Department of Radiotherapy, Centre Antoine-Lacassagne, Nice, France.
Oncology. 2010;79(5-6):349-54. doi: 10.1159/000323483. Epub 2011 Mar 23.
Young age is known to be an independent factor for developing local recurrence (LR) in breast cancer patients. It has also been shown that the occurrence of LR negatively affects patient outcome, especially if LR occurs within 3 years after treatment of the primary tumour. The question whether the impact of LR on patient outcome differs according to the patient's age has not been addressed before. The purpose of the present study is to investigate cancer-specific survival (CSS) as well as overall survival after LR in young patients (<50 years old) and to compare it to older patients. The age cut-off level was taken as 50 to avoid strong imbalance in patient numbers between the 2 groups.
Between 1974 and 2003, 2,130 breast cancer patients were treated with conservative surgery and axillary dissection. All of them received post-operative radiotherapy. Adjuvant chemo- and/or hormonal therapy was given according to the prognostic factors and the treatment policy at the time of diagnosis. Only biopsy-confirmed ipsilateral LRs were taken into account. Early LRs were those observed within 36 months after surgery, and late LRs were those which occurred thereafter. The median follow-up was 100 months. Survival analysis was conducted with the Kaplan-Meier method.
The median age was 59 years. There were 472 patients aged <50 years versus 1,658 older patients. Pathological tumour size, hormone receptor status and lymph node involvement were evenly distributed in the 2 groups. The 5- and 10-year CSS was 92.3 and 83.9% in young patients, and 94.4 and 87.6% in older patients (p = 0.061), respectively. Overall, 200 LRs were observed; 52 of them (26%) were early LRs. The rate of LR was significantly higher in young patients: at 5 years, it was 10.5 versus 3.7% in patients ≥50 years; the respective rates at 10 years were 17.8 and 8.8% (p < 0.0001). The 5- and 10-year CSS in patients who developed LR was 86.8 and 76.0%, versus 94.7 and 88.2% in patients who did not develop LR (p < 0.0001). The 5-year CSS after LR in young and older patients was 77.6 and 65.7%, respectively (p = 0.028).
Although young patients experience more LR than older ones, once LR occurs, young patients have a better outcome than the others. Possible hypotheses are: (1) more aggressive treatment in young patients after LR; (2) the treatment is better sustained in young patients; (3) biological differences in the characteristics of LR.
年轻是乳腺癌患者发生局部复发（LR）的独立因素。已经表明，LR 的发生会对患者的预后产生负面影响，尤其是如果 LR 在原发性肿瘤治疗后 3 年内发生。LR 对患者预后的影响是否因患者年龄而异，这个问题以前尚未得到解决。本研究的目的是调查年轻患者（<50 岁）发生 LR 后的癌症特异性生存率（CSS）和总生存率，并将其与老年患者进行比较。选择 50 岁作为年龄截止点，是为了避免两组患者数量的严重不平衡。
1974 年至 2003 年间，2130 例乳腺癌患者接受了保乳手术和腋窝清扫术。所有患者均接受了术后放疗。辅助化疗和/或激素治疗根据预后因素和诊断时的治疗策略进行。仅考虑经活检证实的同侧 LR。早期 LR 是指手术后 36 个月内观察到的 LR，晚期 LR 是指此后发生的 LR。中位随访时间为 100 个月。采用 Kaplan-Meier 法进行生存分析。
中位年龄为 59 岁。<50 岁的患者有 472 例，年龄较大的患者有 1658 例。两组的病理肿瘤大小、激素受体状态和淋巴结受累情况分布均匀。年轻患者的 5 年和 10 年 CSS 分别为 92.3%和 83.9%，年龄较大的患者分别为 94.4%和 87.6%（p=0.061）。总的来说，观察到 200 例 LR，其中 52 例（26%）为早期 LR。年轻患者的 LR 发生率明显较高：5 年时为 10.5%，而≥50 岁患者为 3.7%；10 年时的相应发生率分别为 17.8%和 8.8%（p<0.0001）。发生 LR 的患者的 5 年和 10 年 CSS 分别为 86.8%和 76.0%，而未发生 LR 的患者分别为 94.7%和 88.2%（p<0.0001）。年轻和老年患者发生 LR 后的 5 年 CSS 分别为 77.6%和 65.7%（p=0.028）。
尽管年轻患者比老年患者发生 LR 的次数更多，但一旦发生 LR，年轻患者的预后要好于其他患者。可能的假设是：（1）LR 后年轻患者接受更积极的治疗；（2）年轻患者的治疗更持续；（3）LR 特征的生物学差异。
