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Background <p>Axillary lymph node (ALN) metastasis is a critical prognostic factor in breast cancer, but current assessment methods have limitations. Trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite, has been implicated in tumor progression, though its role in breast cancer remains unclear.</p> Methods <p>This retrospective study analyzed TMAO levels in breast tissue from benign breast nodules (BBN, <i>n</i> = 10), ductal carcinoma in situ (DCIS, <i>n</i> = 10), and invasive ductal carcinoma (IDC, <i>n</i> = 10). A cohort of 97 treatment-naive IDC patients (26 ALN + , 71 ALN −) was further evaluated. TMAO concentrations were quantified via ELISA, and associations with clinicopathological features were assessed using logistic regression and ROC analysis.</p> Results <p>TMAO levels were significantly higher in IDC (113.9 ± 16.36&#xa0;ng/g) than in DCIS (82.29 ± 13.84&#xa0;ng/g, <i>p</i> &lt; 0.01) or BBN (76.09 ± 10.32 ng/g,&#xa0;<i>p</i> &lt; 0.001). ALN + patients exhibited elevated TMAO (210.92 ± 82.09&#xa0;ng/g) versus ALN − (122.99 ± 48.23&#xa0;ng/g,&#xa0;<i>p</i> &lt; 0.001). Multivariable analysis identified TMAO (OR = 1.022, 95% CI: 1.009–1.031), T-stage (T1 vs T2, OR = 1.201, 95% CI: 1.019–2.169), and axillary ultrasound positivity (OR = 6.993, 95% CI: 1.099–45.455) as independent predictors. A combined model (TMAO + T-stage + ultrasound) improved predictive accuracy (AUC = 0.915; 95% CI: 0.838–0.992).</p> Conclusion <p>TMAO levels correlate with breast cancer progression and ALN metastasis, demonstrating potential as a biomarker. Further studies are needed to validate its clinical utility and mechanistic role.</p>

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Trimethylamine N-oxide as a potential biomarker for predicting axillary lymph node metastasis in breast cancer: a retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月25日

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  • Zhijie Wu,
  • Yi Cheng,
  • Siyuan Lin,
  • Qiongyu Hu,
  • Xiaoyan Fu,
  • Zongyan Li,
  • Ge Qin,
  • Haiyan Li

摘要

Background

Axillary lymph node (ALN) metastasis is a critical prognostic factor in breast cancer, but current assessment methods have limitations. Trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite, has been implicated in tumor progression, though its role in breast cancer remains unclear.

Methods

This retrospective study analyzed TMAO levels in breast tissue from benign breast nodules (BBN, n = 10), ductal carcinoma in situ (DCIS, n = 10), and invasive ductal carcinoma (IDC, n = 10). A cohort of 97 treatment-naive IDC patients (26 ALN + , 71 ALN −) was further evaluated. TMAO concentrations were quantified via ELISA, and associations with clinicopathological features were assessed using logistic regression and ROC analysis.

Results

TMAO levels were significantly higher in IDC (113.9 ± 16.36 ng/g) than in DCIS (82.29 ± 13.84 ng/g, p < 0.01) or BBN (76.09 ± 10.32 ng/g, p < 0.001). ALN + patients exhibited elevated TMAO (210.92 ± 82.09 ng/g) versus ALN − (122.99 ± 48.23 ng/g, p < 0.001). Multivariable analysis identified TMAO (OR = 1.022, 95% CI: 1.009–1.031), T-stage (T1 vs T2, OR = 1.201, 95% CI: 1.019–2.169), and axillary ultrasound positivity (OR = 6.993, 95% CI: 1.099–45.455) as independent predictors. A combined model (TMAO + T-stage + ultrasound) improved predictive accuracy (AUC = 0.915; 95% CI: 0.838–0.992).

Conclusion

TMAO levels correlate with breast cancer progression and ALN metastasis, demonstrating potential as a biomarker. Further studies are needed to validate its clinical utility and mechanistic role.