Dutra Mara Costa, Rezende Marina Alvarenga, de Andrade Victor Piana, Soares Fernando Augusto, Ribeiro Márcio Ventura, de Paula Elbio Cândido, Gobbi Helenice
Programa de Pós-graduação em Patologia Mamária, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Rev Bras Ginecol Obstet. 2009 Feb;31(2):54-60. doi: 10.1590/s0100-72032009000200002.
The objective of this study was to evaluate the clinical, pathological and molecular characteristics in very young women and postmenopausal women with breast cancer.
We selected 106 cases of breast cancer of very young women (<35 years) and 130 cases of postmenopausal women. We evaluated clinical characteristics of patients (age at diagnosis, ethnic group, family history of breast cancer, staging, presence of distant metastases, overall and disease-free survival), pathological characteristics of tumors (tumor size, histological type and grade, axillary lymph nodes status) and expression of molecular markers (hormone receptors, HER2, p53, p63, cytokeratins 5 and 14, and EGFR), using immunohistochemistry and tissue microarray.
When comparing clinicopathologic variables between the age groups, younger women demonstrated greater frequency of nulliparity (p=0.03), larger tumors (p<0.000), higher stage disease (p=0.01), lymph node positivity (p=0.001), and higher grade tumors (p=0.004). Most of the young patients received chemotherapy (90.8%) and radiotherapy (85.2%) and less tamoxifen therapy (31.5%) comparing with postmenopausal women. Lower estrogen receptor positivity 49.1% (p=0.01) and higher HER2 overexpression 28.7% (p=0.03) were observed in young women. In 32 young patients (29.6%) and in 20% of the posmenopausal women, the breast carcinomas were of the triple-negative phenotype (p=0.034). In 16 young women (50%) and in 10 postmenopausal women (7.7%), the tumors expressed positivity for cytokeratin 5 and/or 14, basal phenotype (p=0.064). Systemic metastases were detected in 55.3% of the young women and in 39.2% of the postmenopausal women. Breast cancer overall survival and disease-free survival in five years were, respectively, 63 and 39% for young women and 75 and 67% for postmenopausal women.
Breast cancer arising in very young women showed negative clinicobiological characteristics and more aggressive tumors.
本研究的目的是评估年轻女性和绝经后女性乳腺癌的临床、病理及分子特征。
我们选取了106例年轻女性（<35岁）乳腺癌患者和130例绝经后女性乳腺癌患者。我们使用免疫组织化学和组织芯片评估了患者的临床特征（诊断年龄、种族、乳腺癌家族史、分期、远处转移情况、总生存期和无病生存期）、肿瘤的病理特征（肿瘤大小、组织学类型和分级、腋窝淋巴结状态）以及分子标志物（激素受体、HER2、p53、p63、细胞角蛋白5和14、表皮生长因子受体）的表达情况。
比较不同年龄组之间的临床病理变量时，年轻女性未生育的频率更高（p=0.03），肿瘤更大（p<0.000），疾病分期更高（p=0.01），淋巴结阳性率更高（p=0.001），肿瘤分级更高（p=0.004）。与绝经后女性相比，大多数年轻患者接受了化疗（90.8%）和放疗（85.2%），但接受他莫昔芬治疗的较少（31.5%）。年轻女性雌激素受体阳性率较低，为49.1%（p=0.01），HER2过表达率较高，为28.7%（p=0.03）。在32例年轻患者（29.6%）和20%的绝经后女性中，乳腺癌为三阴性表型（p=0.034）。在16例年轻女性（50%）和10例绝经后女性（7.7%）中，肿瘤细胞角蛋白5和/或14表达阳性，为基底样表型（p=0.064）。年轻女性中55.3%出现全身转移，绝经后女性中这一比例为39.2%。年轻女性乳腺癌的5年总生存期和无病生存期分别为63%和39%，绝经后女性分别为75%和67%。
年轻女性乳腺癌表现出不良的临床生物学特征，肿瘤侵袭性更强。
