背景:较高的乳房X线摄影密度(MD),乳腺中纤维腺体组织比例的放射学测量,和下部末端导管小叶单位(TDLU)内卷,乳腺上皮组织数量的组织学测量,是独立的乳腺癌危险因素。先前在白人女性中进行的研究表明,TDLU消退减少与MD升高相关。
方法:在来自中国的611名浸润性乳腺癌患者(年龄23-91岁[58.4%≥50岁])的队列中,与西方国家相比,乳腺癌发病率较低,乳房致密的患病率较高,我们研究了在肿瘤附近的正常乳腺组织中评估的TDLU退化与从VolparaDensity软件获得的对侧乳腺中评估的定量MD之间的相关性.使用以MD度量作为结果变量的广义线性模型估计关联(对数变换),TDLU测量为解释变量(分为四分位数或三分位数),并根据年龄进行了调整,身体质量指数,奇偶校验,初潮年龄和乳腺癌亚型。
结果:我们发现,在所有女性中,密度百分比(PDV)与TDLU计数呈正相关(最高三分位数与零:Expeta=1.28,95%置信区间[CI]1.08-1.51,ptrend=<.0001),TDLU跨度(最高与最低三元:Expeta=1.23,95%CI1.11-1.37,ptrend=<.0001)和腺泡计数/TDLU(最高与最低三元:Expeta=1.22,95%CI1.09-1.37,ptrend=0.0005),而非致密体积(NDV)与这些指标呈负相关。在调整总乳房体积后,绝对致密体积(ADV)观察到类似的趋势,尽管ADV的关联总体上弱于PDV。MD-TDLU相关性在≥50岁的乳腺癌患者和管腔A肿瘤患者中通常比<50岁的患者和管腔B肿瘤患者更为明显。
结论:我们在中国乳腺癌患者中基于定量MD和TDLU退化测量的发现与在西方人群中报道的结果基本一致,并可能为关系的复杂性提供更多见解。因年龄而异,可能还有乳腺癌亚型.
BACKGROUND: Higher mammographic density (MD), a radiological measure of the proportion of fibroglandular tissue in the breast, and lower terminal duct lobular unit (TDLU) involution, a histological measure of the amount of epithelial tissue in the breast, are independent breast cancer risk factors. Previous studies among predominantly white women have associated reduced TDLU involution with higher MD.
METHODS: In this cohort of 611 invasive breast cancer patients (ages 23-91 years [58.4% ≥ 50 years]) from China, where breast cancer incidence rates are lower and the prevalence of dense breasts is higher compared with Western countries, we examined the associations between TDLU involution assessed in tumor-adjacent normal breast tissue and quantitative MD assessed in the contralateral breast obtained from the VolparaDensity software. Associations were estimated using generalized linear models with MD measures as the outcome variables (log-transformed), TDLU measures as explanatory variables (categorized into quartiles or tertiles), and adjusted for age, body mass index, parity, age at menarche and breast cancer subtype.
RESULTS: We found that, among all women, percent dense volume (PDV) was positively associated with TDLU count (highest tertile vs. zero: Expbeta = 1.28, 95% confidence interval [CI] 1.08-1.51, ptrend = < .0001), TDLU span (highest vs. lowest tertile: Expbeta = 1.23, 95% CI 1.11-1.37, ptrend = < .0001) and acini count/TDLU (highest vs. lowest tertile: Expbeta = 1.22, 95% CI 1.09-1.37, ptrend = 0.0005), while non-dense volume (NDV) was inversely associated with these measures. Similar trend was observed for absolute dense volume (ADV) after the adjustment of total breast volume, although the associations for ADV were in general weaker than those for PDV. The MD-TDLU associations were generally more pronounced among breast cancer patients ≥ 50 years and those with luminal A tumors compared with patients < 50 years and with luminal B tumors.
CONCLUSIONS: Our findings based on quantitative MD and TDLU involution measures among Chinese breast cancer patients are largely consistent with those reported in Western populations and may provide additional insights into the complexity of the relationship, which varies by age, and possibly breast cancer subtype.