Associação entre a síndrome metabólica e o perfil imuno-histoquímico do câncer de mama em mulheres na pós-menopausa.
Arquivos
Data
2020-02-14
Autores
Motoki, Andre Hideo
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Objetivo: Avaliar a associação entre a síndrome metabólica (SM) e o perfil imuno-histoquímico (IHQ) do câncer de mama em mulheres na pós-menopausa. Métodos: Realizou-se estudo clínico de corte transversal com 189 mulheres, idade entre 45-75 anos, atendidas em Hospital Universitário. Foram incluídas mulheres em amenorreia >12 meses e idade ≥ 45 anos, com diagnóstico recente de câncer de mama, sem tratamento oncológico prévio. Por meio de entrevista foram coletados dados clínicos, antropométricos (peso, altura e circunferência da cintura) e bioquímicos (colesterol total, HDL-c, LDL-c, triglicerídeos (TG) e glicose). A partir do anatomopatológico e da imuno-histoquímica foram coletados dados sobre o câncer de mama (histopatológico, grau, estádio do tumor, linfonodos) e o status hormonal (receptor de estrogênio, RE; receptor de progesterona, RP; receptor do fator de crescimento epidérmico humano-2, HER-2) e a atividade proliferativa epitelial (Ki67). Por convenção da IHQ, os tumores foram agrupados em cinco subtipos: Luminal A (RE +, RP +, HER-2 - e Ki-67 <14%); Luminal B HER-2 - (RE+, RP+ ou -, HER-2 - e Ki-67 ≥14%); Luminal B HER-2 + (RE+, RP+ ou -, HER-2 + e qualquer Ki-67); Não-luminal HER-2 (RE -, RP -, HER2 + e qualquer Ki-67) e Triplo-negativo (RE-, RP-, HER2- e qualquer Ki-67). Foram consideradas com SM as mulheres que apresentaram três ou mais critérios diagnósticos: circunferência da cintura (CC) > 88 cm; TG 150 mg/dL; HDL colesterol < 50 mg/dL; pressão arterial 130/85 mmHg; glicose 100 mg/dL. Para análise estatística foram empregados o teste t-student, a Distribuição Gama (variáveis assimétricas), o teste do Qui-quadrado e a regressão logística (odds ratio-OR). Resultados: No momento do diagnóstico do câncer de mama, a SM foi diagnosticada em 33,3% (63/189) das mulheres. A média etária, tempo de menopausa e índice de massa corpórea (IMC) foram de 59.0 ± 10.6 anos, 11.4 ± 9.6 anos e 28.5 ± 5.5 kg/m2, respectivamente, sem diferença entre mulheres com ou sem SM (controle). Mulheres com SM apresentaram maior frequência de tumores ≤ 2cm quando comparadas às sem SM (49.2% vs 31.8%, respectivamente) (p=0.038). Em relação ao grau histológico, estadiamento e envolvimento dos linfonodos axilares não houve diferenças (p>0.05). As pacientes com SM apresentaram maior proporção de tumores com RP positivos (p=0.006), HER-2 negativo (p=0.034) e de tumores do subtipo Luminal B HER-2 negativo (p=0.038) quando comparado a mulheres sem SM (79.4% vs 61.8%, 89.9% vs 78.6%, e 44,5% vs 27,8%, respectivamente). Mulheres com obesidade abdominal (CC > 88cm) também apresentaram maior frequência de tumores com RP positivos (p=0,049) comparadas a mulheres sem deposição central de gordura (75.2% vs 60.0%, respectivamente). Nas pacientes obesas (IMC ≥ 30 kg/m2) foi observada maior ocorrência de tumores HER-2 negativos (p=0,047) e consequentemente de tumores do subtipo Luminal B HER-2 negativo (p=0,032) em comparação àquelas não obesas (90.9% vs 80.5% e 43.9% vs 27.7%, respectivamente). Na análise multivariada, ajustada para idade, tempo de menopausa e IMC, foi observado maior risco para tumores do subtipo Luminal B HER-2 negativo entre as mulheres com SM (OR 2.00, IC 95% 1.03-3.89), obesas (OR 2.03, IC 95% 1.06-3.90) e com deposição central de gordura (OR 1.96, IC 95% 1.01-4.03). Os demais subtipos do câncer de mama (Luminal A, Luminal B HER-2 positivo, Não-luminal HER-2 e Triplo negativo) não apresentaram associação com a SM, ou com seus componentes. Conclusão: Em mulheres na pós-menopausa com diagnóstico recente de câncer de mama, a presença de síndrome metabólica associou-se com indicadores de bom prognóstico do câncer de mama, como menor tamanho tumoral, positividade para receptor de progesterona e negatividade para receptor HER-2 e com tumores do subtipo Luminal B.
Objective: To evaluate the association between metabolic syndrome (MetS) and the breast cancer immunohistochemical profile in postmenopausal women. Methods: An analytical cross sectional study was conducted with 189 women, aged 45-75 years, attended at University Hospital. Women with newly diagnosed breast cancer, no previous cancer treatment, in amenorrhea> 12 months and age ≥ 45 years, were included. Clinical, anthropometric and biochemical (total cholesterol, HDL, LDL, triglycerides (TG) and glucose) data were collected. 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. Tumors were grouped into five subtypes: Luminal A (ER +, PR +, HER-2 -, Ki-67 <14%); Luminal B HER-2 negative (ER+, PP+ or -, HER-2 -, Ki-67 ≥14%); Luminal B HER-2 positive (ER+, PR+ or -, HER-2 +, any Ki-67); Non-luminal HER-2 (ER -, PR -, HER-2 +, any Ki-67) and Triple-negative (ER-, PR-, HER-2-, any Ki-67). Women with three or more of the following criteria were diagnosed with metabolic syndrome (MetS): waist circumference ≥ 88 cm; triglycerides ≥ 150 mg/dL; HDL cholesterol < 50 mg/dL; blood pressure≥ 130/85 mmHg; glucose≥ 100 mg/dL. 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: Among 189 patients, 63 (33.3%) had MetS at the time of breast cancer diagnosis. The mean age, time since menopause and BMI were 59.0 ± 10.6 years, 11.4 ± 9.6 years and 28.5 ± 5.5 kg/m2, respectively, without difference between women with or without MetS (control). Women with MetS had a higher frequency of tumors ≤ 2cm when compared to women without MetS (49.2% vs 31.8%, respectively) (p = 0.038). There were no differences in histological grade, staging, and axillary lymph node (p> 0.05). Patients with MetS had a higher proportion of tumors with positive PR (p = 0.006), negative HER-2 (p = 0.034) and Luminal B HER-2 negative tumors (p = 0.038) when compared to women without MetS (79.4% vs 61.8%, 89.9% vs 78.6%, and 44.5% vs 27.8%, respectively). Women with abdominal obesity (WC> 88cm) also had a higher frequency of tumors with positive PR (p = 0.049) compared to women without abdominal obesity (75.2% vs 60.0%, respectively). In obese patients (BMI ≥ 30 kg/m2), a higher occurrence of HER-2 negative tumors (p = 0.047) and, consequently, Luminal B HER-2 negative tumors (p = 0.032) compared to non-obese patients (90.9% vs 80.5% and 43.9% vs 27.7%, respectively). Multivariate analysis, adjusted for age, time at menopause and BMI, showed a higher risk for Luminal B HER-2 negative tumors among women with MetS (OR 2.00, 95% CI 1.03-3.89), obese (OR 2.03, 95% CI 1.06-3.90) and with abdominal obesity (OR 1.96, 95% CI 1.01-4.03). The other breast cancer subtypes (Luminal A, Luminal B HER-2 positive, Non-luminal HER-2 and Triple-negative) were not associated with MetS or its components. Conclusion: In postmenopausal women with newly diagnosed breast, the presence of metabolic syndrome was associated with indicators of better breast cancer prognosis, such as smaller tumor size, progesterone receptor positivity and HER-2 receptor negativity, and Luminal B HER-2 negative tumors subtype.
Objective: To evaluate the association between metabolic syndrome (MetS) and the breast cancer immunohistochemical profile in postmenopausal women. Methods: An analytical cross sectional study was conducted with 189 women, aged 45-75 years, attended at University Hospital. Women with newly diagnosed breast cancer, no previous cancer treatment, in amenorrhea> 12 months and age ≥ 45 years, were included. Clinical, anthropometric and biochemical (total cholesterol, HDL, LDL, triglycerides (TG) and glucose) data were collected. 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. Tumors were grouped into five subtypes: Luminal A (ER +, PR +, HER-2 -, Ki-67 <14%); Luminal B HER-2 negative (ER+, PP+ or -, HER-2 -, Ki-67 ≥14%); Luminal B HER-2 positive (ER+, PR+ or -, HER-2 +, any Ki-67); Non-luminal HER-2 (ER -, PR -, HER-2 +, any Ki-67) and Triple-negative (ER-, PR-, HER-2-, any Ki-67). Women with three or more of the following criteria were diagnosed with metabolic syndrome (MetS): waist circumference ≥ 88 cm; triglycerides ≥ 150 mg/dL; HDL cholesterol < 50 mg/dL; blood pressure≥ 130/85 mmHg; glucose≥ 100 mg/dL. 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: Among 189 patients, 63 (33.3%) had MetS at the time of breast cancer diagnosis. The mean age, time since menopause and BMI were 59.0 ± 10.6 years, 11.4 ± 9.6 years and 28.5 ± 5.5 kg/m2, respectively, without difference between women with or without MetS (control). Women with MetS had a higher frequency of tumors ≤ 2cm when compared to women without MetS (49.2% vs 31.8%, respectively) (p = 0.038). There were no differences in histological grade, staging, and axillary lymph node (p> 0.05). Patients with MetS had a higher proportion of tumors with positive PR (p = 0.006), negative HER-2 (p = 0.034) and Luminal B HER-2 negative tumors (p = 0.038) when compared to women without MetS (79.4% vs 61.8%, 89.9% vs 78.6%, and 44.5% vs 27.8%, respectively). Women with abdominal obesity (WC> 88cm) also had a higher frequency of tumors with positive PR (p = 0.049) compared to women without abdominal obesity (75.2% vs 60.0%, respectively). In obese patients (BMI ≥ 30 kg/m2), a higher occurrence of HER-2 negative tumors (p = 0.047) and, consequently, Luminal B HER-2 negative tumors (p = 0.032) compared to non-obese patients (90.9% vs 80.5% and 43.9% vs 27.7%, respectively). Multivariate analysis, adjusted for age, time at menopause and BMI, showed a higher risk for Luminal B HER-2 negative tumors among women with MetS (OR 2.00, 95% CI 1.03-3.89), obese (OR 2.03, 95% CI 1.06-3.90) and with abdominal obesity (OR 1.96, 95% CI 1.01-4.03). The other breast cancer subtypes (Luminal A, Luminal B HER-2 positive, Non-luminal HER-2 and Triple-negative) were not associated with MetS or its components. Conclusion: In postmenopausal women with newly diagnosed breast, the presence of metabolic syndrome was associated with indicators of better breast cancer prognosis, such as smaller tumor size, progesterone receptor positivity and HER-2 receptor negativity, and Luminal B HER-2 negative tumors subtype.
Descrição
Palavras-chave
Mamas Câncer, Síndrome metabólica, Menopausa, Imuno-histoquímica, Menopause, Immunohistochemistry, Breast Cancer, Metabolic Syndrome