Associação entre a deficiência de vitamina D e o perfil imuno-histoquímico do câncer de mama em mulheres na pós-menopausa
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Data
2017-02-23
Autores
Almeida Filho, Benedito de Sousa [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Objetivo: Avaliar a associação entre a deficiência de vitamina D (VD) e o perfil imunohistoquímico do câncer de mama em mulheres na pós-menopausa. Métodos: Realizou-se estudo clínico de corte transversal com 192 mulheres, idade entre 45-80 anos, atendidas em Hospital Universitário. Foram incluídas mulheres com diagnóstico recente de câncer de mama, em amenorréia >12 meses e idade ≥ 45 anos, sem uso de medicações ou condições clínicas que interfiram nos valores da VD. Por meio de entrevista foram coletados dados clínicos e antropométricos. Foi solicitada dosagem sérica de 25 hidrovitamina D [25(OH)D], 20-30 dias após o diagnóstico do câncer de mama. Foi considerada deficiência de VD valores séricos de 25(OH)D < 30ng/mL. Foram coletados dados sobre o câncer de mama (histopatológico, grau, estádio do tumor, linfonodos) e o status hormonal (receptor de progesterona, RP; receptor do fator de crescimento epidérmico humano-2, HER2) e a atividade proliferativa epitelial (Ki67). Para análise estatística foram empregados o teste tstudent, a Distribuição Gama (variáveis assimétricas), o teste do Qui-quadrado e a regressão logística (odds ratio-OR). Resultados: O valor médio de 25(OH)D foi de 25,8 ng/mL (12,0 a 59,2 ng/mL). Valores suficientes de VD foram detectados em 65 pacientes (33,8%) e deficientes em 127 (66,2%). Estas apresentaram maior proporção de tumores de alto grau e estádio 3, maior comprometimento linfonodal, menor proporção de tumores RE e RP positivos e maior Ki-67 (p<0.05). As pacientes com VD suficiente apresentaram maior ocorrência de tumores luminal A e luminal B (80,0%) quando comparadas aquelas com hipovitaminose D (65,2%) (p<0.05). Todos os casos de tumores triplos negativo foram detectados em mulheres com deficiência de VD. A análise multivariada, ajustada para idade, tempo de menopausa e índice de massa corpórea, mostrou que pacientes com deficiência de VD apresentaram maior risco para ocorrência de tumores RE negativo (OR 4.18, CI 95% 1.17-15.87, p=0.034) e Ki-67 positivo (OR 2.78, CI 95% 1.34-66.65, p=0.005) e com comprometimento linfonodal axilar (OR 2.26, CI 95% 1.10-5-16, p=0.043). Conclusão: Em mulheres na pós-menopausa com câncer de mama observou-se associação entre a deficiência de VD e tumores com perfil imuno-histoquímico de pior prognóstico. A deficiência de vitamina D mostrou-se como fator de risco para tumores RE negativos, com axila positiva e maior taxa de proliferação celular.
Objective: To evaluate the association between vitamin D (VD) deficiency and the breast cancer immunohistochemical profile in postmenopausal women. Methods: An analytical cross sectional study was conducted with 192 women, aged 45- 75 years, attended at University Hospital. Women with recent diagnosis of breast cancer, in amenorrhea> 12 months and age ≥ 45 years, without medication use or clinical conditions that interfere with vitamin D values were included. Clinical and anthropometric data were collected. Serum level of 25 hydroxyvitamin D [25(OH)D] was measured in all patients, 20 to 30 days after breast cancer diagnosis, and values of 25(OH)D <30ng / mL were considered as VD deficiency. Data on breast cancer (histopathology, grade, tumor stage, lymph nodes), hormone status (estrogen receptor, ER, progesterone receptor, PR, human epidermal growth factor receptor-2, HER2) and epithelial proliferative activity (Ki67) were collected. For statistical analysis, the t-student test, the Gamma Distribution (asymmetric variables), the chi-square test and the logistic regression (OR-odds ratio) were used. Results: The median 25(OH)D level was 25.8 ng/ml (range 12.0 to 59.2 ng/ml). Sufficient vitamin D levels were detected in 65 patients (33.8%), while deficient levels in 127 cases (66.2%). Participants with deficient 25(OH)D levels had a higher proportion of tumors with a high grade and stage 3, more positive lymph node, a lower proportion of ER, PR positives tumors and higher Ki-67 (p<0.05). Patients with normal vitamin D had higher frequency of luminal A and luminal B (80%) when compared to patients with vitamin D deficiency (65,2%) (p<0.05). Further, all cases of triple negative were detected in vitamin D deficient women. Multivariate analysis, after adjusting for age, time since menopause and BMI, showed that a deficient level of vitamin D was an independent prognostic indicator of positive axilar lymph node (OR 2.26, CI 95% 1.10- 5-16, p=0.043), negative estrogen receptor (OR 4.18, CI 95% 1.17-15.87, p=0.034), and positive Ki-67 (OR 2.78, CI 95% 1.34-66.65, p=0.005). Conclusions: In postmenopausal women with breast cancer, there was an association between VD deficiency and tumors with worse immunohistochemical profile. Vitamin D deficiency was shown to be a risk factor for ER negative tumors, with positive axilla and higher rate of cell proliferation.
Objective: To evaluate the association between vitamin D (VD) deficiency and the breast cancer immunohistochemical profile in postmenopausal women. Methods: An analytical cross sectional study was conducted with 192 women, aged 45- 75 years, attended at University Hospital. Women with recent diagnosis of breast cancer, in amenorrhea> 12 months and age ≥ 45 years, without medication use or clinical conditions that interfere with vitamin D values were included. Clinical and anthropometric data were collected. Serum level of 25 hydroxyvitamin D [25(OH)D] was measured in all patients, 20 to 30 days after breast cancer diagnosis, and values of 25(OH)D <30ng / mL were considered as VD deficiency. Data on breast cancer (histopathology, grade, tumor stage, lymph nodes), hormone status (estrogen receptor, ER, progesterone receptor, PR, human epidermal growth factor receptor-2, HER2) and epithelial proliferative activity (Ki67) were collected. For statistical analysis, the t-student test, the Gamma Distribution (asymmetric variables), the chi-square test and the logistic regression (OR-odds ratio) were used. Results: The median 25(OH)D level was 25.8 ng/ml (range 12.0 to 59.2 ng/ml). Sufficient vitamin D levels were detected in 65 patients (33.8%), while deficient levels in 127 cases (66.2%). Participants with deficient 25(OH)D levels had a higher proportion of tumors with a high grade and stage 3, more positive lymph node, a lower proportion of ER, PR positives tumors and higher Ki-67 (p<0.05). Patients with normal vitamin D had higher frequency of luminal A and luminal B (80%) when compared to patients with vitamin D deficiency (65,2%) (p<0.05). Further, all cases of triple negative were detected in vitamin D deficient women. Multivariate analysis, after adjusting for age, time since menopause and BMI, showed that a deficient level of vitamin D was an independent prognostic indicator of positive axilar lymph node (OR 2.26, CI 95% 1.10- 5-16, p=0.043), negative estrogen receptor (OR 4.18, CI 95% 1.17-15.87, p=0.034), and positive Ki-67 (OR 2.78, CI 95% 1.34-66.65, p=0.005). Conclusions: In postmenopausal women with breast cancer, there was an association between VD deficiency and tumors with worse immunohistochemical profile. Vitamin D deficiency was shown to be a risk factor for ER negative tumors, with positive axilla and higher rate of cell proliferation.
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Palavras-chave
Câncer de mama, Menopausa, Prognóstico, Vitamina D