| Background and ObjectiveAt present,great progress has been made in the research of breast cancer,but breast cancer is still one of the health problems that every adult woman needs to be aware of,and its incidence rate has been increasing in recent years.Up to now,there are few tumor markers related to breast cancer,but their sensitivity is not high and they can not reflect the progress of breast cancer.However,many studies have shown that prolactin(PRL)and vascular endothelial growth factor(VEGF)play an important role in the occurrence and development of breast cancer,and may be related to drug resistance during the treatment,recurrence and metastasis.At present,domestic and foreign research on the relationship between PRL,VEGF and breast cancer has made some breakthroughs.However,the relationship between PRL,VEGF and the clinicopathological characteristics and prognosis of breast cancer,especially the effect of PRL on breast cancer,has not been unified.Thisstudy collected a large number of clinicopathological datas of breast cancer patients.We analyzed the difference of PRL and VEGF in different types of breast cancer patients and their influence on prognosis.The purpose is to improve the understanding of breast cancer and to explore the role of PRL and VEGF in the growth,invasion and metastasis of breast cancer,so as to provide some help for the diagnosis and treatment of breast cancer.MethodsFrom September 1,2013 to August 31,2016,the clinical datas of 327 patients with pathologically diagnosed as breast cancer admitted to the First Affiliated Hospital of Zhengzhou University were collected,including the age,menopausal state,tumor size,pathological type,TNM staging,histological grading,molecular typing,lymph node metastasis,serum PRL and serum VEGF when the patients were diagnosed.At the same time,the clinical datas of 330 patients with breast benign tumor in the same period were collected to analyze the differences of serum PRL and VEGF in breast cancer patients and breast benign tumor patients as well as in breast cancer patients with different clinicopathological characteristics.The patients were divided into high PRL group,low PRL group,high VEGF group and low VEGF group according to the median of serum PRL and VEGF when the patients were diagnosed.The patients were followed up by reexamination and telephone.The deadline of follow-up was December 31,2019.The prognosis of all breast cancer patients,including DFS(disease-free survival)and OS(overall survival),was analyzed.Kaplan Meier method was used to draw the survival curve of breast cancer patients with different PRL groups and different VEGF groups.Log rank test was used to compare the survival rate of the patients.P < 0.05 was considered statistically significant.At the same time,Cox proportional risk regression model was used to analyze the prognosis of breast cancer.Results(1)The levels of serum PRL and serum VEGF in breast cancer patients were significantly higher than those in benign breast cancer patients(32.5±14.6ng/m L vs.11.9±4.5ng/m L,241.3±91.2pg/m L vs.67.1±28.3pg/m L,P <0.001).(2)The levels of serum PRL of breast cancer patients were related tomenopausal state,pathological type,TNM staging and lymph node metastasis(P <0.05).The levels of serum PRL of breast cancer patient were not related to age,tumor size,histological grading and molecular typing(P > 0.05).The levels of serum PRL of postmenopausal patients were higher than that of postmenopausal patients(37.4±16.1ng/m L vs.26.8±11.3ng/m L,P<0.001).The levels of serum PRL of invasive breast cancer patients were higher than that of non invasive breast cancer patients(33.4±15.3ng/m L vs.15.0±6.7ng/m L,P<0.001).The levels of serum PRL of patients with staging III were higher than that of patients with staging II and I or0(40.6±17.2ng/m L vs.31.9±14.0ng/m L,40.6±17.2ng/m L vs.18.7±6.9ng/m L,P <0.001).The levels of serum PRL of patients with lymph node metastasis were higher than that of patients without lymph node metastasis(36.7±15.9ng/m L vs.28.8±12.4ng/m L,P<0.001).(3)The levels of serum VEGF of breast cancer patients were related to tumor size,histological grading,TNM staging,pathological type and molecular typing(P <0.05).The levels of serum VEGF of breast cancer patients were not related to age,menopause and lymph node metastasis(P > 0.05).The levels of serum VEGF of patients with tumor diameter ≥ 2cm were higher than that of patients with tumor diameter < 2cm(273.1±106.4pg/m L vs.184.2±74.1pg/m L,P < 0.001).The levels of serum VEGF of patients with histological grading III were higher than that of patients with grading II and I(268.0±104.3 pg/m L vs.238.1±92.6 pg/m L,268.0±104.3 pg/m L vs.177.5±62.1pg/m L,P<0.001).The levels of serum VEGF of patients with TNM staging III were higher than that of patients with staging II and I or0(301.2±121.5pg/m Lvs.232.7±89.8pg/m L,301.2±121.5pg/m Lvs.152.9±57.4pg/m L,P<0.001).The levels of serum VEGF of patients with invasive breast cancer were higher than that of patients with non invasive breast cancer(245.3±95.2pg/m L vs.163.8±52.9pg/m L,P < 0.001).The levels of serum VEGF of patients with molecular typing of Her-2 overexpression and basal like were higher than that of patients with molecular typing of luminal A and luminal B(P < 0.001).(4)There was a positive correlation between serum PRL and VEGF in breast cancer patients(r = 0.684,P = 0.042).(5)The follow-up time of 327 breast cancer patients ranged from 26 months to71 months,and the median follow-up time was 49 months.By the end of follow-up,21 patients had metastasis(6.4%)and 12 patients died(3.7%).The three-year DFS was related to tumor size,lymph node metastasis,serum PRL,and serum VEGF(P <0.05).The three-year OS was related to TNM staging,molecular typing,serum PRL,and serum VEGF(P < 0.05).Kaplan-Meier survival analysis demonstrated that the three-year DFS and OS in the high PRL group were lower than those in the low PRL group(90.9% vs.98.2%,P = 0.004;93.9% vs.99.4%,P = 0.006).The three-year DFS and OS in the high VEGF group were lower than those in the low VEGF group(91.5% vs.97.5%,P = 0.016;94.5% vs.98.8%,P = 0.033).(6)The multivariate Cox proportional risk regression analysis showed that TNM staging(P = 0.014),molecular typing(P = 0.025),high levels of serum PRL(P< 0.001)were independent risk factors for OS.Conclusion(1)The levels of serum PRL and serum VEGF have significant difference between breast cancer patients and breast benign tumor patients,which can provide some help for the differentiation of breast cancer and breast benign tumor.(2)The levels of serum PRL and serum VEGF were closely related to the clinicopathological characteristics of breast cancer patients.The levels of the serum PRL were higher in patients with premenopausal,invasive breast cancer,high TNM staging and lymph node metastasis.The levels of the serum VEGF were higher in patients with large tumor diameter,poor histological grading,high TNM staging,invasive breast cancer,molecular typing of HER-2 overexpression and basal-like.(3)Univariate analysis suggested that high levels of serum PRL and serum VEGF were associated with poor prognosis of breast cancer patients.High levels of serum PRL was also an independent risk factor for OS. |
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