Aryandono Teguh
Department of Surgery, Faculty of Medicine, Gadjah Mada University, Yogyakarta 55284, Indonesia.
Asian Pac J Cancer Prev. 2006 Jul-Sep;7(3):451-4.
A young age at diagnosis of breast cancer as a negative prognostic factor is a controversial issue. Some reports indicate that breast cancer in young women has different clinicopathological characteristics than in the elderly, while others found no correlation between prognosis and age. The aim of the present study was to assess the clinicopathological characteristics and prognostic factors of breast cancer in young women compared with elderly patients.
Thirty-seven operable breast cancer patients below 40 years of age, treated with mastectomy or breast conserving treatment and radiation therapy with or without adjuvant chemotherapy and tamoxifen, were assessed clinically and pathologically. Tumor size, lymph node status, histological grade, mitotic index, presence of estrogen and progesterone receptors, c-erbB2 expression, p53 and the MIB-1 proliferation index were evaluated histopathologically and immunohistochemically. Prognostic factors were compared to those for breast cancer patients age 60 years and older, with special attention to recurrence, distant metastasis and five-year survival between two groups.
Breast cancer in young women showed a more aggressive phenotype than in elderly patients, with a larger tumor size, more lymph node involvement, and higher c-erbB2 and p53 expression, although the latter were usually limited to more advanced stages. A higher MIB-1 proliferation index than in the elderly group was also noted, despite higher positivity and ER and PR. While adjuvant chemotherapy, including tamoxifen treatment, was more common, recurrence, metastasis and death were still higher than in elderly patients.
Thus a young age is associated with a poor prognosis in Indonesia.
乳腺癌诊断时年龄小作为一个负面预后因素是一个有争议的问题。一些报告表明，年轻女性乳腺癌与老年女性具有不同的临床病理特征，而另一些报告则发现预后与年龄之间并无关联。本研究的目的是评估年轻女性乳腺癌与老年患者相比的临床病理特征及预后因素。
对37例40岁以下可手术乳腺癌患者进行了评估，这些患者接受了乳房切除术或保乳治疗以及放疗，部分患者还接受了辅助化疗和他莫昔芬治疗，评估内容包括临床和病理方面。对肿瘤大小、淋巴结状态、组织学分级、有丝分裂指数、雌激素和孕激素受体的存在情况、c-erbB2表达、p53和MIB-1增殖指数进行了组织病理学和免疫组织化学评估。将预后因素与60岁及以上乳腺癌患者的预后因素进行比较，特别关注两组之间的复发、远处转移和五年生存率。
年轻女性乳腺癌表现出比老年患者更具侵袭性的表型，肿瘤更大、淋巴结受累更多、c-erbB2和p53表达更高，尽管后者通常局限于更晚期阶段。尽管雌激素受体（ER）和孕激素受体（PR）阳性率更高，但仍发现年轻组的MIB-1增殖指数高于老年组。虽然辅助化疗（包括他莫昔芬治疗）更为常见，但年轻患者的复发、转移和死亡率仍高于老年患者。
因此，在印度尼西亚，年轻与预后不良相关。
