Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Campus Lübeck, Ratzeburgerallee 160, 23538 Lübeck, Germany.
Arch Gynecol Obstet. 2012 Aug;286(2):489-93. doi: 10.1007/s00404-012-2291-9. Epub 2012 Apr 11.
The objective of the study is to investigate what kind of tumors young, premenopausal breast cancer patients in Germany show at diagnosis and how they are treated adjuvantly in comparison with a normally distributed cohort.
The study describes the data of 535 patients who were treated adjuvantly between 2002 and 2006 and participated in a resident mother-child program for rehabilitation (Groemitz cohort). The data includes TNM categories, biology of tumor and therapies. This population is being compared to an age-heterogeneous cohort from the state of Schleswig-Holstein and the DMP-report of the state of North Rhine-Westphalia.
45.8 % of the patients were diagnosed with tumor category pT1, 37 % pT2, 7.3 % pT3 and 1.9 % pT4. 5 % had merely DCIS. 48.8 % of the patients were pN0, 31.4 % pN1 and 17.4 % had a more intense manifestation of lymph nodes. 43.5 % of the tumors showed a grading classified as G3, 64.3 % were estrogen and progesterone hormone receptor positive and 26.2 % Her2 positive. 21 % of the examined cohort members/patients showed a triple negative carcinoma. 59.1 % of the patients with pT1 underwent breast-conserving surgery, 56.1 % of those with pT2 and 25.6 % of those with pT3. Overall 31.0 % of the women received mastectomy and 14.8 % received mastectomy with subsequent reconstruction. 97.6 % of the patients received axillary surgery, 89.9 % chemotherapy. Overall 23.7 % of the patients received their treatment in connection with clinical studies. 95.3 % of the patients with hormone receptor positive tumor received endocrine therapy, 61.3 % of them with GnRH-analogs. In comparison with the OVIS and DMP cohorts patients of the Groemitz cohort were on average 20 years younger. Their tumors were of bigger size and had more often reached the axillary lymph nodes (pN0 48.8 % Groemitz/62.0 % OVIS/66.7 % DMP). The hormone receptor status was more often negative (35.7/16.6/16.5 %) and tumor grading higher (G3 43.5/29.0/28.5 %). Surgery was more extensive even with small tumors (breast conserving surgery with tumor stage pT1 59.1/81.2/77.6 %) and axillary surgery was performed more often in the young collective (97.6/89.3/62.5 %). More patients of the young collective received chemotherapy (89.9/58.4 %/unknown) and more patients of the young collective with hormone receptor positive tumor received endocrine therapy (95.3/77.4/90.6 %).
Our study shows that young breast cancer patients in Germany can be regarded as a special group. At the time of diagnosis the tumor has frequently reached a more advanced stage, and carcinomas are more aggressive. Operative and medical treatment will often be more aggressive.
本研究旨在调查德国年轻、绝经前乳腺癌患者在诊断时表现出何种类型的肿瘤，以及与正态分布队列相比，她们如何接受辅助治疗。
本研究描述了 2002 年至 2006 年间接受辅助治疗并参加居民母婴康复计划（Groemitz 队列）的 535 名患者的数据。该数据包括 TNM 分类、肿瘤生物学和治疗方法。将该人群与来自石勒苏益格-荷尔斯泰因州的年龄异质队列和北莱茵-威斯特法伦州的 DMP 报告进行比较。
45.8%的患者被诊断为肿瘤类别 pT1，37%为 pT2，7.3%为 pT3，1.9%为 pT4。仅有 5%的患者为单纯 DCIS。48.8%的患者为 pN0，31.4%为 pN1，17.4%的患者淋巴结表现更严重。43.5%的肿瘤分级为 G3，64.3%的患者雌激素和孕激素受体阳性，26.2%的患者 Her2 阳性。21%的检查队列成员/患者表现出三阴性乳腺癌。59.1%的 pT1 患者接受保乳手术，56.1%的 pT2 患者和 25.6%的 pT3 患者接受保乳手术。总体而言，31.0%的女性接受了乳房切除术，14.8%接受了乳房切除术和随后的重建。97.6%的患者接受了腋窝手术，89.9%接受了化疗。总体而言，23.7%的患者在接受治疗的同时参与了临床研究。95.3%的激素受体阳性肿瘤患者接受了内分泌治疗，其中 61.3%接受了 GnRH 类似物治疗。与 OVIS 和 DMP 队列相比，Groemitz 队列的患者平均年轻 20 岁。他们的肿瘤体积更大，更常累及腋窝淋巴结（pN0 48.8%Groemitz/62.0%OVIS/66.7%DMP）。激素受体状态更常为阴性（35.7/16.6/16.5%），肿瘤分级更高（G3 43.5/29.0/28.5%）。即使肿瘤较小，手术也更为广泛（肿瘤分期 pT1 时保乳手术 59.1/81.2/77.6%），年轻患者的腋窝手术更为常见（97.6/89.3/62.5%）。更多年轻患者接受化疗（89.9/58.4%/未知），更多年轻的激素受体阳性肿瘤患者接受内分泌治疗（95.3/77.4%/90.6%）。
我们的研究表明，德国的年轻乳腺癌患者可以被视为一个特殊群体。在诊断时，肿瘤通常已处于更晚期，且癌症更具侵袭性。手术和药物治疗通常更为激进。
