated with endocrine therapy resistance.2.Hypercholesterolemia may lead to an increased incidence of resistance to endocrine therapy.3.Lymph node metastasis,elevated serum total cholesterol and low density lipoprotein are independent risk factors for drug resistance to endocrine therapy,and high cholesterol level may be the most critical factor.4.Hypercholesterolemia may adversely affect the prognosis of patients with Luminal type breast cancer. |
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