유방암에서 항핵항체의 임상적 의의 평가
Evaluation of the Clinical Significance of Anti-Nuclear Antibodies in Breast Cancer
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배경: 여러 암에서 항핵항체(antinuclear antibodies, ANAs)가 검출되는 것으로 보고되고 있다. 이 연구의 목적은 한국인 유방암 환자에서 ANA의 유병률을 파악하고 류마티스 질환의 발병과 종양 예후에서 ANA 양성 반응의 중요성을 평가하는 것이다. 방법: 유방 질환으로 진단받은 여성 신환 187명(유방암 125명, 유방 양성질환 62명)을 대상으로 Mosaic HEp-20-10 (Euroimmun, Germany) 간접면역형광법을 이용하여 항핵항체를, EUROLINE ANA Pro le 3 (Euroimmun) 라인면역분석법을 이용하여 ENA 및 항미토콘드리아 항체를 측정하였다. 임상 소견 및 조직병리학적 자료는 의무기록 검토를 통해 수집하였다. 결과: 유방암군에서 유방양성질환군에 비해 ANA 양성 유병률이 유의하게 높았다(24.0% vs. 8.1%, P<0.05). 두 군에서 면역형광 패턴의 차이가 관찰되었다. 유방암군에서 1:160 이상의 역가 빈도가 유의하게 높았다(P<0.05). 예후 인자(병기, 림프절 상태, 분자 아형, p53 과발현)의 빈도는 ANA 양성군과 음성군 간에 차이가 없었다. 역가가 1:160 이상인 7명의 유방암 환자에서 특정 자가항체(항-ENA 및 항-미토콘드리아)가 검출되었지만, 이들 중 류마티스 질환이 동반된 환자는 없었다. 결론: 유방암군에서 양성 ANA의 유병률과 1:160 이상의 역가 빈도는 유방양성질환군보다 높았다. 종양의 예후 인자는 ANA의 존재와 관련이 없었다. ANA와 추가적인 자가항체의 존재는 류마티스 질환의 발병과 관련되지 않을 것으로 판단된다.
Abstract
Background: Anti-nuclear antibodies (ANAs) have been detected in several cancers. This study aimed to determine the prevalence of ANAs in Korean patients with breast cancer and to investigate the significance of ANA positivity in the development of rheumatic diseases and tumor prognosis. Methods: ANAs were investigated with Mosaic HEp-20-10 indirect immunofluorescence test kit (Euroimmun, Germany) in 187 newly diagnosed women (125 breast cancer and 62 benign breast disease). Antibodies against extractable nuclear antigens (ENAs) and mitochondria were determined using line immunoassay EUROLINE ANA Profile 3 (Euroimmun). Clinical and histopathological data were collected through medical record reviews. Results: The prevalence of ANA positivity was significantly higher in the breast cancer group than in the benign breast disease group (24.0% vs. 8.1%, P<0.05). Differences in immunofluorescence patterns were observed between the two groups. The frequency of ANA titers≥1:160 was significantly higher in the breast cancer group. The frequencies of prognostic factors (stage, lymph node status, molecular subtypes, and p53 overexpression) did not differ between ANA-positive and ANA-negative patients. Specific autoantibodies (anti-ENA and anti-mitochondrial) were detected in seven breast cancer patients with titers≥1:160, but none of them had concomitant rheumatic diseases. Conclusions: The prevalence of ANA positivity was higher and titers≥1:160 were more common in patients with breast cancer than those with benign breast diseases. The presence of ANA was not associated with any tumor prognostic factors. The presence of ANA and additional autoantibodies may not be related with the development of rheumatic diseases.
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