关键词: 乳腺肿瘤, 非三阴性乳腺癌, 三阴性乳腺癌, 无病生存, 总生存期, 血脂水平, 预后

Abstract: Background　Dyslipidemia is one of high risk factors of breast cancer. Current studies have found that the level of blood lipid metabolism may also be closely related to the stage，pathology，overall survival（OS） and disease free survival（DFS） of breast cancer，but the results were stil controversial. Objective　To explore the effect of baseline blood lipid metabolism on the prognosis of non-Triple Negative Breast Cancer（TNBC）. Methods　Retrieved from January 2019 to March 2021 in Sun Yat-sen memorial Hospital from January 2016 to March 2017 in the electronic medical record system，202 cases of non-triple-negative breast cancer patients were included. All the patients had no history of diabetes，dyslipidemia，cardiovascular or cerebrovascular disease. The clinical general information including age，menopausal status，history of hypertension，body mass index（BMI），fasting blood glucose，blood lipids〔including total cholesterol（TC），triacylglycerol（TG），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），apolipoprotein A1（APOA1），apolipoprotein B（APOB），apolipoprotein E（APOE）〕，high-sensitivity C-reactive protein （hsCRP），uric acid，pathological results 〔including tumor size（T stage），lymph node metastasis（N stage），ER，PR，HER-2，Ki-67，tissue grade〕were collected. The OS and DFS time until three years of diagnosis were recorded. The patients were divided into two groups according to the breast cancer stage. Group 1was stage Ⅰ-Ⅱ and group 2 was stage Ⅲ. Kaplan-Meier curves were used to determine OS and DFS rates. Log rank-tests were performed to compare differences in survival curves. Multivariable Cox proportional hazards regression models were used to study the associations between pre-diagnostic lipids and DFS，OS of non-TNBC. Results　The TG level of group 2 was higher than that of group 1，while the level of HDL-C was lower than that of group 1
（P<0.05）. The optimal cutoff values of the TG level and HDL-C were determined to be 1.39 mmol/L〔AUC=0.626，95%CI（0.562，0.690）〕 and 1.14 mmol/L〔AUC=0.599，95%CI（0.531，0.668）〕，respectively. The proportion of stage Ⅲ was higher in patients with TG≥1.39 mmol/L or HDL-C<1.14 mmol/L than TG<1.39 mmol/L or HDL-C≥1.14 mmol/L（P<0.05）. Patients with TG≥1.39 mmol/L had higher proportion of lymph node metastasis than with TG<1.39 mmol/L. Patients had more advanced T stage in group with HDL-C<1.14 mmol/L than HDL-C≥1.14 mmol/L. Patients with HDL-C≥1.14 mmol/L had higher OS（98.1%）and DFS（89.8%） than HDL-C<1.14 mmol/L，which was 90.9% and 77.4% respectively（χ2=4.669，P=0.031；χ2=3.859，P=0.049）. After adjusting for menopausal status，BMI，blood pressure and blood glucose levels，baseline HDL-C<1.14 mmol/L is considered recurrence，metastasis〔HR=2.907，95%CI（1.024，8.255），P=0.045〕 and death〔HR=8.718，95%CI （1.148，66.198），P=0.036〕 influencing factors. Conclusion　HDL-C<1.14 mmol/L might be an influencing factor for the poor clinical prognosis of non-triple-negative breast cancer.

Key words: Breast neoplasms, Non-triple negative breast cancer, Triple negative breast neoplasms, Disease-free survival, Overall survival, Lipids, Prognosis