Plasma testosterone and prognosis of postmenopausal breast cancer patients.
OBJECTIVE
High endogenous testosterone is associated with increased breast cancer (BC) risk. We designed this study specifically to assess the long-term prognostic role of testosterone in a cohort of postmenopausal BC patients.


METHODS
We considered 194 postmenopausal women, operated on for early BC (T1-2N0M0), who never received chemotherapy or hormonal therapy, and who participated in a fenretinide BC prevention trial as untreated controls. Blood samples were collected 3 months (median) after surgery; plasma samples, stored at -80 degrees C, were radioimmunoassayed for testosterone. Median follow-up was 14 years. The main end point was any cancer event. Event-free survival was estimated by the Kaplan-Meier method. Hazard ratios (HRs) of events by testosterone level were estimated by the Cox model, adjusting for age, tumor size, and histology.


RESULTS
Patients with high testosterone (> or = 0.40 ng/mL, median of distribution) had significantly lower event-free survival than those with low testosterone (log-rank P = .004). The adjusted HR of patients with high versus low testosterone was 2.05 (95% CI, 1.28 to 3.27). High testosterone was also associated with a significantly higher risk of BC events (relapse and second primary) with an adjusted HR of 1.77 (95% CI, 1.06 to 2.96). Eleven second primaries (non-BC) occurred in the high-testosterone group, four in the low-testosterone group.


CONCLUSIONS
High plasma testosterone strongly predicts poorer prognosis in postmenopausal BC patients not administered adjuvant therapy. Testosterone levels should be determined as part of the prognostic work-up.
Micheli
Andrea
A
Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. andrea.micheli@istitutotumori.mi.it
Meneghini
Elisabetta
E
Secreto
Giorgio
G
Berrino
Franco
F
Venturelli
Elisabetta
E
Cavalleri
Adalberto
A
Camerini
Tiziana
T
Di Mauro
Maria G
MG
Cavadini
Elena
E
De Palo
Giuseppe
G
Veronesi
Umberto
U
Formelli
Franca
F
D000368:Aged; D001943:Breast Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011379:Prognosis; D011863:Radioimmunoassay; D013739:Testosterone / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome
D013739:Testosterone